What is malaria?
Good question. Malaria is a disease caused by a parasite called Plasmodium and spread by the female anopheles mosquito, who transmits the parasite from one person to another when she bites them.1
What happens when you get malaria? Is it fatal?
When a mosquito injects someone with malaria parasites, the parasites enter a person’s liver where they bide their time, not yet causing symptoms but multiplying for seven to ten days. The parasites then invade the blood stream where they wreak havoc on the red blood cells, causing many unpleasant symptoms, and sometimes even death. Generally, malaria can be categorized in two ways: uncomplicated malaria and severe (or complicated) malaria.
Symptoms of uncomplicated malaria include fever, shivering, headache, body/joint pains, mild cough, vomiting, diarrhea, irritability, and refusal to feed/loss of appetite. Usually uncomplicated malaria can be treated at home after receiving a positive test result for malaria parasites. If not treated within 24 hours, the patient usually gets worse and their uncomplicated malaria might progress to severe malaria.
Symptoms of severe malaria include convulsions, severe weakness, abnormal breathing, inability to eat/drink/breastfeed, severe vomiting, severe diarrhea, coma, and severe pallor (discoloration of the skin). If not referred to a hospital immediately, a person with severe malaria can die or suffer damage to their brain or other organs that cannot be reversed even after treatment.
For those that have eventually acquired immunity through surviving repeated malaria infections, it’s also possible to harbor parasites in the body but not show any symptoms at all. Such asymptomatic carriers can serve as unsuspecting transmitters of the disease, inadvertently allowing it to be passed to others if bitten by a mosquito.2
Some of those symptoms are indications of other illnesses too. How do I know for sure if I specifically have malaria?
If you suspect you might have malaria, you should be tested as soon as possible. If you are near a clinic with lab equipment, then microscopy—that is, viewing a blood sample under a microscope—can determine whether or not you have the disease. Or your health worker may use a rapid diagnostic test, a small device that detects the presence of malaria parasites in the blood. A drop of blood from your finger is all that is needed to determine if you indeed have malaria.3
Who is getting malaria?
Lots of people. Globally, an estimated 3.3 billion people in 97 countries and territories are at risk of being infected with malaria. The burden is heaviest in sub-Saharan Africa, where an estimated 90 percent of malaria deaths occur, and in children under five years of age, who account for 78 percent of all malaria deaths.4
Is there a vaccine?
For the first time in history, there is a promising candidate in the works.
What do I do if I get malaria?
It depends on what type of malaria you have. If you were to test positive for, say, Plasmodium falciparum, which is responsible for the most malaria deaths, the recommended treatment is an artemisinin-based combination therapy—or “ACT.” ACTs are effective because they combine fast-acting compounds that kill the majority of parasites with a slower acting drug that clears the remaining parasites.
But if you have Plasmodium vivax, which has a wide geographic distribution, then the drug chloroquine would be the recommended treatment.
Wait, there are multiple types of malaria parasites?
There sure are. In humans, Plasmodium falciparum is the most lethal parasite and occurs primarily in sub-Saharan Africa. P. vivax occurs primarily in South America, Southeast Asia, Latin America, and the Horn of Africa. P. malariae and P. ovale are the other, less common human malaria species, and P. knowlesi, a species that causes malaria among monkeys in certain areas of South-East Asia, has recently been recorded in humans as well.
That’s a lot of parasites and they cover a lot of ground. How can we avoid them?
Malaria can be prevented by sleeping under an insecticide-treated mosquito net every night, allowing your home to be sprayed with insecticide, and, if you are pregnant, taking preventive medication. If you suspect you have malaria, seeking diagnosis and treatment within 24 hours of treatment is recommended.
Tell me more about the nets.
Insecticide-treated mosquito nets are hung over a sleeping space and form a protective barrier around those sleeping under them. The nets are treated with insecticides that kill or repel mosquitoes and reduce the number of mosquitoes that enter the house and attempt to feed on people.
How long are these nets good for? Are they expensive?
