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TIPS ON MALARIA

  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

  • HOW CAN I PROTECT MYSELF FROM MOSQUITO-BORN DISEASES?

    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

  • WHO ARE AT RISK?


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

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THE CONTRIBUTION OF THE INDEPTH NETWORK TO MALARIA RESEARCH

In July 2012, INDEPTH partnered with the African Institute for Development Policy (AFIDEP) to conduct a review that would: identify and describe the work that has been done by the INDETH Network on Malaria.The review of INDEPTH network's contribution to malaria research for the period 1998 to 2009 uncovered a vast body of knowledge on the changing patterns in transmission; incidence of clinical disease in some sites in  sub-Saharan Africa, and the significant impact of malaria control interventions such as insecticide Treated  Bed nets (ITNs) and Artemisinin Combination Therapies (ACTs). The synthesis and systematic review  found  that socioeconomic, environmental and genetic factors were significant determinants of malaria risk in most endemic settings. In addition, knowledge gaps were identified in vector and parasite resistance,  urban malaria, the impact of climate change and interventions to reduce inequities in access to  malaria control interventions.

Below  is  a  summary  of  the  key findings of the review.

MALARIA EPIDEMIOLOGY
Children and pregnant women in sub-Saharan Africa are at the highest risk of malaria infection and subsequent death: The studies conducted by the INDEPTH network concurred with  other studies that  demonstrated  that  malaria  is  a major cause of morbidity and mortality, particularly in Sub Saharan Africa, with children  and pregnant women being at the highest risk.

Whilst the risk of malaria was  demonstrated to be high all year round in a few sites,  the  majority  demonstrated  a higher risk of  malaria  transmission  in the  wet  rather  than  dry  season,  with infective bites occurring mostly at night.
 
Malaria transmission rates are decreasing  in  some  areas  in  sub-Saharan Africa,  but  are  not  easily predictable even across short distances:
INDEPTH  network studies  contributed to current evidence demonstrating that malaria  transmission  is  declining  in most  but  not  all  sites in Sub  Saharan Africa.  In  several  sites,  this  has  been accompanied by a significant decline in the incidence of clinical malaria disease. However,  it  is  noteworthy  that  the reductions in  the  incidence  of clinical disease  were not immediate, highlighting  the  need  for  sustained  malaria control  efforts  to  achieve  significant declines.  Further,  data  from  several INDEPTH  network  studies  also  show that more severe disease is observed in older  age  groups  in  the  regions  with lower transmission and lower incidence of clinical disease.

Climatic  and  environmental  factors are sound predictors of malaria transmission and incidence of clinical malaria:
A  study  from  the  INDEPTH  network showed  that  climate  factors  (rainfall, humidity and temperature) were significantly associated with the risk of clinical  malaria,  suggesting  a need for better  integration  between  malaria control  and  meteorological programmes.

Socioeconomic and  environmental factors  are  stronger  predictors  of malaria  transmission  than  genetic factors:
Various  genetic  factors  significantly influence  the  risk  of  morbidity  and mortality due to  malaria.  For example children with  the sickle cell and alpha thalassemia genotypes (HbAS and αα/αα) are significantly more protected from severe malaria and resultant death than  those  who  do  not  carry  these genotypes. The findings of one INDEPTH study suggested that genotype testing of HIV positive pregnant women may predict the risk of placental  malaria  transmission  to  the unborn baby. Therefore, further research is warranted in order to generate more conclusive knowledge on the  effects  of  various  genetic  factors, and how such knowledge can be translated into practice.

IMPACT OF MALARIA CONTROL INTERVENTIONS
Insecticide  Treated  Nets  (ITNs)  are highly  protective  against  malaria infection:  Studies  from  the  INDEPTH network  contributed  to  the  current evidence that when used properly,  bed nets and curtains treated with permethrin are highly protective against malaria in  children less than 5 years in  sub-Saharan  Africa,  with  bed nets offering higher levels of protection. The  optimal  use  of  ITNs  also  significantly  improves  child  growth and  the chances of survival through  childhood.  The  use  of  ITNs  led  to  significant economic benefits,  both  at the house-hold and health system level.
 
Prompt, accurate diagnosis and treatment  with  ACTs  are  important cornerstones of malaria control:
Prompt access  to primary  health  care facilities is essential in promoting early treatment  and  reducing  gravity  of malaria  episodes, and has been shown to  reduce the malaria  burden. Studies from  the  INDEPTH  Network  contributed to the current evidence that combination therapies with artemisinin derivatives (ACTs) are more effective in clearing  malaria  parasites  than  older monotherapies  (such  as  chloroquine and sulphadoxine-pyrimethamine ), and advocated for the continued use of  the integrated  Management  of  Childhood Illness  (IMCI)  approach  in  paediatric malaria case management.
 
