Malaria Burden

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Malaria Burden

• Dr Afework Hailemariam
• National Malaria Prevention Control Program
• Federal Ministry of Health

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Outline of the Presentation

• Global Malaria burden
• Africa/Regional picture
• Socioeconomic Burden
• Millennium Development Goals
• Malaria Situation in Ethiopia

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Malaria Burden

• One fifth of the world population at risk in over
  100 malaria endemic countries
• Facing a huge disease burden
• 300-500 million cases of malaria per year
• 1 million malaria deaths per year
• gt 90 of deaths in Africa
• Disability from severe form of the disease

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Malaria distribution
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Measuring Malaria Burden

• The term endemicity is used to define the
  intensity of malaria transmission in a location.
• Endemicity can be measured in various ways but is
  conveniently defined on the basis of the
  parasiterate (PR) in sample of children often
  between 2 and 10 years of age.
• A conceptual transmission continuum exists from
  high-stable to low-unstable, frequently
  subdivided as
• Holoendemic (PR gt75),
• Hyperendemic (PR 50-74.9),
• Mesoendemic (PR 10-49.9) and
• Hypoendemic (PR lt 10)
• (Bruce-Chwatt 1991).

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Malaria distribution
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The Burden of Malaria in Africa

• Globally 300 million acute cases more than a
  million deaths reported every year 90 of these
  deaths occur in Africa,
• Constitutes 10 of the continent's overall
  disease burden
• Leading cause of under-five mortality (20)
• It accounts for 40 of public health expenditure,
  
• 30-50 of inpatient admissions,
• 50 of outpatient visits,

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Malaria in sub-Saharan Africa

• Accounts for 20 of all childhood deaths lt5 years
• Up to 975,000 children lt5 years and up to 10,000
  pregnant women are estimated to die each year
  from severe malarial anaemia

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Kenya Malaria burden

• 20M at risk of infection
• 3.7M childrenlt5 and 1.2M PW at risk of infection
• Main cause of death in under fives (34,000
  annually)
• Each HH spends US 20 for management of malaria
  attacks
• 170 million working days lost

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Overview
High transmission Riverine Urban
Hypo-

• P. falciparum
• A. arabiensis, A. funestus and A. gambiae

Meso-
Hyper-
High perineal transmission
epidemic-prone areas
Irrigated malaria
Seasonal malaria
Urban malaria
Desert-fringe malaria
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Mortality Morbidity
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A malarious community is an impoverished
community.

• Weller 1958

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In Rwanda in 1987, each episode costs 11.83 or
3.5 days of production. Ettling and
Sheppard 1991

• Weller 1958

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Malaria Socio-economic Burden

• Malaria is frequently referred to as a disease of
  the poor or a disease of poverty.
• Even a cursory examination of the global
  distribution of malaria is sufficient to accept
  this claim on a macro scale, given the
  concentration of malaria in the worlds poorest
  continents and countries.
• While only 0.2 of global malaria deaths are
  found in the worlds richest population quintile,
  57.9 of global malaria deaths are concentrated
  among the worlds poorest population quintile.

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In Burkina Faso, each malaria episode costs
5.96, or 1.15 per capita. Sauerborn
et al. 1991
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In Burkina Faso, each malaria-like episode causes
workers to miss 3.5 days of work. Each year,
17 of workers experience such episodes.
Gazin et al. 1988
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In Ghana, an episode of malaria in a holoendemic
site produces 5 days of morbidity and costs
8.67. Effort diverted for nursing includes 3.7
days of male activity or 4.7 days of female
activity. Such losses may play a critical role
in inhibiting the transformation of subsistence
farms into viable agricultural units.
Bonilla and Rodriguez 1993
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Malaria Socio-economic Burden

• Similarly, when the burden is measured as
  disability-adjusted life years (DALYs),
• 58 of the total global burden due to malaria is
  concentrated among the poorest 20 of the global
  population,
• while only 0.2 of total global DALYs are lost by
  the richest global 20 (Gwatkin and Guillot,
  2000).
• Sachs and Malaney (2002) demonstrate a
  correlation between the presence of malaria in a
  country and that countrys per capita GDP,
  arguing that there is an inverse relationship
  between the two and that malaria causes
  underdevelopment.