Some nets need be retreated every 6 to 12 months, or even more frequently if the nets have been washed, but there’s a form of mosquito net called long-lasting insecticide-treated bednets—or “LLINs”—that maintain effective levels of insecticide for at least three years, even after repeated washing.
Most of the 97 countries with ongoing malaria transmission distribute nets free of charge,5 and delivery of nets to African countries has increased from 6 million in 2004 to over 142 million in 2013 with more than 900 million nets being delivered to malaria-endemic countries in sub-Saharan Africa between 2004 and 2014.6
Another prevention method you mentioned was spraying the household. How does that work?
Health workers spray the inner walls of households with insecticides that kill mosquitoes when they land, usually after they have fed on a humans, thus preventing transmission. The method is called indoor residual spraying, or “IRS.”
This is proven to work? Has this method been embraced by many countries?
Yes, and yes. In 2013 IRS helped protect 124 million people worldwide, and it has been adopted as policy for the control of malaria in 90 countries, including 42 of 45 malaria-endemic countries in the WHO African Region.7
You also mentioned an intervention specifically for pregnant women.
Yes, malaria is a major cause of anemia in pregnant women, causing stillbirths, preterm birth, and low birth weight (a significant contributor to infant mortality), and contributing to maternal death at delivery.8 Intermittent preventive treatment during pregnancy—known as “IPTp”—is the recommended intervention for protecting pregnant women and unborn children from the adverse effects of malaria during pregnancy.
How does IPTp work?
With IPTp, all pregnant women, whether or not they are infected with the malaria parasite, are given a curative dose of an effective antimalarial drug (currently sulfadoxine-pyrimethamine). Starting in their second trimester, pregnant women should get IPTp at each routine antenatal care visit.
Has the wide-scale use of these interventions led to results?
It has. Worldwide, over 6.2 million malaria deaths have been averted between 2000 and 2015, primarily of children under five years of age in sub-Saharan Africa. The global malaria incidence rate has fallen by an estimated 37 percent and the mortality rate by 58 percent.9
This marked decrease in malaria cases and deaths comes even as the number of people living in endemic areas has continued to grow. Such impact is a testament to the effectiveness of increased bednet use, expansion of IRS, rapid diagnostic tests becoming available, and the use of ACTs and IPTp.10
It is clear that the interventions we’re using work, but in order move from malaria control to malaria elimination, we need to optimize the use of these interventions and add a few more.
Can malaria actually be eliminated?
Yes, it can. In fact, it’s been eliminated in many countries already, including the United States. Thirty-seven of the 143 countries that were malaria-endemic in 1950 were malaria-free by 1978, including 27 in Europe and the Americas.11 However, the groundbreaking work of charting how the disease can be eliminated in sub-Saharan Africa has only recently begun.
So how can malaria be eliminated altogether?
To eliminate malaria, we must optimize the use of existing strategies and tools, while continuing to invest in the development of new ones. This means helping countries with high levels of transmission to continue to scale up coverage with proven tools, while testing new strategies to end transmission of the disease altogether.12
A big reason why elimination is considered feasible is because over a decade ago an approach called Scale-up For Impact—or “SUFI”—was initiated that focused on rapidly increasing the access and use of proven interventions to quickly achieve optimal health effects. The approach was and continues to be embraced and has provided dramatic impact on malaria mortality and morbidity. But SUFI alone isn’t enough; it is just an initial step. To continue to progress toward elimination we need to build on prior successes and continue to scale up coverage of life-saving tools where it hasn’t been done yet.
Ok. What else needs to happen to move toward elimination?
In addition to continuing to use nets, IRS, and IPTp, we need to collect data in a timely way. Right now, 47 countries use District Health Information Software, or DHIS, an open-source health information system, which enables ministries of health to make strategic, data-driven decisions to improve service delivery. With the advent of data entry via commonly available mobile phones, reporting has become more flexible and timely than ever.
We also need to develop effective population-wide interventions, like proactively going into communities, testing people, and treating them. One approach currently being piloted involves going into communities and giving everyone a dose of safe, parasite-killing drugs, whether they have malaria or not.13
What is a major challenge standing in the way of malaria elimination?
