Epidemiology is the study of disease patterns in populations and the factors that influence disease distribution, with the ultimate goal of disease prevention and control. Malaria transmission requires an interaction between the Plasmodium parasite, a human host, and an Anopheles mosquito vector within a conducive environmental setting. More than 90% of malaria cases occur in sub-Saharan Africa, where it is estimated to cause over 1 million deaths per year, primarily among young children in remote rural areas with limited access to healthcare. In the Philippines, malaria remains endemic in many provinces, placing approximately 11 million people at risk, including subsistence farmers, indigenous groups, and migrant workers living in forested and frontier areas. Controlling malaria
Epidemiology is the study of disease patterns in populations and the factors that influence disease distribution, with the ultimate goal of disease prevention and control. Malaria transmission requires an interaction between the Plasmodium parasite, a human host, and an Anopheles mosquito vector within a conducive environmental setting. More than 90% of malaria cases occur in sub-Saharan Africa, where it is estimated to cause over 1 million deaths per year, primarily among young children in remote rural areas with limited access to healthcare. In the Philippines, malaria remains endemic in many provinces, placing approximately 11 million people at risk, including subsistence farmers, indigenous groups, and migrant workers living in forested and frontier areas. Controlling malaria
Epidemiology is the study of disease patterns in populations and the factors that influence disease distribution, with the ultimate goal of disease prevention and control. Malaria transmission requires an interaction between the Plasmodium parasite, a human host, and an Anopheles mosquito vector within a conducive environmental setting. More than 90% of malaria cases occur in sub-Saharan Africa, where it is estimated to cause over 1 million deaths per year, primarily among young children in remote rural areas with limited access to healthcare. In the Philippines, malaria remains endemic in many provinces, placing approximately 11 million people at risk, including subsistence farmers, indigenous groups, and migrant workers living in forested and frontier areas. Controlling malaria
Epidemiology is the study of disease patterns in populations and the factors that influence disease distribution, with the ultimate goal of disease prevention and control. Malaria transmission requires an interaction between the Plasmodium parasite, a human host, and an Anopheles mosquito vector within a conducive environmental setting. More than 90% of malaria cases occur in sub-Saharan Africa, where it is estimated to cause over 1 million deaths per year, primarily among young children in remote rural areas with limited access to healthcare. In the Philippines, malaria remains endemic in many provinces, placing approximately 11 million people at risk, including subsistence farmers, indigenous groups, and migrant workers living in forested and frontier areas. Controlling malaria
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Lyndon L.
Lee Suy, MD, MPH
Epidemiology A science that is concerned with: Describing the pattern of occurrence of disease in a population Determining the factors that influence disease distribution Ultimate objective of providing the basis for prevention & control Epidemiology AGENT (Plasmodium sp.) HOST (man) VECTOR (Anopheles sp.) ENVIRONMENT Basic Factors In Malaria Transmission Components of the Malaria Life Cycle Mosquito Vector Human Host Sporogonic cycle Infective Period Mosquito bites gametocytemic person Mosquito bites uninfected person Prepatent Period Incubation Period Clinical Illness Parasites visible Recovery Symptom onset Adapted from: CDC Host Factors Inherent in Man Race Immunity Age Sex
More susceptible population Young children Pregnant women Non-immunes Agent Plasmodium falciparum Plasmodium vivax Plasmodium malariae Plasmodium ovale Vector Anopheles flavirostris Anopheles litoralis Anopheles maculatus Anopheles mangyanus Anopheles balabacensis Anopheles
Environmental Factors Affecting Transmission Physical, chemical, biological & socio-economic environments Prevailing climatic conditions In general, transmission is higher during the rainy season than during the dry season Peaks of transmission is usually two months after the start of the rainy months & towards the end of the rainy season
More than 90% of all malaria cases are in sub-Saharan Africa.
Current Global Picture Mortality is estimated to be over 1 million deaths each year.
