MALARIA SEMINAR, IFMt, VIENTIANE LAOS 5-9 December 2005 MALARIA IN HIGHLANDS. Dr Aneley Getahun MD, MCTM
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1 MALARIA SEMINAR, IFMt, VIENTIANE LAOS 5-9 December 2005 MALARIA IN HIGHLANDS Dr Aneley Getahun MD, MCTM
2 MALARIA TRANSMISSION High altitude Low temperature, lack of breeding sites Little or no malaria transmission
3 MALARIA TRANSMISSION The upper height limit for malaria transmission is 1,500 m Highland malaria refers to malaria transmitted - Generally > 1,500 m - In Africa >2,000 m e.g. Burundi, Ethiopia, Kenya,, Malaria species involved Plasmodium falciparum, Plasmodium vivax
4 MALARIA IN THE HIGHLANDS Increasing incidence of malaria in the highlands - epidemic in Indonesia, Afghanistan, East Africa - endemic in Ethiopia
5 FACTORS AFFECTING MALARIA INCIDENCE IN HIGHLANDS Environmental factors Climate temp, rainfall Drought Changes in vegetation Socioeconomic factors - land use & agricultural practices -migration - health system Biological factors Parasite development rate, drug resistance Vector density, breeding sites, longevity Host immune status, nutritional status
6 1. ENVIRONMENTAL FACTORS 1.1 Temperature (T ) Optimum T C for transmission Increase in temperature results from: - Deforestation - Inter-annual variation in T -? Global warming
7 1. ENVIRONMENTAL FACTORS 1.2 Rainfall Change in rainfall - Variation in inter-annual rain fall - El Nino Southern Oscillation (ENSO) Short rain - excessive rainfall prolonged dry season ( T ) - breeding sites drought
8 2. SOCIOECONOMIC FACTORS 2.1. Irrigation / dam projects - Breeding sites (Kenya, Burundi, Rwanda, Madagascar) 2.2 Migration highlands lowlands - relapse/ recrudescence - increased population - increased human vector contact
9 2. SOCIOECONOMIC FACTORS 2.3 Land use - land clearance for housing, farming, roads - Deforestation - Increased breeding site - Importation of mosquitoes
10 2 SOCIOECONOMIC FACTORS 2.4 Health system - Deteriorating health infrastructures civil conflicts, war - Cessation of vector control programs - Lack of human & material resources - Drug resistance
11 3.1 Vectors - Breeding site (valleys) - Flight activity - Feeding time 3 BIOLOGICAL FACTORS Highland vectors A. gambiae (Ethiopia, Kenya, Uganda, Tanzania) A. arabiensis A. funestus (Madagascar, Kenya)
12 3 BIOLOGICAL FACTORS 3.2 Host - Susceptible host - Immune status - Nutrition status
13 CASE STUDY 1 1. Indonesia (Michael JB and Budi DS, Southeast Asian J Trop Med Public Health : ) Irian Jaya (Western New Guinea), - Highland > 1,500 m - extremely remote - steep mountainous terrain - > 550 unexpected deaths between Aug-Oct malaria principal cause of the excess morbidity and mortality
14 CASE STUDY 1 Factors El Nino Southern Population migration Oscillation (ENSO) -short rain -transient pools of standing water - Anopheles punctulatus complex exacerbating factors - low level of immunity - prolonged and severe drought - compromised nutritional status
15 CASE STUDY 2 2. Afganistan (Abdur Rab M et al. East Mediterr Health J :232-9) Bamian Province - Altitude 2,250-2,400 m - Previously malaria-free - epidemic of Plasmodium falciparum - severe morbidity and high mortality
16 CASE STUDY 2 Factors Population migration (civil war) Inter-annual variation in (increased summer T ) poorly-provisioned health care facilities
17 CASE STUDY 3 3. Ethiopia (Negash K et al. East Afr Med J :186-92) malaria epidemics in 25 districts - since 2002 sustained transmission in 22 districts - 1,500 and 2,500 m
18 CASE STUDY 3 Factors - Variation in annual rain fall (ENSO) - Short rain, prolonged dry season - transmission with low vector densities Exacerbating factors - Changing agricultural practices (irrigation) - Migration - Drought (poor nutritional status) - Poor health system
19 MPACT OF MALARIA IN HIGHLANDS - Increased mortality and morbidity (adult & children have equally low immunity) - Burden on fragile health system - Expansion of malaria transmission
20 - Sustained surveillance INITIATIVES - Define epidemic prone areas - Identify the reasons for increased malaria - Reinforce health system - Protect the population
21 Tropical highlands : not all malaria free Kenya Ethiopia Madagascar Papua New Guinea
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