Malaria: Society

1. Malaria: Society By: Senait Gebrehiwot Jennie Xiong Picture by www.rbm.who.int

2. Malaria Statistics • It is a leading cause of death and disease in many developing countries. • Young children and pregnant women are the most affected group. • At the end of 2004, some 3.2 billion people lived in areas at risk of malaria transmission in 107 countries and territories. • 350-500 million infections per year. • 1 million deaths occur every year. • About 60% of the cases of malaria and 80% of death due to malaria worldwide occur in Africa south of the Sahara.

3. Malaria Geography • It occurs mostly in poor, tropical and subtropical areas of the world. • About 90% of deaths due to malaria occur in the sub-Saharan Africa. This is due to: • A very efficient mosquito vector (Anapheles gambiae) assuring high transmission. • The predominant parasite species is Plasmodium falciparum, which causes severe malaria. • Weather conditions allowing transmission to occur year round. • Scarce resource and socio-economic instability hinder inefficient malaria control. • In South America and Southeast Asia, malaria causes substantial disease and incapacitation.

4. Who is Most Vulnerable • People with no or little protective immunity against malaria including: • Young children • Pregnant women • HIV positive people • Travelers or migrants who lack immunity.

5. Social and Economic Tolls • Countries with malaria make 1.3% lower economic growth per year than countries without malaria • Direct Cost • Indirect Cost • Social and Economical Decisions

6. Direct Costs of Malaria • Personal Expenditures • Individual/Family spending on insecticide treated mosquito nets (ITNs) • Doctor fees • Anti-malarial drugs • Transport to health facilities • Household expenditures in and out of the hospital

7. Reasons Why ITNs Aren’t Effective • Cost of ITNs plays a role in its availability to families • Nets are about US $1.70 each (RBM) • Insecticides for treatment range from US $0.30 to $0.60 each (RBM) • Families unfamiliar with ITNs must be convinced of their usefulness • Families need to be persuaded to re-treatment of ITNs with insecticidal properties on a regular basis • Less than 5% of nets are re-treated (RBM)

8. If Used Properly ITNs • 20% reduction in young children deaths (RBM) • 25% fewer underweight or premature babies (RBM) Picture by www.cdc.gov

9. Doctor Fees • Average cost per outpatient visit ranged from US $1.54 to $4.49 (Chima) • Average cost per inpatient admission was between US $3.05 and $21.29 (Chima) Picture by www.cdc.gov

10. Antimalarial Drugs • Drug Resistance • Chloroquine – cheapest and most widely used antimalarial • Sulfadozine-pyrimethanime (SP) - usually the first and least expensive alternative to chloroquine • Many countries need to change treatment policies and use more expensive drugs making antimalarial drugs less affordable

11. Household Expenditures • Monthly per person for malaria-related prevention methods range between US $0.05 to $2.10 or US $0.24 to $15 per household (Chima) • Monthly per person for malaria-related treatment range between US $0.41 to $3.88 or US $1.88 to $26 per household (Chima)

12. Direct Costs of Malaria • Public expenditures • Spending by government on maintaining health facilities • Health care infrastructure • Publicly managed vector control • Education • Research Picture by www.rmb.who.int

13. Health Care Infrastructure • Establish systems for ensuring adequate stocks of drugs and clinical consumables • Provide health facility staff that are trained and supervised in rapid identification, resuscitation and subsequent clinical care

14. Research • Development of long-lasting ITNs that will retain insecticidal properties for 4-5 years making retreatment unnecessary • Research of Antimalarial drug combination therapy to improve on malaria resistance • Artemether/lumefantrine • Artesunate plus amodiaquine • Artesunate plus mefloquine • Artesunate plus sulfadozine

15. Indirect Cost of Malaria • Lost of productivity • Lost of income associated with illness or death • Human pain and suffering • Effects on children’s schooling and social development Picture by www.rbm.who.int

16. Lost of Productivity • 2 to 6% loss of gross domestic product annually (GDP) (Chima) • 50% loss in agricultural (Chima) • 10% loss in industrial (Chima)

17. Loss of Income • Average time lost per episode for a sick adult ranges from 1 to 5 days (Chima) • Time lost by adults caring for sick children ranges from 1 to 5 days per episode (Chima)

18. Schooling and Development • 7% of children who survive cerebral malaria have permanent neurological problems • Limited availability of specialized education provision and equipment for these children effects learning opportunities • Children who appear to have complete neurological recovery from cerebral malaria can still develop cognitive problems that affects their school performance • Attention deficits • Difficulty with planning and initiating tasks • Speech and language problems • Domestic chores at home due to sick family members results in absence from school

19. Household Coping Methods For Direct and Indirect Costs • Mobilizing cash reserves and savings • Selling livestock • Jeopardizes household asset • Receiving gifts from other households • No livestock can result in not being able to receive gifts resulting in taking out loans and falling into debt

20. Effects on Social and Economical Decisions • Undeveloped tourism of country • Reluctance of travelers to visit malaria endemic areas • Undeveloped markets • Traders’ unwillingness to travel to and invest in malaria areas • Less productive agriculture • Planting subsistence crops rather than more labor-intensive cash crops because of harvest seasons

21. Aid for Economic Problems • Private Companies • Abuja Summit: Roll Back Malaria (RBM) Pictures by www.rbm.who.int

22. Private Companies • Contribution to programs • Assisting in research and development of new treatments and interventions • Providing management and business expertise to help market INTs and antimalarial drugs • Using their networks to distribute and carry life saving medicines and prevention measures to remote communities • Using their marketing and PR expertise to assist in public education campaigns

23. Abuja Summit: Roll Back Malaria (RBM) • Social marketing schemes • Abuja Declaration • Development of local industries • Further government involvement • WHO standards for ITNs • Strategic Framework for Coordinated National Action for Scaling-up Insecticide-treated Netting Programs in Africa

24. Results of RBM • Almost 20 African countries have reduced or eliminated taxes and tariffs on ITNs to make them more affordable (RBM) • Half of African countries have established County Strategic Plans to achieve RMB goals and targets (RBM)

25. Multiple Choice 1) What is an indirect cost of Malaria? a) Doctor fees b) Human pain and suffering c) Publicly managed vector control b

26. Fill In the Blank 2) ________ helps to promote health education campaigns. Roll Back Malaria 3) Time lost by adults caring for sick children ranges from __ to __ days 1 to 5

27. Short Answer 4) Name one of the three household coping methods • Mobilizing cash reserves and savings • Selling livestock • Receiving gifts from other households

28. True or False 5) Agricultural irrigation promotes an increase in frequency and transmission of Malaria. False, In a couple studies on irrigation in sub-Saharan Africa the introduction of irrigated agriculture had little impact on Malaria because with enhanced income there were better protective measures against it

29. References • 2001-2010 United Nations Decade to Roll Back Malaria. Retrieved February 8, 2007: http://www.rbm.who.int • Chima, R., Goodman, C., Mills, A. The Economic Impact of Malaria In Africa: A Critical Review of The Evidence. Health Policy 2003;63:17-36 • Gallup, J., Sachs, J. The Economic Burden of Malaria. Am J Trop Hyg 2001;64 (1,2) S:85-96. • The Impact of Malaria, a Leading Cause of Death Worldwide. Retrieved February 13, 2007: http://www.cdc.gov/malaria/impact/index.htm