The vast majority of deaths occur among young children in Africa, especially in remote rural areas with poor access to health services. Modified from CDC Website,2001 National Situation Control of malaria in the Philippines in the 1990s had significantly reduced cases by 60% (from 89,047 in 1990 to 34,787 in 2001) Malaria remains endemic in 65 of the 78 provinces, 760 of the 1,600 municipalities & 9,345 of the 42,979 barangays nationwide At risk of malaria nationwide are 11 million Filipinos mainly living in the remote hard to reach areas National Situation Endemicity is now generally moderate to low with pockets of high endemicity persisting along the provincial/regional borders, in frontier areas, places populated by indigenous cultural groups & areas with socio-political conflicts It continues to be a major impediment to human & economic development in areas where it persists It still costs the economy over 100 million pesos to sustain control efforts Category A Provinces 9 provinces (from 26 provinces)
Category B Provinces 23 provinces (from 22 provinces) Category C Provinces 31 provinces (from 18 provinces) Category D Provinces 16 provinces (from 13 provinces) 13 provinces remain malaria-free status
GEOGRAPHICAL DISTRIBUTION OF MALARIA, PHILIPPINES (Based on 5-year Ave, 2001 2005) Source: Malaria Control Program, 2006 Extent of the Problem Around 10.5 million population live in areas endemic for malaria Commonly affected: Upland subsistence farmers Indigenous cultural groups Forest product gatherers Settlers in frontier areas Migrant agricultural workers Charcoal makers Miners Malaria is not just a health problem it is also a socio-economic problem that affects the well- being of the people as well as the country. Factors in the Persistence or Re-emergence of Malaria Inadequate program integration in health services Lack of quality assurance & control in diagnosis Poor public awareness Uncoordinated control efforts Inadequate technical expertise Inadequate researches Other Inter-related Socio-economic, Biological & Environmental Factors include: Poverty Drug & insecticide resistance Socio-political conflict Population movement Climatic change Current Concerns Delivery of treatment that gives clinical & parasitological cure to drug resistant malaria Protection of current drugs in the face of emerging drug resistance Vector Control Use of insecticide treated mosquito nets Main vector control strategy in malarious areas Help prevent mosquito bites & kills mosquitoes Target: At least 1 treated mosquito net per household Re-treatment at least once a year Coverage should be no less than 85-90% Vector Control Environmental management by stream clearing To increase streamflow to make it unsuitable for vector breeding Vector Control Seeding of streams with larvivorous fishes To reduce mosquito density by predation of mosquito-eating fishes Vector Control Indoor residual spraying of houses with insecticides To kill the adult mosquitoes that rest on walls thereby reducing their population Vector control in case of outbreaks Vector Control Personal Protection Measures Use of mosquito nets Chemoprophylaxis Use of mosquito repellents Screening of houses Use of protective clothing Malaria Diagnosis Clinical Diagnosis Based on signs & symptoms & history of travel to a malaria endemic area Done by all trained health workers especially in areas where microscopic diagnosis is not available within 24 hours Malaria Diagnosis Microscopic Diagnosis Gold standard Definitive diagnosis of infection is based on demonstration of malaria parasites in blood films Malaria Diagnosis Rapid Diagnostic Tests Uses immunochromatographic methods to detect Plasmodium specific antigens Community Health Education Aims to strengthen the knowledge, attitude & practices of the people in the community in the prevention & control of malaria Drug Resistance Mortality Morbidity Transmission in areas of low level malaria Major Challenges Improving the managerial & technical capacities in MCP Working beyond the health sector to reach out to remote communities Empowering the communities at risk, including the indigenous people, to become active partners & not just passive recipients of health services Detecting & responding early to control outbreaks & preventing its occurrence Combating drug resistance Guiding Principles Focus on the disadvantaged groups to help address inequity Positioning MCP to improve its performance Ensure sustainability through community & multi-sectoral involvement Evidence based approaches
