1. Increasing the Awareness of Malaria Incidence in African Children & Pregnant Women
Ogbojaoluwafemi Precious
Walden University
PUBH Environmental Health
April 18th, 2014
Good Morning all. My name is Ogbojaoluwafemi Precious, an MPH student at Walden University. I will be presenting a topic on “increasing the awareness to reduce malaria incidence in children and pregnant women”.
The purpose of this presentation is to educate the pregnant women in our community as well as mothers having children less than 5 years old. You are my target audience because of the danger that malaria poses to your well being and your children and the effect it has on our community health budget.

2. Agenda Expected Learning outcome
Targeted Audience/Reason for targeting them
Malaria Etiology
Malaria Epidemiology
Malaria Mortality and Morbidity
Significance of Malaria Incidence
Who is at Risk
Diagnosis and Treatment
Malaria Control
At the end of this discussion, we will all be educated enough on malaria Etiology, it’s significance, who is at risk, the diagnosis and treatment of the disease, the control measures, transmission mechanism of the disease, identification of the stakeholders, what the stakeholders need to do in controlling the disease, the available barriers and the conclusion.

3. Agenda Cont. Surveillance Elimination Who are the stakeholders
Stakeholders’ efforts
Identify Barriers in fighting Malaria
Conclusion

4. Expected Learning Outcome
Understanding Malaria Epidemiology
Understanding Significance of Malaria Incidence
Identify Who is at Risk
Ability to Diagnosis and Treat Malaria
Understanding of the various Control Measures
Reviewing of the Stakeholders’ efforts
Identification of Barriers in fighting Malaria
Conclusion
At the end of this presentation, every pregnant women and mothers sitting here today will understand the epidemiology of malaria, identify who is at risk, be able to diagnose the disease with its symptoms and be a healthy person by avoiding possible causes of the disease.

5. Targeted Audience/Reason for Targeting Them
Malaria affects children and pregnant women mostly
Malaria infection in pregnancy is a serious public health problem
It has adverse effects on the woman, her fetus, and the newborn child (WHO)
It leads to chronic anemia and placental malaria infection(WHO)
It increases the risk of neonatal death(WHO)
Low awareness on the control of malaria in Africa
Poor socioeconomic status of most of the African families
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected mosquitoes. In 2012, malaria caused an estimated 627 000 deaths (with an uncertainty range of 473 000 to 789 000), mostly among African children. Malaria is preventable and curable. Increased malaria prevention and control measures are dramatically reducing the malaria burden in many places(WHO)
Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. Malaria-associated maternal illness and low birth weight is mostly the result of Plasmodium falciparum infection and occurs predominantly in Africa. The symptoms and complications of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area, and the individual’s level of acquired immunity(WHO)
Malaria in pregnancy is associated with anaemia, an increased risk of severe malaria, and it may lead to spontaneous abortion, stillbirth, prematurity and low birth weight. In such settings, malaria affects all pregnant women, regardless of the number of times they have been pregnant(WHO).
As you can see, Malaria is dangerous to pregnant women as well as children which is why you are the targeted audience. I am sure that at the end of this training, you will have more knowledge enough to reduce the spread of this disease.

6. Malaria Etiology Malaria causes flu-like symptoms
Spread by female anopheles mosquitoes that bite at night.
Parasites are being injected into the blood and take less than 30minutes to get into the liver
Four different classes of malaria parasites are identified namely:
Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale.
Plasmodium vivax is universal and common in subtropical regions; Plasmodium Falciparum is the most dangerous and kills. It is mostly present in tropical regions, subtropical areas serves as habitat for Plasmodium malariae and Plasmodium Ovale is the least common and found in Africa (WHO, 2009).This disease affects over 40% of the world population and infects million people yearly and causes almost 1 million deaths yearly worldwide with more than 80% of those in Africa.
The parasites are spread to people through the bites of infected Anopheles mosquitoes, called "malaria vectors", which bite mainly between dusk and dawn.

7. Malaria Etiology Cont.
Plasmodium Vivax is universal and common in subtropical regions
Plasmodium Falciparum is the most dangerous and kills.
Plasmodium Malariae and Plasmodium Ovale is the least common and found in Africa (WHO, 2009)
It affects over 40% of the world population
It infects million people yearly
It causes almost 1 million deaths yearly worldwide with more than 80% of those in Africa
There are four parasite species that cause malaria in humans:
Plasmodium falciparum
Plasmodium vivax Plasmodium malariae Plasmodium ovale.
Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly.
From the time one gets bitten to the appearance of the symptoms, it is about 7-60 days (Schlumberger Malaria prevention program, 2014).
For both P. vivax and P. ovale, clinical relapses may occur weeks to months after the first infection, even if the patient has left the malarious area.

