1. Geographic factors and impacts of disease Examine the geographic factors responsible for the incidence and spread of TWO diseases (AIDS and Malaria). Evaluate the geographic impact of these two diseases at the local, national and international scales. Evaluate the management strategies that have been applied in any one country or region for these diseases

2. Malaria

3. Starter: In this landscape there are five elements that can cause the spread of malaria. Can you identify/label them?

4. Hut: having your home open to the elements allows the mosquito free access. You are just as likely to be infected while you sleep at night as you are during the day. Cow: mosquitoes are just as happy feeding on the blood of animals. One source of blood is as good as another. Villager: the mosquito feeds on blood. It needs a blood supply in order to live. Leaving bare flesh exposed is asking for trouble. People also migrate a lot more. This makes it easy for the disease to spread. Stagnant water: the mosquito needs still or slow moving water in order to breed. They don't need large pools of water to breed. Irrigation ditches and water in potholes in the road are just as suitable. Sun: the mosquito needs warm conditions to exist. They can be found in areas where the temperatures are above 16 degrees Celsius.

5. “Health Politics” – talk on malaria by Dr Mike Magee (2006) Watch the video and complete the worksheet Watch the BBC news clip (1m) from Feb 2012 How has the situation changed over time?

6. Geographic factors responsible for spread and incidence of malaria Temperature –Above 16 C for parasite to develop –Below 32 C Water –Stagnant water to lay eggs e.g. swamp/marsh

7. Geographic impact of malaria nationally Southern Tanzania 80% of children infected by age 6 months 4% of children under 5 die Belize – stopped using DDT in 1992 disease virtually eliminated but by 1994 10,000 cases out of population of 200,000

8. Geographic impact of malaria internationally Kills up to 3 million annually Mostly in sub-saharan Africa 500 million more suffer with disease Cost of malaria $2 billion/year Prevention would cost $12 billion/year on known prevention and halve number dying Tourism spreading disease Trade spreading disease Global warming → new breeding grounds? Agricultural schemes expanding and increase in irrigation

9. Strategies to over come the disease i.e. barriers to diffusion Drain malarial swamps and marshes (in tropics too great a task) DDT very effective but long lasting effects on environment and build up in food chain Medicine chloroquine e.g. G & T! but side effects e.g. liver failure and blindness and mosquitoes becoming resistant Mosquito net – one of the MDG

12. Malaria task You are going to be working in groups – each making an info page on an aspect of malaria. You will then give them in to me and I will scan them and send them to you all – so you have a complete malaria stufy Make it clear – easy to read/understand –– use diagrams/images where appropriate

13. Malaria Resources: Malaria information booklet Areas that need a info page: Background info on malaria – key stats and facts Geographic factors responsible for incidence and spread of malaria Impact of malaria at the local scale (evaluate) Impact of malaria at the national scale (evaluate) Impact of malaria at the international scale (evaluate) Evaluate the management strategies that have been applied in any one country or region for malaria. –Chosen country/ region: –Management strategy –Successes –Failures

14. Background information on malaria – key stats and facts ●Malaria is a life-threatening, vector-borne infectious disease caused by Plasmodium parasites ●The vector, the Anopheles mosquito, and its parasite, thrive in tropical areas ●They are usually found in stagnant water and irrigation channels ●The disease is transmitted through the bites of infected mosquitoes ●The parasite travels into the blood, centers on the liver and affects the red blood cells where it multiplies ●The malaria epidemic can be triggered by both natural and human factors ●The disease is widespread in tropical regions such as Sub Saharan Africa and countries near the equator ●Key stats: ○2010: 216M cases and 655,000 deaths ○Mortality rate has been more than 25% since 2000 ○Malaria accounts for approximately 22% of all childhood deaths ○Malaria can decrease the GDP by as much as 1.3% in countries with high disease rates ●Symptoms: ○Fever ○Shivering ○Headache ○Vomiting ●Effects: ○Organ failure ○Comatose ○Death ●Methods of control: ○Protect humans from mosquito attack ○Reduce the mosquito population

15. Geographic factors responsible for incidence and spread of malaria PHYSICAL: ●Mosquitos need a temp. of 20 - 32 degrees celsius ●30 - 45 degrees of the equator ●Areas with water (esp. stagnant) ●Mosquitoes can fly approx. 200 metres Lake Victoria, Kenya HUMAN: ●Human travel can make mosquitoes of different locations vector for malaria ●If unable to obtain vaccinations and living with low immunity (ie. refugees), or if not properly educated or informed (ie. not given proper vaccinations) ●Children with low immunity (esp. below the age of 6 months) ●Government spending not prioritizing malaria prevention (e.g insecticides, preventative measures like anti-malarials etc.)

