Ethiopia malaria case study Flashcards
Where is Ethiopia?
LIDC is sub-saharan africa - horn of africa
What is malaria?
World’s deadliest disease, caused by plasmodium parasite, which is spread by the anopheles mosquito (vector)
Killed 584,000 worldwide in 2013 - mainly children under 5 years old
What are the incidence and patterns of the disease in Ethiopia?
Endemic in 75% of Ethiopia’s land area - 2/3 of population at risk from the disease
70,000 killed by the disease every year
Not distributed evenly
Areas at highest risk are western lowlands in Tigray, Amhara and Gambella provinces
Transmission peaks in September to December, following the rainy season
In Eastern lowlands the arid climate confines the malaria to river valleys
The central highlands (around 1/4 of the country’s land area) are malaria-free
What are the environmental causes of the disease?
Warm, humid tropical climates with stagnant surface water - ideal conditions for mosquitos to breed
Altitude strongly influences - temp drops 6.5°C per km (environmental lapse rate) - central higjlands, which exceed 2400m, are too cold for the mosquitos and parasite (which requires 21-28°C to develop)
Rainfall - Anopheles mosquitos breed in stagnant pools. Large amounts of precipitation lead to increased amounts of pooling in the tropical climate, allowing mosquitos to breed in large amounts and cause rapid spread of the disease. However, stagnant pools can be washed away by very heavy rainfall, slowing the spread of malaria by mosquito vectors
Disease is most prevalent just after the rainy season - september to december
What are the human causes of the disease?
Population movements - agriculture in lowlands, people live in the highlands - many workers migrate during planting and harvesting season - coincides with rainy season - many workers sleep in fields overnight, when mosquitos are most active.
Irrigation schemes - in Awash valley and Gambella province - construction of canals, micro-dams, ponds, cultivation of rice have expanded breeding grounds for mosquitos.
Urbanisation - flooded excavations, garbage dumps, discarded containers provide lots of stagnant water and therefore ideal breeding conditions for the vectors
Malarial parasite becoming increasingly drug-resistant due to misuse of drugs
What are the socio-economic impacts of malaria in Ethiopia?
Kills around 70,000 a year
5 million incidences annually
Leads to low work output, absenteeism, slow economic growth and poverty cycle - in sub-saharan Africa lost production of $12 billion due to malaria
Ethiopia spend 40% of their national health budget on malaria
Limited development in western lowlands as highlands get higher population densities - land degradation in highland areas - linked to famines in 1980s
Tourists are put off by the presence of malaria - less income through tourism
What is the PMI? What is the GHI?
Presidents malaria initiative and Global Health Initiative
- scale up malaria prevention and treatment in sub-saharan Africa since 2005
- Ethiopia recieved grants of $20-43 million a year between 2008 and 2013
2011 Ethiopian government implemented a 5 year plan for malaria prevention and control, which operates in partnership with agencies including UNICEF, the World Bank and WHO.
What are direct mitigation strategies used in Ethiopia?
Periodic spraying of dwellings with insecticides
Managing environment to destroy breeding sites (e.g. flushing away stagnant water
Genetic modification of mosquitos that will not carry malaria - gradually replacing parasite-carrying ones with GM ones - unethical?
What are indirect mitigation strategies used?
Mass publicity campaigns to minimise potential mosquito breeding sites
Providing early diagnosis and treatment of malaria
Distributing insecticide treated bed nets to all households in infected areas
Distributing mosquito nets
Education schemes
ACTs - most effective antimalarials available today - currently no vaccine - only reduces risk of infection by 90% - still requires steps to avoid bites (e.g. nets)
How successful have the strategies been?
Death rates from malaria halved between 2000 and 2010
No epidemics since 2003 (previously 8 year cycles of epidemics)
Between 1990-2015 cases of malaria reduced by nearly 80%, deaths by 95%, DALYs decreased by 92% (disability adjusted life years)
Overall very successful but more could be and is being done.
