Malaria Prevention and Control

 
What is Malaria?
 
Malaria is transmitted to humans by infected mosquitoes that carry a parasite called Plasmodium. Malaria parasites infect the liver and red blood cells, leading to their dysfunction and destruction. Malaria reduces the number of red blood cells in the body, which results in anemia. 
 
Plasmodium falciparum is the most life-threatening type of malaria, with greatest prevalence in Sub-Sarahan Africa. Plasmodium vivax is another type of malaria which is less dangerous than Plasmodium falciparum, although it is more widespread across regions. The symptoms of malaria are fever and headache. Severe cases put individuals at high risk of dying. 
 
Where is Malaria Found, and How Many People are Affected?
 
Malaria is a widespread problem in tropical and subtropical regions generally around the equator. In 2010, there were an estimated 219 million cases of malaria, with 80% of these cases ocurring in just 17 countries. Three countries, the Democratic Republic of Congo, Nigeria, and India, account for 40% of all estimated malaria cases (WHO World Malaria Report, 2012).
 
 
What are the Consequences of Malaria?
 
Malaria causes over 600,000 deaths annually, with 90% of the malaria deaths occurring in Africa. In 2010, there were an estimated 660,00 deaths due to malaria, and 80% of these deaths were from just 14 countries. Globally, both the Democratic Republic of the Congo and Nigeria account for over 40% of these estimated deaths (WHO World Malaria Report, 2012). Malaria also contributes to anemia in both pregnant women and children and is associated with prematurity and low birth weight in newborns. 
 
Who is Most Affected by Malaria?
 
In malaria-endemic areas, most people are exposed as children to malaria. If they survive childhood malaria and other infections and malnutrition, they acquire immunity to malaria, which provides protection from severe morbidity from malaria throughout life. Children younger than two years of age who have not acquired immunity are at high risk of dying from malaria. Repeated episodes of malaria result in severe anemia, from which untreated children may eventually die. Pregnant women, particularly those in their first and second pregnancies, lose some of their immunity to malaria, which puts them at risk of anemia and poor delivery and birth outcomes. In malaria-endemic areas, it is estimated that around 19% of infant low birth weights (LBWs) are due to malaria and 6% of infant deaths are due to LBW caused by malaria (Guyatt et al, 2004). These deaths are mediated by LBW, which is caused because the malaria parasite residing in the placenta and umbilical cord blocks nutrients to the fetus. Preventing malaria in pregnancy could reduce LBW in infants by 20% (WHO, 2011).
 
The anemia caused by malaria in children and in pregnancy is accompanied by iron deficiency, which is prevalent in both these groups. There are concerns about giving and withholding iron in areas where malaria transmission is high. Ensuring that malaria prevention and control and nutrition programs work together to integrate and monitor these two interventions is imperative to maximize the outcomes for both. Click here for information on IFA supplementation and the safety of giving iron.
 
Malaria Prevention and Control Interventions
 
Malaria is a preventable and treatable disease. Interventions to prevent malaria include:
  • Vector control: sleeping under insecticide-treated nets (ITNs), indoor residual spraying (IRS), and, in some specific settings, larval control
  • Intermittent preventive treatment for pregnant women and infants and seasonal chemoprophylaxis for children 1-5 years of age
  • Diagnosis and treatment of malaria
Specific Prevention and Treatment Measures for Pregnant Women and Children
 
All the interventions above should be part of the integrated package. We provide more information interventions for pregnant and lactating women and young children.
 
Prevention of Malaria using ITNs
Pregnant women and children younger than two years of age should sleep under ITNs to prevent infection by malaria. The coverage of ITNs in these groups has increased dramatically in some African countries. Eighty-nine countries have a policy to provide ITNs free of charge (UNICEF). In 2012, 41% of children younger than five slept under a bednet in Africa. More information on the coverage of ITNs and other anemia-related programs is coming soon here.
 
Malaria Prevention in Pregnancy (MiP)
In areas of moderate-to-high malaria transmission in sub-Saharan Africa, intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for all pregnant women at each scheduled antenatal care visit. The first dose should be given as early in the second trimester as possible and at each antenatal care visit thereafter, with spacing of doses one month apart. It is safe to give the last dose after the 36th month of pregnancy. Because large doses of folic acid (5 mg or greater) interfere with IPTp-SP, the World Health Organization recommends that women receive less than a 5 mg dose of folic acid during pregnancy. Click here for more information on Malaria Prevention and Treatment Regimens.
 
Currently, coverage is still low for MiP. Click here for a compilation of anemia prevalence and anemia control-related indicators including IPTp from Demographic and Health Surveys.
 
The most recent policy brief from WHO can be viewed by clicking here.
 
Malaria Prevention in Infants
Where malaria prevalence is moderate to high, intermittent preventive treatment in infants (IPTi) using sulfadoxine-pyrimethamine (SP-IPTi) also is recommended for infants (WHO, 2010). IPTi should be administered with the second and third diphtheria-pertussis-tetanus (DPT) and measles vaccinations of infants (usually at 10 weeks, 14 weeks and 9 months of age) through Expanded Programme on Immunization (EPI). Click here for more information click on immunization schedules.
 
The use of SP as the drug of choice is dependent on parasite resistance and each country should monitor drug resistance  SP-IPTi should not be given to infants receiving a sulfa-based medication including co-trimoxazole which is widely used as prophylaxis against opportunistic infections in HIV-infected infants.
 
Seasonal malaria chemoprevention (SMC) with amodiaquine plus sulfadoxine-pyrimethamine (AQ+SP) for children aged 3–59 months is recommended in areas of highly seasonal malaria transmission across the Sahel sub-region in Africa.
 
For more information on Malaria Prevention and Treatment Regimens, click here.
 
The most recent recommendations from WHO can be viewed by clicking here.
 
Malaria Treatment and Case Management in Women and Children
Regimens for treatment differ by country. For pregnant women, regimens differ by first and second-third trimesters and the first and second line treatments. Many countries use quinine plus clindamycin in the first trimester when the risk of severe anemia and hypoglycemia are lower and concerns are higher about using artemisinin-based therapies (ACT). Click here for more information on the types of treatment regimens (but not the actual doses) for pregnant and lactating women and children.
 
Click here for the complete WHO guidelines on Malaria Treatment.

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