Malaria: Old infections, Changing Epidemiology

Presented by:
Muhammad Waqas
(Bscn02123006)
Presented to:
Ms. Robina Kouser

Objectives:
At the end of this presentation learner will be able to:
Identify a topic of research article related to public
health.

Define the selected topic

Discuss the distribution and prevalence of problem.
Discuss the major determinant factors of problem.
Discuss the morbidity and mortality associated with

problem.

Cont..
Describe the problem with the use of a model of the

natural history
Describe the problem with the use of relevant
literature.
Discuss the preventive measures for problem.
Explains role of nurse in the prevention and
management of disease

Malaria: old infections, changing

epidemiology
D.J. Bradley
Department of Epidemiology and Population

Sciences, London School of Hygiene and Tropical

Medicine, London, UK
Research Conducted in Africa

Introduction of Topic
Malaria has been around since ancient times. It is old

Infection that has affected the world and its people

since the beginning of recorded human history,
malaria remains an entrenched global health
challenge.
The epidemiological pattern is changing. In spite of
this long-term host-parasite relationship, there have
been major epidemiological changes in human malaria
over the last fifty years and they are taking place at an
accelerating rate.

Cont..
In the Africa, water-resource developments and

Environmental Factors tend to lengthen the

transmission season, though less than might be
expected.
The spread of multiple drug resistance of the parasites
is making case management harder and deaths rises.

Distribution and Prevalence

Global geography of malaria is increasingly

disproportionate. The vast majority of malaria cases

and malaria-related deaths occur in sub-Saharan
Africa.
About 90% of all malaria deaths in the world today
occur in Africa south of the Sahara.
This is because the majority of infections in Africa
are caused by Plasmodium falciparum.

Cont..
Malaria is endemic in some of the offshore islands to

the west of mainland Africa Sao Tome and Principe

and So Tiago Island of Cape Verde.
In the east, malaria is endemic in Madagascar, in the
Comoro islands (both the Islamic Federal Republic of
the Comoros and the French Territorial Collectivity of
Mayotte) and on Pemba and Zanzibar.
In Mauritius, malaria has been well controlled since
the 1950s, but occasional outbreaks of vivax malaria
occur.

Prevalence
The course of malaria as a world problem has one of

massive incidence and prevalence rate with great

mortality
Prevalence of Malaria in Africa
Exposed 2,073 million
Infected 270 million
Ill 110 million
Died 1 million

Major determinants factors of

Malaria
Although there are various factors that contribute to

Malaria disease, in which the first factor is its agents.

Plasmodium falciparum mainly found in Africa, it
is the most common type of malaria parasite and is
responsible for most malaria deaths worldwide.
Environment is an other important determinant,
changes in the environment may also contribute in the
disease occurrence, i.e Malarial Parasite Can't Survive
in Cold Climate. And Malarial Cases increased warmer
climate.

Cont
In the Africa, water-resource developments and

Environmental Factors tend to lengthen the

transmission season, though less than might be
expected.
Socio-economic conditions and the public health
infrastructure also contribute in the disease
distribution

Morbidity and Mortality

300-500 million clinical cases of malaria that occur

globally each year, 90 percent of them are in Africa.

An estimated one million people in Africa die from
malaria each year and most of these are children under 5
years old.
Malaria causes at least 20% of all deaths in children
under 5 years of age in Africa
85 % of all malaria deaths in Africa occur in young
children.
In every 1 Min , a child dies of malaria of Africa

Research Design
Descriptive Observational Study;
On the bases of
Case report
Case series
Survey

Model of the natural history

Agents;

Agents of malaria are the four species of

plasmodium, P.vivax, P.falciparum, P.ovale ,P.

malariae.
Majority of infections in Africa are caused by
Plasmodium falciparum, the most dangerous of the
four human malaria parasites and the most difficult
to control
Hosts;
Anophelesvector; a kind of female mosquito
Humans; The agents transmit into human through
mosquito bite

Cont..

Environment;

Environment

play an important role in the disease

occurrence. Environment suitable for mosquitos can
enhance the disease

Agent, host, and environmental factors interrelate in a

variety of complex ways to produce disease in humans.

