Running head: HEALTH IMPACT FRAMEWORK: MALARIA 1

Health Impact Framework: Malaria

Delaware Technical Community College

NUR 310 Global Health

Veronica Franco

April 1, 2017
HEALTH IMPACT FRAMEWORK: MALARIA 2

Abstract

Malaria is a disease that places a great burden on the world population. It is very prominent in

several areas of the world and continues to pose a threat to the wellbeing of many individuals. It

is a disease caused by the bite of a female anopheles mosquito that carries the parasite. The

infectious disease has a high prevalence on poor countries and impacts economic development.

In order to combat poverty, measures against malaria must be implemented. Incorporating the

use of long lasting insecticide treated bed nets (LLIN) is essential for protecting the most

vulnerable populations. Proper diagnosis such as microscopy and rapid diagnostic testing (RDT)

must be provided in a timely manner in order to provide quick and effective treatment. Educating

the population about the importance of recognizing the signs and symptoms of the disease, and

the importance of using repellants to protect themselves is fundamental to decrease contact with

the vector. Finally, it is important to consider future interventions that could aid in ending the

spread of malaria such as the creation of the vaccine.

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Introduction

Malaria is an infectious disease that has remained an important public health issue. It

continues to pose a threat to the wellbeing of many individuals throughout the world. According

to the World Health Organization (WHO), in 2015, there were 212 million cases of malaria

worldwide and 429,000 deaths (2016b). The disease is caused by the bite of a female Anopheles

mosquito that carries the parasite. In humans, there are a total of five parasites that can cause

malaria. Two of the five parasites, Plasmodium Falciparum and Plasmodium Vivax, create the

most serious infection (WHO, 2016b). Certain locations are more susceptible in having a higher

predominance of the disease. The area with greatest occurrences is Sub-Saharan Africa but Latin

America, South East Asia, and the Middle East are also at risk (WHO, 2016b). Malaria can affect

anyone but certain people can be susceptible in acquiring the disease. The WHO explains that

pregnant women, infants, children younger than 5 years, HIV/AIDS patients, immigrants, or any

individual with decreased immune system function can be at risk for developing malaria (2016b).

The following paper will apply the Health Impact Pyramid, an approach for public health action

against malaria and incorporate Sustainable Developmental Goals (SDGS), which contain targets

to help with improvement of society.

Socioeconomic Factors

The first level of the pyramid, are socioeconomic factors. Malaria is prevalent in areas

with low economic status and contributes further to a decrease production among individuals

because they are unable to work. In order to reduce poverty, malaria must be controlled. This

disease is also known as the epidemic of the poor because it places a significant burden to

families and slows economic development (European Alliance Against Malaria, n.d., pg.1).

Malaria affects the poorest countries in the world and deprives many individuals from their
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income. Countries with high poverty often have improper housing, lack of clean water, and

sanitation. In the African continent alone, it is estimated that $12 billion is the cost of dealing

with malaria yearly (Skolnik, 2016). SDG 1, which is to end poverty in all its forms, should be

the primary objective to follow once malaria is controlled (United Nations, n.d.). There are many

economic obstacles that the disease poses on a nations economy and they include a restraint in

trade, tourism, investment from foreign nations, and business development (Skolnik, 2016).

A great way to decrease and manage the spread of the vector is modifying the physical

environment. A particular country affected by malaria is Mali. According to the Institute for

Health Metrics and Evaluations (IHME), in 2015, the population of Mali was 17.6 million and

the death rate per 100,000 was 996.2 (n.d). Among the top 10 causes of death, the number one

cause is malaria and has become more prevalent since 2015 with an increase of 16% (IHME,

n.d.). The Years of Life Lost (YLL), years lost due to premature death, per 100,000 from malaria

in 2015, was 9,356.4 (IHME, n.d.). Essential strategies to aid in the reduction of the vector may

include cutting vegetation, canal lining to reduce water pooling, and alternating between

irrigation and dry farming (The Health and Environmental Linkage Initiative, n.d.). It is

important to follow these precautions in order for a reduction in the amount of mosquito

reproduction to occur. Besides reducing poverty and improving the environment, it is essential to

provide better access to clean water and food.

Changing the Context

The second step in the pyramid is changing the context to make individuals default

decisions healthy. Individuals might not be able to access healthcare facilities because of long

travel distances or because of road conditions. It is essential to provide better road infrastructure

in order for the population to obtain a timely treatment of malaria. In addition, it is essential to
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provide appropriate access to clean water and food. It is essential to target SDG 2, which is to

end hunger, through improved nutrition and agriculture, and, SGD 6, which focuses on

improving the accessibility of clean water (United Nations, n.d.). It is essential for organizations

to provide investments into the creation of effective infrastructure that could provide effective

access to clean water (United Nations, n.d.). When individuals are affected by malaria,

consuming a healthy diet and clean water, can aid in a faster recovery. In addition to changing

the context, it is essential to provide interventions that are long lasting.