8. Malaria Epidemiology
Malaria has an extremely heterogeneous epidemiology and ecology
This was not very clear until recently.
Behavioral issues in humans, settlement, climate and control of vector populations shapes epidemiology of this disease
Many factors shape this epidemiology including behavioral issues in humans, settlement, climate and control of vector populations (Robert, Snow,Punam, Amratia,Caroline, Kabaria, Abdisalan , Noor,Kevin Marsh&2012)

9. Malaria Mortality and Morbidity
Roughly 8.8 million children die yearly and malaria accounts for 16% of this death.
Endemicity is a key player.)
Malaria mortality rates have fallen by 42% globally since 2000(WHO)
Approximately 8.8 million children die yearly and malaria accounts for 16% of this (Akachi & Atun, 2011). However, worldwide mortality and morbidity cases due to malaria are still a scientific guess and endemicity is a key player.
According to the latest estimates, released in December 2013, there were about 207 million cases of malaria in 2012 (with an uncertainty range of 135 million to 287 million) and an estimated 627 000 deaths (with an uncertainty range of to ). Malaria mortality rates have fallen by 42% globally since 2000, and by 49% in the WHO African Region.
Most deaths occur among children living in Africa where a child dies every minute from malaria. Malaria mortality rates among children in Africa have been reduced by an estimated 54% since 2000(WHO)

10. Significance of Malaria Incidence
Malaria is a life-threatening disease.
In 2012, malaria caused an estimated 627 000 deaths (WHO)
Malaria is preventable and curable(WHO)
Non-immune travelers from malaria-free areas are very vulnerable
Malaria impacts high social and economic cost on homes
It is estimated recently that there were about 207 million cases of malaria in 2012 (with an uncertainty range of 135 million to 287 million) and an estimated deaths (with an uncertainty range of to ). Globally the mortality rates have fallen by 42% globally since 2000, and by 49% in the WHO African Region.
Most deaths affects Africa children where a child dies every minute from malaria. Mortality rates due to malaria among children in Africa have been reduced by an estimated 54%(WHO)

11. Significance of Malaria Incidence Cont.
Poorest nations are mostly affected.
Direct and indirect costs can be attributed to the disease.
The attendance of children in school is also affected
Malaria impacts high social and economic cost on homes and alarming cost on resources management of the affected nations. Poorest nations are mostly affected. Direct and indirect costs can be attributed to the disease. Direct costs are related to management and movement costs due to severity of the disease and duration of the illness while indirect cost are related to effects on livelihood abilities as well low productivity at work. According to statistics, malaria costs students almost 3-12 days per year (Leighton & Foster, 1994). 8 percent of school absenteeism is related to malaria (Brooker, Guyatt, Omumbo, Shretta, Drake & Ouma, 2000). The attendance of children in school is also affected.

12. Who is at Risk? About half of the world's population is at risk
Young children in sub-Saharan Africa
Non-immune pregnant women
Semi-immune pregnant women in areas of high transmission
semi-immune HIV-infected pregnant women
people with HIV/AIDS
Non-immune international travelers from non-endemic areas
immigrants from endemic areas
Approximately half of the world's population is at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. Asia, Latin America, and to a lesser extent the Middle East and parts of Europe are also affected. In 2013, 97 countries and territories had ongoing malaria transmission.
Specific population risk groups include:
young children in stable transmission areas who have not yet developed protective immunity against the most severe forms of the disease;
non-immune pregnant women as malaria causes high rates of miscarriage and can lead to maternal death;
semi-immune pregnant women in areas of high transmission. Malaria can result in miscarriage and low birth weight, especially during first and second pregnancies;
semi-immune HIV-infected pregnant women in stable transmission areas, during all pregnancies. Women with malaria infection of the placenta also have a higher risk of passing HIV infection to their newborns;
people with HIV/AIDS;
international travellers from non-endemic areas because they lack immunity;
immigrants from endemic areas and their children living in non-endemic areas and returning to their home countries to visit friends and relatives are similarly at risk because of waning or absent immunity.

13. Diagnosis and treatment
Early diagnosis is key
Malaria treatment reduces the transmission and prevents deaths
Artemisinin-based combination therapy (ACT) is the best available treatment till date
WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Early diagnosis and treatment of malaria reduces disease and prevents deaths and reduces transmission.
Treatment solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible.