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Economic burden
GNP per capita (1995)

• 1.3 reduced growth of national economies
• 3 - 12 b US short term cost per year
• Affects mainly agricultural productivity and
  school attendance of children

0-70
1941-2580
0
0
3
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Malaria Index
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A cross-country growth estimate for the 150 most
populous nations

• Gallup and Sachs, this study

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A 0.3 increase in GDP growth follows a 10
reduction in malaria prevalence.Gallup and
Sachs, this study
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Drug resistance
Chloroquine resistance
S/P resistance
Mefloquine resistance
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Millennium Development Goals

• Goal 1. Eradicate extreme poverty and hunger
• The economic and social burden of malaria is
• acknowledged as a major impediment to
  development in Africa (WHO 2001)
• Goal 2. Achieve universal primary education
• Goal 3. Promote gender equality and empower women
• Goal 4. Reduce child mortality
• 20 of child mortality in Africa from malaria
• Goal 5. Improve maternal health
• pregnant women are very vulnerable to malaria
• Goal 6. Combat HIV/AIDS, malaria and other
  diseases
• Goal 7. Ensure environmental sustainability
• Goal 8. Develop a Global Partnership for
  Development
• Control of malaria essential to achieving MDGs.

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The Millennium Development Goals - MDGs

• The MDGs are derived from the broader "Millennium
  Declaration" that was signed in 2000 by all UN
  member states in the General Assembly resolution
  55/2 of 8 September 2000

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MDGs Targets
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MDGs Targets on Malaria
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The Burden of Malaria in Africa

• Lost productivity due to illness, school
  absenteeism permanent neurological and other
  damage,
• Malaria has been estimated to cost Africa more
  than US 12 billion every year in lost GDP -
  Severely restrains investment economic growth,
• Why Africa bears Most of the malaria burden.
• Most malaria infections in caused by Plasmodium
  falciparum,
• most efficient species of the mosquitoes An.
  Gambie
• Lack of adequate infrastructure resources

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National Overview Malaria Burden

• Malaria Epidemiology
• Altitude and climate are the most important
  determinant factors
• Areas below 2000m are malarious
• 75 of the landmass malarious
• 68 of the population (50 million) are at risk of
  malaria
• Five major eco-epidemiological zones

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Malaria Burden contd

• Malaria is major public health problem in
  Ethiopia
• A total of 5.8 million malaria cases/year
• 800,000 confirmed malaria cases/year
• Over 5 million clinical cases/year
• Source Health and health related indicator,
  FMOH, 2004/5
• Source RHBs

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Malaria Burden contd

• Malaria is the first cause of illness death in
  Ethiopia
• Data for 2004/5
• First cause of Outpatient visits (16.57)
• 1st cause for Female pts (15.21)
• 1st cause for Infant pts (19.03)
• First cause of Admissions (14.98)
• 2nd cause for Female pts (19.14)
• 1st cause for Infant pts (17.79)
• First cause of Hospital deaths (28.91)
• 1st cause for Female pts (28.51)
• 1st cause for Infant pts (28.10)
• Source Health and health related indicator,
  FMOH, 1997 EC (2004/5)

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Malaria Burden
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Malaria Burden
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Malaria Burden
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Malaria Burden.
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Malaria Burden.
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Confirmed Malaria Cases, Ethiopia, 1990 - 2005
Source Health and health related indicators,
FMOH
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TOTAL (ConfirmedClinical) Malaria Cases,
Ethiopia, 2001 - 2005
Source RHBs
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Yearly Confirmed Malaria Cases by Species
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Observed versus expected reductions in the
relative percentage of outpatient consultations,
hospital admissions and deaths attributed to
malaria in Ethiopia, 2000-2005 (July-June)
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Together We Can Beat Malaria!
Thank you