mmmmm Mohamed M. B. Alnoor CHP400 COMMUNITY HEALTH PROGRAM-II mmmmm Malaria Epidemiology & Control

mmmmm Malaria  Importance of malaria  Mode of Transmission  Factors Influencing Transmission  Stable and unstable malaria  Control and prevention of malaria

mmmmm Malaria Importance:  1/2 world pop: live in malarious areas  219 million infections(154 – 289 million),  Kills a child every minute  660,00 deaths( mostly African children)  90% deaths in Africa (1/6 childhood deaths)  Untreated P. falicparum < 25%  Anaemia among children  pregnancy :anaemia & low birth weight

mmmmm Malaria Importance:  Serious economic impacts in Africa.  A disease of poverty — the poor in malaria-prone rural areas live in poorly- constructed dwellings offering no barriers against mosquitoes.  Malaria is both preventable and treatable,  Resistance of parasite to drugs  Resistance of mosquito to insecticdes

mmmmm Malaria Agent: Plasmodium sp. P. falciparum P. vivax P. ovale P. malariae Vector: Anopheline Reservoir: Man Mode of Transmission:

mmmmm Malaria Mode of Transmission: 1-3 yrs : P. vivax 1 yr : P. falciparum Mosquito Man Mosquito

mmmmm Malaria Mode of Transmission:

mmmmm Malaria Mode of Transmission: Factors Influencing Transmission:  Host factors  Parasite factors  The vector  The environment

mmmmm Malaria Immunity: Unstable malaria: Low endemicity spleen rate ≤ 50% Stable malaria: High endemicity spleen rate ≥ 50%

mmmmm Malaria Immunity: Unstable malaria: All population groups Stable malaria: Newborn:3-6/12(immune mothers): childhood: Clinical malaria Intermittent absence of parasitaemia. Lower parasite density. Premunition. Splenomegaly.

mmmmm Malaria Immunity: Stable malaria: Adolescents and adults: Parasitaemia: sometimes Clinical symptoms: occasional Pregnant: especially primigravidae Immunity Use of prophylaxis: Delays the process of immunity Serious disease on re-exposure

mmmmm Malaria

mmmmm Malaria Control (and Prevention):  Vector Reduction  Vector-host contact reduction  Parasite reduction  Research

mmmmm Malaria Control (and Prevention):  Vector Reduction Breeding sites Destruction of larvae Adult anophelines

mmmmm Malaria Control (and Prevention):  Vector-host contact reduction Well screened areas. Mosquito nets (ITN). Cover most of the body. Use repellent on exposed skin. Insecticide spray. Antisporozoite vaccine?

mmmmm Malaria Control (and Prevention):  Parasite reduction Chemotherapy Chemoprophylaxis Antimerozoite vaccine? Antigamitocyte vaccine?  Research

mmmmm Malaria - ITN - Treatment - Anemia - IPT: IPTi: 3,6&9- 59% IPTc IPTsc: anemia IPTp: twice (RBM) Roll Back Malaria Control (and Prevention): WHO, UNICEF, UNDP and the World Bank,

mmmmm Malaria

mmmmm Malaria Resurgence The problem is increasing Vector: Breeding site Cost and resistance Changing habits Parasite: Resistance and cost

mmmmm Malaria Resurgence Chloroquine 16 years Fansidar 6 years Mefloquine 4 years Atovaquone 6 months

mmmmm Malaria  Population: Movement. In-cooperation.  Neighboring countries  Inadequate Control: Political and economic. Technical. Resurgence

mmmmm Malaria