Long Lasting Interventions

The third level of the pyramid involves providing long lasting protective interventions.

One important solution that can aid in the control of malaria involves the use of long lasting

insecticide treated bed nets (LLIN). Because the female Anopheles mosquito feeds in early

hours, a child dies from malaria every two minutes and yearly it takes the lives 453,000

individuals; 90% deaths are from Africa (Malaria No More, 2017). The use of bed nets is

essential because it helps to protect the most vulnerable population without extensive

interventions and clinical care. According to WHO, the use of nets has been proven to reduce

deaths by 25% worldwide and 33% in Sub-Saharan Africa alone (CDC Foundation, 2017).

Children are at risk for developing the disease because of their decreased immune system. Bed

nets is an essential barrier that helps prevents the mosquito from coming in contact with the

individual. Even when the bed nets have an opening, the insecticide eliminates the mosquito

even when it enters the net and contributes in protecting the user (CDC Foundation, 2017). The

cost of the net is approximately five dollars and is able to provide protection to three children

(CDC Foundation, 2017). Even though bed nets are inexpensive, communities with low income

are unable to afford the net. The CDC Foundation has aided in the distribution of bed nets
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throughout Africa and since 2006, they have been able to collect more than $80,000 to aid in

costing the nets.

A model or theory for behavior change is the Health Belief Model. To help with the

control of malaria, the use of insecticide-treated bed nets are used. Individuals might be

noncompliant with the use of the nets because there might be barriers that impede the

engagement of the preventative behavior. These barriers might include not knowing how to use

them, they might feel uncomfortable using them, or they might be too expensive (Skolnik, 2016).

In addition, they might believe that they have a low likelihood of acquiring the disease and they

might not be aware of the benefits of changing their behavior (Skolnik, 2016). It is important to

educate these individuals on the importance of protecting themselves and their loved ones. Now,

with the understanding of the long lasting interventions against malaria, it is important to know

what clinical interventions are available.

Clinical Interventions

The next level of the pyramid is clinical interventions to help treat malaria. It is essential to

obtain a proper diagnosis to help with the management of the disease. The WHO recommends

the use of both microscopy and rapid diagnostic tests (RDTs), the detection of the parasite

through a prick of the patients finger (WHO, 2016a). Microscopy is most commonly used in

hospitals or clinics and RDTs are used in areas where microscopy is not available (WHO,

2016a). These two methods are able to detect the type of parasitic infection that could be

affecting the individual and helps to determine the best course of treatment. Nucleic acid

amplification tests (NAATs) detects low-density malaria, is mostly performed during medical

research (WHO, 2016a). Once the diagnosis is implemented, proper treatment can be

administered. It is essential to receive treatment within the first 24 hours of developing the fever
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in order to prevent complications from occurring (WHO, 2016c). The front line treatment of

malaria is a series of artemisin-based combination therapies (ACTs) for the treatment of

Plasmodium Falciparum, the most common type of malaria (WHO, 2016c). It is important for

individuals to adhere to the medication regime and take the full dose of the medication in order

to prevent resistance. The medication for the treatment of malaria contains two active ingredients

and sometimes individuals use tablets with a single component, which could contribute to

resistance (WHO, 2016c). For the treatment of Plasmodium Vivax, the second most common

infection, chloroquine treatment is implemented and primaquine is used to prevent relapses

(WHO, 2016c). When diagnosis is not performed in a timely manner and complications such as

severe malaria occur, a different treatment is implemented. The patient is given an injectable

medication called artesunate for 24 hours and then is given ACT for three days (WHO, 2016c).

According to the WHO, in 2014, 337 million ACTs treatments were administered. ACT

medications have become the number one treatment for malaria in 81 countries (WHO, 2016c).

In order for the prevention of malaria to occur, proper education needs to be established.

Together with clinical interventions, implementing counseling and education can help with

malaria eradication.

Counseling and Education

The final level of the health impact pyramid is counseling and educating the population.

It is essential for the population to understand the importance of recognizing the signs and

symptoms and seeking treatment as soon as possible in order to prevent complications.

Individuals, because of their cultural beliefs, might have erroneous perceptions of the disease.