14. Malaria Control
Vector control reduces malaria transmission at the community level.
It is the only intervention that can reduce malaria transmission from very high levels
For individuals, personal protection against mosquito bites represents the first line of defense.
Antimalarial medicines can also be used to prevent malaria
Insecticide-treated mosquito nets (ITNs) & Indoor spraying with residual insecticides is effective in treating Malaria
Vector control is the main way to reduce malaria transmission at the community level. It is the only intervention that can reduce malaria transmission from very high levels to close to zero(WHO). WHO recommends coverage for all at-risk persons; and in most settings. The most cost effective way to achieve this is through provision of free mosqitoe nets so that everyone sleeps under it every night

15. Surveillance Progress in controlling malaria should be tracked.
Of the estimated global number of cases, only 14% could be tracked
More resources need to be committed to this
Tracking progress is challenging. Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences(WHO)
Malaria surveillance systems detect only around 14% of the estimated global number of cases. In April 2012, the WHO Director-General launched new global surveillance manuals for malaria control and elimination, and urged endemic countries to strengthen their surveillance systems for malaria. We all need to be involved in this.

16. Elimination
Disrupting Malaria transmission is key to eliminating the disease
improve environmental hygiene around the homes will control the larva stage of mosquitoes
Research on finding a malaria vaccination should be pursued rigorously,
On the basis of reported cases for 2012, 52 countries are on track to reduce their malaria case incidence rates by 75%, in line with World Health Assembly targets for Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by a specific agent; i.e. applies to a particular malaria parasite species(WHO)

17. Who are the Stakeholders?
The Federal Ministry of Health
State Ministry of health
World Health Organization (WHO)
United Nations International Children Fund (UNICEF)
Department of Public Health
Local communities,
Public and private sectors,
All tiers of government
Non-Governmental Organizations
People in the community that feel the effect of the disease are the stakeholders. The list here is not exhaustive but a very good way to start the engagement which could be used to control the disease.

18. Efforts of the stakeholders
Stakeholders mobilizes for actions to eradicate this disease.
Vaccines against malaria-WHO currently evaluating malaria vaccines in 7 African countries
The WHO Global Malaria Programme (GMP) is charting way for malaria elimination
Identification of threats to malaria control
Making approaches to capacity building-Roll back programme
Monitoring global progress
The partnership mobilizes for action and resources and forges consensus among partners(WHO).
They also help in setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines; keeping independent score of global progress; developing approaches for capacity building, systems strengthening, and surveillance; identifying threats to malaria control and elimination as well as new areas for action.

19. Identify Barriers in fighting Malaria
Mosquito resistance to pyrethroids has emerged in many countries.
There are less primary healthcare providers in the inner city and rural areas
Risk of Financial burden in poor countries
Barriers identified in fighting malaria are:
Political barriers such as weak national policies and budget allocations for healthcare
Financial barriers that prevent countries from improving healthcare delivery or medicine procurement
Physical barriers such as inadequate logistical infrastructure and transportation to reach healthcare facilities in rural areas
Capacity building in the health sector remains a priority challenge that has to be met in order to guarantee a rational use of drugs

20. Conclusion Malaria is dangerous to Women and children
It can be controlled by following basic hygiene rules
All stakeholders have part to play in its control
Sleeping under nets is effective in keeping the disease out
Malaria infection in pregnant women is associated with high risks of both maternal and perinatal morbidity and mortality. While the mechanism is poorly understood, pregnant women have a reduced immune response and therefore less effectively clear malaria infections. In addition, malaria parasites sequester and replicate in the placenta. Pregnant women are three times more likely to develop severe disease than non-pregnant women acquiring infections from the same area. Malaria infection during pregnancy can lead to miscarriage, premature delivery, low birth weight, congenital infection, and/or perinatal death.
Patients who are considered to have manifestations of more severe disease should be treated aggressively with parenteral antimalarial therapy regardless of the species of malaria seen on the blood smear.
Vector control is the main way to reduce malaria transmission at the community level. It is the only intervention that can reduce malaria transmission from very high levels to close to zero. For individuals, personal protection against mosquito bites represents the first line of defense for malaria prevention(WHO).

21. Reference
Snow, R.W., Gouws, E., Omumbo, J., Rapuoda ,B., Craig, M.H., Tanser,F.C., le Sueur, D., Ouma, J .(1998). Models to predict the intensity of Plasmodium falciparum transmission (1998): applications to the burden of disease in Kenya retrieved from:
World Health Organization. (2009). Malaria. Retrieved December 23, 2009.Retrieved from:
Akachi. Y & Atun .R (2011). Effect of investment in malaria control on child mortality in sub-Saharan Africa in Retrieved from idspan-review-re-akachi-and-atun-on-malaria-2011-en.pdf

22. Reference cont.
Brooker, S., Guyatt, H., Omumbo, J., Shretta, R., Drake, L., & Ouma, J. (2000). Situation analysis of malaria in school-aged children in Kenya - what can be done? 16: Retrieved from