Teen Newsletter: June 2021 – Malaria

Public health problems are diverse and can include infectious diseases, chronic diseases, emergencies, injuries, environmental health problems, as well as other health threats. Regardless of the topic, we take the same systematic, science-based approach to a public health problem by following four general steps.

1. Surveillance (What is the problem?)

In public health, we identify the problem by using surveillance systems to monitor health events and behaviors occurring among a population.

Malaria is a reportable disease in the United States and its territories. Health-care providers are required to report all cases of laboratory-confirmed malaria occurring in the United States and its territories to their local or state health department. Reports including epidemiological and clinical information on malaria cases diagnosed in the United States are transmitted to CDC through the National Malaria Surveillance System (NMSS).

Annual reports are created and published through the MMWR. Reports are also analyzed by the prevalence of malaria cases by species of Plasmodium. Let’s consider infections by the species P. falciparum as our example. From the table below we see that P. falciparum is the most common form of Plasmodium in the United States and has steadily increased each year in percentage among all infections.

The map below shows the number of malaria cases in every state in 2017.

2. Risk Factor Identification (What is the cause?)

After we’ve identified the problem, the next question is, “What is the cause of the problem?” For example, are there factors that might make certain populations more susceptible to diseases, such as something in the environment or certain behaviors that people are practicing?

Anyone can get malaria. Most cases occur in people who live in countries with malaria transmission. People from countries with no malaria can become infected when they travel to countries with malaria or through a blood transfusion (although this is very rare). Also, an infected mother can transmit malaria to her infant before or during delivery.

People who are heavily exposed to the bites of mosquitoes infected with P. falciparum are most at risk of dying from malaria. People who have little or no immunity to malaria, such as young children and pregnant women or travelers coming from areas with no malaria, are more likely to become very sick and die.

Poor people living in rural areas who lack access to health care are at greater risk for malaria. As a result of all these factors, an estimated 90% of deaths due to malaria occur in Africa south of the Sahara; most of these deaths occur in children under 5 years of age.

3. Intervention Evaluation (What works?)

Once we’ve identified the risk factors related to the problem, we ask, “What intervention works to address the problem?” We look at what has worked in the past in addressing this same problem and if a proposed intervention makes sense with our affected population.

Malaria control is carried out through the following recommended malaria treatment and prevention interventions. The choice of interventions depends on the malaria transmission level in the area (e.g., in areas of low transmission level, intermittent preventive treatment for pregnant women [IPTp] is usually not recommended).

• Case management (diagnosis and treatment) of patients with malaria

Prevention

• Insecticide-treated nets (ITNs)
• Intermittent preventive treatment of malaria in pregnant women (IPTp)
• Intermittent preventive treatment of malaria in infancy (IPTi)
• Indoor Residual Spraying Prevention Strategies

In most malaria-endemic countries, four interventions—case management (diagnosis and treatment), ITNs, IPTp, and IRS—make up the essential package of malaria interventions.

A pregnant woman during an antenatal consultation in Malawi receives IPTp. The plastic bag on the table holds an insecticide-treated bed net, another method for protecting her against malaria.

Occasionally, other interventions are used:

Larval control and other vector control interventions

Mass drug administration and mass fever treatment

In addition, several companies and groups are at work developing a malaria vaccine, but there is currently no effective malaria vaccine on the market.

Implementation (How did we do it?)

In the last step, we ask, “How can we implement the intervention? Given the resources we have and what we know about the affected population, will this work?”

One example of how CDC implements the intervention is through the U.S. President’s Malaria Initiative (PMI).

PMI is a U.S. Government interagency initiative designed to drastically reduce malaria deaths and illnesses in target countries in sub-Saharan Africa with a long-term vision of a world without malaria. The initiative was announced on June 30, 2005, when President Bush pledged to increase U.S. funding of malaria prevention and treatment in sub-Saharan Africa by more than $1.2 billion over 5 years (FY2006–FY2010).

Mother cradling sick child in her arms, Tanzania (Courtesy UNHCR Malaria Team).

With passage of the Lantos-Hyde Act in 2008, PMI developed a U.S. Government Malaria Strategy (2009–2014) which included achieving Africa-wide impact by halving the burden of malaria in 70 percent of at-risk populations in sub-Saharan Africa, or approximately 450 million people. The next PMI Strategy (2015–2020) reaffirmed support for the long-term goal of worldwide malaria eradication and aimed to build on progress made in the last decade and address new challenges that could hamper further progress. The strategy was in line with the goals articulated in the Roll Back Malaria Partnership’s Action and Investment to Defeat Malaria 2016–2030 and the World Health Organization’s Global Technical Strategy for Malaria 2016–2030.

As you can see, using The Public Health Approach helps public health professionals identify a problem, find out what is causing it, and determine what solutions/interventions work.