People might be unable to afford the expense of the traditional Western doctor and rely on the

traditional healer for treatment. In addition to mosquitos, some people believe that consuming
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mangoes, fatty foods, sugar cane, maize, and the intake of contaminated water can cause malaria

(Mutua et al., 2016). In African countries, men are less likely to seek treatment compared to

women in order to not be portrayed as weak (Mutua et al., 2016). In some areas, it is believed

that children should not be exposed to the chemicals present in the bed nets and that pregnant

woman should not consume medications such as Chloroquine for the treatment of malaria

because it might cause abortion or dry up breast milk (Heggenhougen et al., n.d.). It is essential

to educate about the importance of following safe practices. Methods to combat malaria can

include using chemically treated nets, wearing long sleeve shirts to prevent the bite of the

mosquito, and the use of insect repellent. It is essential to educate individuals in how to assess

their homes and water collecting containers in order to prevent the breeding of mosquitos and

implement an indoor residual spraying (IRS) of their homes (The Health and Environmental

Linkages Initiative, n.d.). Schooling and education are needed in order for children to find better

jobs and aid in improving their economy. Unfortunately, malaria causes approximately 10

million missed days of school attendance in Africa (Malaria No More, 2017). It is important to

apply SDG 4 in which its main purpose is to ensure that quality education is provided to all

(United Nations, n.d.). It is important for education to be available to children and adults in order

to aid in forming stronger societies. In addition to educating the population, it is important to

consider what future interventions could be used as weapons against the disease.

Future interventions recommended to help with the eradication of malaria can include

developing a vaccine and implementing an integrator vector management. Creating a vaccine is a

great solution towards helping with the eradication of malaria. Today, the vaccine RTS,S/AS01

(RST,S), is considered an important candidate to help with the control of Plasmodium

Falciparum, the deadliest parasitic infection (WHO, 2016d). This vaccine is ahead of others by 5
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to 10 years and has received favorable reactions from medicine regulatory agencies such as the

European Medicine Agency (WHO, 2016d). A trial was conducted in several countries in Africa

including Ghana, Kenya, Malawi, Mozambique, in an attempt to assess the efficacy of the

vaccine. Infants were vaccinated at 6, 10, and 14 weeks and children were vaccinated at 5 and 17

months (WHO, 2016d). The results of the trial demonstrated a 27% success against malaria when

the 4 doses were given and 18% in those that didnt obtain the full doses (WHO, 2016d). The

application of the vaccine has been proven to positively influence the reduction of the infection

in children.

The Health and Environmental Linkages Initiative (HELI) created by WHO and United

Nations Environment Program (UNEP) was developed to help countries fight against malaria

while taking precautions to save the environment. According to HELI, integrated vector

management (IVM), a strategy to aid in the control of the disease is best implemented by

improving water supply and providing natural predators such as bacteria and fish (HELI, n.d.).

Through the use of these predators, the use of chemicals that could pose a threat to the

environment can be reduced. Through environmental protective measures, SDG 14, which aims

at protecting life on land and combat climate change, can be followed (United Nations, n.d.). It is

important to take care of the environment and controlling malaria can be a determining factor in

the health of the population.

As malaria remains one of the leading conditions affecting the worlds population,

measures need to be taken in order to help decrease the spread of the disease. It is essential to

understand the importance of applying the Health Impact Pyramid as a public health approach

into reducing the disease and ensure that the Sustainable Developmental Goals are being met.
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References

CDC Foundation (2017). Bed nets for children. Retrieved from

http://www.cdcfoundation.org/bednets

European Alliance Against Malaria (n.d.). Malaria and poverty. Retrieved from

http://www.malariaconsortium.org/userfiles/file/Past%20events/factsheet2%20-

%20malaria%20and%20poverty.pdf

Heggenhougen H. K., Hackethal V., Vikek P. (n.d.) The behavior and social aspects of malaria

and its control. Retrieved from

http://www.who.int/tdr/publications/documents/seb_malaria.pdf

Institute for Health Metrics and Evaluation. (n.d.). Mali. Retrieved from

http://www.healthdata.org/mali

Malaria No More. (2017). The challenge. Retrieved from

https://www.malarianomore.org/pages/the-challenge

Mutua, E. N., Bukachi, S. A., Bett, B. K., Estambale, B. A., & Nyamongo, I. K. (2016). Lay

knowledge and management of malaria in Baringo county, Kenya. Malaria Journal, 151-

12. doi:10.1186/s12936-016-1542-9

Ricci, F. (2012). Social Implications of Malaria and Their Relationships with Poverty.

Mediterranean Journal Of Hematology & Infectious Diseases, 4(1), 1-10.

Doi:10.4084/MJHID.2012.048

Skolnik, R. (2016). Global Health 101 (3rd ed.) Burlington, MA: Jones & Barlet Learning

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http://www.who.int/heli/risks/vectors/malariacontrol/en/
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World Health Organization (2016a). Diagnostic testing. Retrieved from

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World Health Organization. (2016b). Malaria. Retrieved from

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World Health Organization (2016d). Questions and answers on RTS,S/AS01 malaria vaccine.

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http://www.who.int/immunization/research/development/malaria_vaccine_qa/en/

United Nations. (n.d.) Sustainable developmental goals. Retrieved from

http://www.un.org/sustainabledevelopment/sustainable-development-goals/