Raising and sustaining funding levels to see elimination through. Since the 1930s, there have been 75 documented local resurgences of malaria, the majority linked to decreased program funding.
Resurgence resulting from failures to maintain coverage with nets and IRS illustrates why the long-term goal must be malaria elimination, not merely malaria control.
That sounds good, but isn’t this going to cost a lot of money?
Yes, the cost of eliminating malaria would be significant. But investing in the malaria fight is one of the best buys in global health because it can serve as a foundation for achieving many other development objectives: child health, maternal health, and economic health to name a few. The global malaria community has established a set of targets to be met by 2030.14 It is estimated that meeting these targets would generate more than US$4 trillion of additional economic output from 2016 to 2030.15
Plus, eliminating malaria would be a critical step toward ending poverty and improving maternal and child health. Less malaria means less infant and maternal mortality, fewer days missed at school and work, more productive communities, and stronger economies.
To continue to allow lives—even one life, for that matter—to be lost to a disease we can beat is unacceptable. That’s why PATH, and our many partners, are committed to malaria elimination.
- For etymology buffs, “malaria” comes from the Italian term mal’aria, meaning “bad air” as it was once commonly believed that malaria was caused by breathing in swamp fumes (it’s definitely not, by the way).
In French it’s called “paludisme,” derived from the Latin word “palus,” meaning “swamp.” French physician Charles Laveran, who in 1893 became the first person to see the malarial organism in blood, hated the term “malaria,” considering it unscientific and vulgar. So he opted for the much more highbrow word, “swamp.”
- Aren’t mosquitoes the worst? That’s not a rhetorical question, and the answer is yes, they literally are the deadliest animal on earth.
Scientists say mosquitoes, with their penchant for carrying diseases, have killed more people than all the world’s wars combined. Other mosquito-born illnesses include dengue fever, yellow fever, and encephalitis.
- Inexpensive, accessible, and easy to use, rapid diagnostic tests are commonly used in rural areas when access to a lab is not possible. These tests can detect malaria parasites in less than 20 minutes.
- Per the World Health Organization’s World Malaria Report 2014.
- Per the World Health Organization’s World Malaria Report 2014.
- Per the United Nations’ Millennium Development Goals Report 2015.
- Once again, per the World Health Organization’s World Malaria Report 2014.
- Per the Roll Back Malaria Progress and Impact Series report, The contribution of malaria control to maternal and newborn health.
- Per the United Nations’ Millennium Development Goals Report 2015.
- Procurement of ACTs—crucial in the fight against malaria as they combine fast-acting compounds that kill the majority of parasites and a slower acting drug that clears the remaining parasites—by both the public and private sectors rose from 11 million in 2005 to 392 million in 2013 (per the World Health Organization’s World Malaria Report 2014).
Furthermore, it is estimated that 94,000 deaths among newborns were averted between 2009 and 2012 thanks to the scale-up of interventions for malaria in pregnancy (per the Roll Back Malaria Progress and Impact Series report, The contribution of malaria control to maternal and newborn health).
- Per the Roll Back Malaria Partnership’s Global Malaria Action Plan.
- To be clear, “malaria control” means reducing malaria burden to where it is no longer a public health concern. “Malaria elimination” means reducing the incidence of malaria parasite infection to zero transmission through targeted efforts within a defined geographical area.
- Giving everyone anti-malaria medication in a population reduces the reservoir of parasites in both people who are sick with this disease and those who feel fine but are asymptomatic carriers (and don’t know they even have malaria). This reduces the chances that a mosquito will transmit the parasite to someone else. This approach has worked well for other diseases like trachoma and river blindness and it’s currently being applied to malaria in parts of Zambia.
- They are:
- Reduce malaria mortality rates globally by 90 percent.
- Reduce malaria case incidence globally by 90 percent.
- Eliminate the disease in at least 35 more countries.
- Prevent re-establishment of malaria in all countries that are malaria-free.
- Per the Roll Back Malaria Partnership’s Action and Investment to Defeat Malaria 2016–2030 report.