16. Impact of malaria at the local scale (evaluate) In Southern Tanzania, 80% of children are infected by age 6 months and 4% of children under 5 die Belize – stopped using DDT in 1992 disease virtually eliminated but by 1994 10,000 cases out of population of 200,000 Mopti, Mali: ●Mopti - 75/1000 have malaria ●Malaria prevention practice where there were 339 random selected households. ●Within each household mothers of children 1 to 9 years of age were interviewed regarding knowledge of malaria and prevention practices ●11% used ITNs (ITNs= insecticide- treated nets) ●98% used bed nets ● 22% used insecticide sprays ●39% used mosquito coils Philippines: ●In 1990, more than 86,200 cases of Malaria in the Philippines were recorded. It has fallen to 37,005 in 2002 and 43,644 in 2003 ●Cebu, Catanduanes, and Leyte were declared of being malaria-free cities after a couple of years. ●The endemic provinces in the country with the most number of cases were Palawan (292 cases), Tawi-Tawi (185 cases), Occidental Mindoro (57 cases), Saranggani Province (37 cases), Cagayan (31 cases) and Zambales (29 cases).

17. Impact of malaria at the national scale (evaluate) MALARIA IN MALI: Entire population is at risk of contracting malaria Endemic particularly in the central and southern regions (e.g Mupti), and potentially epidemic in northern areas. Increased transmission during the rainy season (stagnant water → mosquito breeding grounds) MALARIA DEATH STATS: Killed 22,000 people in 2005 Ranked third among all causes of death after respiratory infections and diarrheal diseases: o Malaria causes 17% of the 218 deaths per 1000 children under five o Children under five suffer from an average of two episodes of malaria per year o People over five years old suffer from an average of one episode of malaria per year MALARIA TREATMENT (Impacts and Opportunity costs): More than 30% of consultations in health structures are linked to malaria (opportunity cost) However, number of patients visiting health centres is very low: o Many families struggle to transport sick people to clinics, and buy medication o Majority of malaria cases treated at home or at the community level (limited resources) Potential to destroy family and community assets: o Families can spend as much as 60% of their income on health care o Chronic illness can decrease family income by at least 25% a year o Low productivity in communities due to illness

18. Impact of malaria at the international scale (evaluate) ●Kills 3 million people every year. ●1 child in Africa dies from malaria every 30 seconds ●First symptoms usually occur 10 days to 4 weeks after infection. ●300-500 million cases of malaria each year (CDC) ○ Of which at least 1 million will die ●216 million malaria cases each year. ●In 2012, 90% of malaria deaths occurred in Africa. 100,000 African children under 5 died. Global economic impact: ●A comparison of average per capita GDP in 1995, adjusted to give parity of purchasing power, between malarious and non-malarious countries demonstrate a fivefold difference (US$1,526 versus US$8,268). ●Moreover, in countries where malaria is common, average per capita GDP has risen (between 1965 and 1990) only 0.4% per year, compared to 2.4% per year in other countries. ●Malaria has been estimated to cost Africa US$12 billion every year ○ This cost includes costs of healthcare, working days lost due to sickness, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism ●In some countries with a heavy malaria burden, the disease may account for as much as 40% of public health expenditure, 30-50% of inpatient admissions, and up to 50% of outpatient visits (opportunity cost → money could be spent elsewhere)

19. Evaluate the management strategies that have been applied in any one country or region for malaria (MALI). Total population: 14.85 million (2012) LE: 51.37 Infant mortality rate: total: 106.49 deaths/1,000 live births (2012) 154/1,000 (2007) country comparison to the world: 2male: 113.23 deaths/1,000 live births2 female: 99.56 deaths/1,000 live births (2013 est.) GDP: - $1,100 (2012 est.) country comparison to the world: 214$1,200 (2011 est.)214 $1,200 (2010 est.) note: data are in 2012 US dollars Deaths of Children under 5:. Mali ranks 175 out of 177 countries in the rate of death from all causes of children under five, at 218 per 1,000, and malaria causes about 17 percent of those deaths. Renamed from the Sudanese republic after being independent from france. Management strategies: Drugs to treat malaria will be distributed around the country in March and April. Pregnant women will receive mosquito nets and preventive treatment, and a campaign to spray mosquito repellent inside and outside houses and public buildings will be launched. The government also promised that all children under five will receive free treatment at health clinics this year. Insecticide-treated mosquito nets (ITNs): Sleeping under a longlasting ITN provides protection from malaria-carrying mosquitoes. The nets are nontoxic to humans but can repel and kill mosquitoes for up to three years. Indoor residual spraying (IRS): IRS involves spraying the inside walls of houses with insecticides so that mosquitoes are killed and malaria transmission is reduced.

20. Mali Success Mosquito net usage nowadays - Mali now has the highest mosquito net utilization rate in Africa. - 78.% of all children sleep under 5 sleep under a net. - 73.9%of pregnant women sleep under a net. In 2009 there were 2,331 malarial deaths and 1,633,423 cases of malaria In 2010 there were 1,018,846 with 3,006 deaths IMR: 154/1000 (2007) IMR: 106/1000 (2012) - Malaria has gone down between 1998- 2006 – this is because up to 37% of this decrease is due to the distributions of bed net treatment kits in 2001

21. Mali Failures 11% used ITNs (ITNs= insecticide- treated nets) 98% used bed nets 22% used insecticide sprays 39% used mosquito coils The households that used ITNs has more knowledge than any other household about malaria and its prevention In 2009 there were 2,331 malarial deaths and 1,633,423 cases of malaria In 2010 there were 1,018,846 with 3,006 deaths In 2010, malaria caused 11.11% of deaths. In 2012, this was 45%.