By eradicating one of the factor(Agent, host and

environment), the whole disease process may be eradicated

Literature Support
Ninety-five million of Pakistan's 161 million people,

roughly 60% of Pakistans population, live in malaria

endemic regions.
(Khatak etal. 2013)
After eradication efforts in the 1960s, malaria surged
back to an epidemic level in the 1970s.
(Khatak etal. 2013)

In recent years, an uptick in malaria can be partially

attributed to floods that affected approximately 20

million people in over 60 districts.
(Tarar etal.2013)

Cont..
Despite a well-established malaria control

programmed, 500,000 malaria infections and 50,000

malaria-attributable deaths occur each year in
Pakistan, with approximately 37% of cases estimated
to occur in regions along the borders with Afghanistan
and Iran.
(Yasinzai,2013)
Caused By Plasmodium vivax(responsible for
approximately 64% of infections) and Plasmodium
falciparum(causing 36% of infections).

Cont..
Malaria is primarily found in the provinces of Khyber

Pakhtunkhwa, Balochistan, Sindh and the Federally

Administered Tribal Areas.
(Yasinzai,2013)
Malaria transmission is considered to be unstable, with
major P. vivax transmission peaking from June to
September and again in April to June, when relapses of
infections acquired the previous season are observed.
The major transmission period for P. falciparum in
Pakistan is between August and December. (Tarar
etal.2013)

Preventive measures:
Malaria can often be avoided using the ABCD approach to

prevention which stands for:

Awareness of risk find out whether you are at risk of
getting malaria.
Bite prevention avoid mosquito bites by using insect
repellent, covering your arms and legs and using a mosquito
net.
Check whether you need to take malaria prevention
tablets if you do, make sure you take the right antimalarial
tablets at the right dose, and finish the course.
Diagnosis seek immediate medical advice if you
have malaria symptoms,

Cont
Stay inside when it is dark outside, preferably in a

screened or air-conditioned room

Wear protective clothing (long pants and long-sleeved
shirts).
Use insect repellent with DEET (N,N
diethylmetatoluamide). The repellent is available in
varying strengths up to 100%. In young children, use
a preparation containing less than 24% strength,
because too much of the chemical can be absorbed
through the skin.

Cont
Use bed nets (mosquito netting) sprayed with or soaked

in an insecticide such as permethrin or deltamethrin. But

make sure that these insecticides still work against the
mosquitoes where you are. In some areas, mosquitoes
have become resistant to permethrin and deltamethrin. So
the bed nets do not offer much protection.
Use flying-insect spray indoors around sleeping areas.
Avoid areas where malaria and mosquitoes are present

Cont
As a result of the scale-up of use of insecticide-

treated nets, Indoor residual spraying, intermittent

preventive treatment during pregnancy and
Artemisinin-based combination therapy, 10 countries
in the WHO African region have reduced malaria
cases.

Role of Nurse:
At community the nurse can educate people by

organizing seminars and also teach them about further

complications of the disease.
Nurses could conduct a medical camp with the
cooperation of the government at different endemic
regions mostly rural areas.
By distributing pamphlets and displaying banners at
public places.

References
Bradley,D.j. (2005) Malaria: old infections, changing
epidemiology : Department of Epidemiology and
Population Sciences, London
Khattak, A.,Venkatesan,M.,Nadeem,F,M., Yaqoob,A., &
Strauss, K. (2013). Prevalence and distribution of
human Plasmodium infection in Pakistan. Malaria
Journal of Pakistan. Retrieved from
http://www.malariajournal.com/content/12/1
/ 297

Yasinzai,. M. I & Kakarsulemankhel,. J. K. (2013). Prevalence

of human malaria infection in Pakistani areas bordering
with Iran. Journal of Pakistan Medical association. Retrieved
from
http://www.jpma.org.pk/full_article_text.php?arti
cle_id=4051
Tarar, A. S & Ayub, S. M. (2013). Malaria. Directorate of
Malaria Control of Pakistan. Retrieved From
http://www.dmc.gov.pk/index.php?option=com_cont
ent&view=article&id=55&Itemid=78