MALARIA CONTROL INTERVENTIONS THAT REQUIRE  FURTHER    EVALUATION
More research is needed to determine the role and  applicability  of malaria chemoprophylaxis in endemic areas:

Malaria  chemoprophylaxis  has  been cited as a potentially useful strategy for malaria  control. However, there  is relatively little  evidence to adequately determine  its  effectiveness  and  applicability  in various populations living in endemic areas. Further, it is feared that the widespread use of chemo-prophylaxis  could  lead  to  the  rapid development of drug resistance.
 
Two INDEPTH network studies examined malaria chemoprophylaxis in adults. The  first  study demonstrated a dose-response protective effect of tafenoquine against P.falciparum infection in semi-immune adults whilst the  second  demonstrated  that  radical cure of asymptomatic P.  falciparum led to an increased risk of clinical malaria in adults  living  in  an  endemic  area  in Africa.  Further  research is needed  for more conclusive evidence on the role of chemoprophylaxis in malaria control.

A safe and effective malaria vaccine is feasible:
Although  there  is  no  licensed  malaria vaccine currently in clinical  use, there are three main types of malaria vaccines under development: 1) Vaccines targeted at  the pre-erythrocytic stages (sporozoites and liver stages); 2) asexual  blood-stage  vaccines;  and  3) transmission-blocking vaccines. Most of the  research  carried  out  in  INDEPTH Network sites focuses on  the first and second categories of vaccines.
 
RTS,S (also known as RTS,S/AS) is  the first malaria vaccine candidate  to ever reach  large-scale  Phase  III  clinical testing.

Other  candidate  vaccines  such  as  the FP9 ME–TRAP primer and MVA ME–TRAP booster vaccination  and the multistage  synthetic  peptide  vaccine (SPf66) were  shown to confer   significant levels  of protection making  them potential candidates for future  vaccine development.
 
SUMMARY OF KNOWLEDGE GAPS

National  level  impact  evaluation  of malaria interventions:
In  most  malaria  endemic  countries, measuring the impact of malaria control interventions  is  greatly  hampered  by inadequate  health management information systems (HMIS), and inadequate  tools  (such  as  the  verbal autopsy  method)  to  estimate  malaria deaths  outside  the  formal health  care system.  The  INDEPTH  network  can contribute  to  this  by  improving  on current tools,  collecting  requisite data using their robust longitudinal platform, and  working more closely with the national divisions of malaria control  to collate  such  data  with  other  national level data.

Urban malaria:
Many malaria endemic countries, particularly  in  sub-Saharan  Africa  are experiencing rapid  urbanization, which is largely characterized by the growth of an  urban poor population who can neither afford protection from  malaria nor access quality health  care. Further, the continuous changes in  urban ecology highlight the need to investigate changes in the risk of malaria transmission in order to adequately tailor malaria  control  strategies  in  these settings. The INDEPTH network centres operating  in  urban  settings  provide  a suitable platform to  generate this knowledge.

Malaria eradication and elimination: Although current efforts in sub-Saharan Africa  must  be  focused  on  achieving adequate malaria control, the INDEPTH network is uniquely placed to steer the knowledge discourse and future strategies  towards  sustainable  strategies for effective eradication  a n d elimination,  in line with the agenda of the Malaria Eradication Research Agenda (maIERA).
 
Translation of genetic knowledge  on malaria into practice:
There  is  a  need  for  more  research  to determine the best ways of  translating genetic  knowledge  in  malaria  into practice.

Vector and parasite resistance:
Understanding the dynamics of behavioural and genetic  vector resistance was cited as a major priority, particularly in the  context of changing malaria  transmission. Malaria drug resistance is also a major concern, with resistance  to  artemisinin  combination therapies  (ACTs)  already  reported  in South East  Asia. There is therefore an urgent need to develop the right methods and  tools to track the  emergence  and  spread  of  drug  resistance, particularly in sub-Saharan Africa where  ACTs  have  been  most  recently deployed.  The  INDEPTH  network  is uniquely  placed to work with other stakeholders  such  as  the  World  Wide Anti malarial Resistance Network (WWARN) towards this end.
 

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INDEPTH Edition