THE CHANGING EPIDEMIOLOGY OF MALARIA ELIMINATION: New Strategies for New Challenges

The theme for World Malaria Day 2023 is “Malaria – a disease without borders.”

• Majority of the cases were reported from WHO African Region (AFR) (90%)
• South-East Asian Region (SEAR) and Eastern Mediterranean Region (EMR) contributed 7 and 2% of global malaria respectively.
• Sub-Saharan Africa region has reported such a high endemicity that shared 80% of total malaria burden.
• The global deadline for the elimination of Malaria is 2024……….???

DRIVERS OF DECLINE/ELIMINATION
Attributed it to a scale-up of combinations of control strategies:
Long-lasting insecticide-treated nets (LLINs) or insecticide treated nets (ITNs), indoor residual spraying (IRS) and intermittent preventive therapy for pregnant women (IPTp) & other special groups for prevention, better diagnostics for case ascertainment, and effective treatments using artemisinin-based combination therapies (ACTs)

EPIDEMIOLOGICAL CHANGES

• The spread of An. stephensi a mosquito species that can transmit both P. falciparum and P. vivax malaria parasites.
• Epidemiological impact of insecticide resistance of LLIN & IRS
  • LLIN: net survivorship, fabric integrity and insecticidal activity
    (bioefficacy)
  • IRS: resistance, the timing of spraying and the quality of spraying.
    In addition, at large scale, the costs are high.
• Impact of RDT with Pfhrp2/3 deletions in the sen/sep; detecting p.vivax
• Complexity of malarial drugs (ACT) for active trt & drugs for various chemoprophylaxis
• Uninterrupted malaria importation into the malaria free and eliminating countries
• The effect of global warming!!
• Disruptions to malaria prevention, testing and treatment services owing to the COVID-19 pandemic
• Changes in Clinical epidemiology:
  • increase in median age of hosp admission
  • less anemia but more cerebral malaria
• Emerging population at risk:
  • Adults, school age children & teenagers
  • geographycal risk areas (Hotspots) & silent sustainers

STRATEGY FOR THE CHALLENGES

• WHO recommends a shift to non-HRP2-based RDT tests & seek to improve diagnostic tools related to P. vivax
• There are several ongoing innovations in malaria medicines for case management and chemoprevention
• The RTS,S/AS01 malaria vaccine for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission.
• The strategies called for collaboration, improved surveillance, information exchange, normative guidance and research as the key to the response.
• Require a multidisciplinary and multisectoral response with trusted national leadership and well-functioning, equitable and resilient health systems.

THE ROLE OF HEALTHCARE WORKERS

Team consist of ALL cadre with varied coordination and responsibilties, accross ALL level of HCF:

• Ensure early diagnosis and treatment EDT: RDT & ACT
• Prompt referal
• Health education & counselling on prevention & control
• Perssive & active surviellence
• Information tech
• Monitoring & evaluation

Thank you!
This presentation was presented at a panel discussion organized by
Shalina Healthcare on 24th April 2023