Malaria is one of the most occurring and fatal infectious diseases which proves to be a major public health problem worldwide, particularly in south Asian and Africa. Around three billion people in 109 countries are at risk of gaining the infection. Each year approximately 250 million cases of malaria are reported with about one million deaths, most common in children under five (). There a five-different parasitic organism which infect humans and cause different forms off malaria. These include Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, plasmodium knowlesi and most dangerous form Plasmodium falciparum. These parasites are transmitted by mosquito species of Anopheles genus and only through the females of the species.
Mosquitoes are often considered vegetarian species which feed on fruit juices and nectar. During pregnancy, they often seek human blood due to the nutrients and proteins to nourish her developing eggs (). In this period is when usually people get malaria once they’re bitten by an infective female Anopheles mosquito. Anopheles mosquito can only transmit malaria only if they have taken a previous blood meal from an infected person. Once a mosquito bites an infected person, blood is taken in which contains the microscopic malaria parasite. Parasites which have formed sexual stages(gametocytes) are able to reproduce and form a cyst on the mosquito stomach lining which will produces thousands of new parasites which then infects the mosquito salivary glands and are injected in to the person when the mosquito takes its next blood meal ().
As malaria parasites are found in red blood cells they can also be transmitted through organ transplant, blood transfusion and shared syringes or needles contaminated with blood. Congenital malaria, results in malaria being transmitted vertically from mother to her infant before or during pregnancy.
Malaria transmission occurs in 5 WHO regions. An estimated 3.4 billion people in 92 countries and territories are at risk of developing malaria disease with 1.1 billion people having a high risk (; 1 in 1000 chance of developing malaria in a year). There were 212 million cases of malaria globally in 2015, with 429000 deaths which saw significant decrease in cases and deaths by 22% and 50% respectively since 2000(). But in 2016 malaria progress has stalled with roughly about 216 million malaria cases and 445000 malaria deaths. An increase of approximately 2.35% and 3.72% respectively. The major burden being in the African region, where about 92% of all malaria deaths occurred, with two thirds in children aged under 5 years old ().
Fever, chills and sweating are the most common symptoms of uncomplicated falciparum malaria, which is triggered by the release of plasmodia from blood schizonts into the blood stream (). Without treatment, the number of parasites will increase every 2-day cycle of reproduction and lead to serious life threatening conditions such as multi organ failure and eventually leading to death. Although malaria is life-threatening and deadly disease, it is also a treatable and preventable disease. The primary main objective of treatment is to provide complete cure, to assure rapid and full elimination of Plasmodium parasite from patient’s blood, to prevent any progression from uncomplicated to severe malaria to death and chronic related anemia (). Treatment is also meant to reduce transmission of the disease from one person to another, by reducing the infectious source and by preventing the spread and emergence of resistance to antimalarial drugs. Antimalarial drugs are designed to cure or prevent malaria. In the parasites lifecycle, unique biological properties are revealed which offer a target for antimalarial drugs. Most antimalarial drugs target the erythrocytic stage of the infection, which is the acute blood stage which causes symptomatic illness. Quinolone derivatives which include quinine, chloroquine, primaquine and halofantrine are drugs which work against the erythrocytic stage of the infection, while primaquine also kills gametocytes. Artemisins derivatives work against acute attacks and also transmission preventions.
Although these antimalarial drugs have proven to be a success, overtime resistance has appeared to all antimalarial drugs except artemisins, which is responsible for recent increases in malaria cases and mortality, specifically in Africa. Drug resistant have reported mainly P. Vivax and P. falciparum which have been countered with Artemisinin combination therapies(ACT). Which As
The current goal of eradication programs is to reduce malarial burden, which is reducing the transmission of the disease. The most efficient prevention measures include using mosquito beds nets with insecticides to avoid mosquito bites and reduce vectors. Which contributes to the reduction incidence of disease. Also, spraying house walls with insecticides is another effective prevention approach. The most effective treatment for malaria include a combination of anti-malarial drugs, in which one is an artemisinin derivative. Which is also used as a preventive treatment for pregnant women that help reduce the effects of malaria on mother and unborn child. These approaches have been effective as the use of bed nets and insecticides have significantly reduced malaria vector populations and has been linked with decline of anopheles’ species, following ; 5 years of 70-86% bed nets coverage, the density of indoor mosquitos were reduced by more than 92%(). While antimalarial drugs have been a key tool in malaria control but as resistance arises, new approaches have been developed to help regain control of malarial cases and reduce number of incidence. One approach includes the development of vaccines, RTS, S is a vaccine which provides protection against malaria in young children, RTS, S aims to trigger the body’s immune system against the disease. It is the only vaccine candidate that had shown to provide a protective effect against malaria in young children, it could provide significant public health benefits by reducing the burden of malaria along with insecticides and antimalarial drugs.
Despite improved development in technology and resources many of those in need lack the supply and correct intervention. Malaria tends to flourish the most in poor countries and increase in malaria incidence and deaths in countries with largest malaria cases. Primarily due to the poor delivery health system Therefore, new malaria control programs have been applied to Improve coverage of malaria intervention. In sub-Saharan Africa, the number of ITNs and antimalarial medication have increased from 189 million to over one billion over period of time (). Surveillance
All these approaches are implanted in the WHO Global Technical Strategy for Malaria 2016-2030. Which aims to work towards malaria control and elimination. The strategy sets achievable global targets, including:
• Reduction of malaria cases and mortality rates by at least 90% by 2030
• Malaria elimination in 35 countries by 2030
• Offer malaria treatment and prevention to at least 80% by 2030
This strategy is based on 3 key pillars, to ensure universal access to malaria prevention, diagnosis and treatment. Accelerate elimination and attain malaria free status. Transform malaria surveillance into core intervention.
The need to eliminate malaria
Despite enormous progress, malaria remains one of the top killers claiming millions of lives and is a significant cause of inequity and poverty in Africa. The rise of resistance has stalled malaria progress and malaria incidence and death rates have even reversed in some regions. Today, more than ever Increased researched and investments such as improved antimalarial medication, improved surveillance and control programs are in need to end malaria It will not only save millions of lives, it will give families and communities the ability to grow and prosper. It will give opportunities for children to attend school and learn efficiently, impacting their ability to earn a living. By sustaining investments in improving health and ending malaria, it will give rise to economic growth and human potential. As previous study, have shown Malaria free countries have 5x greater economic growth than those with malaria (). There is no easy path to becoming a malaria free world but with increased efforts and focus to overcome these challenges and achieve these goals can lead to a malaria free world.