Term Paper on "Malaria Public Health Issues"

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I. POPULATION AFFECTED by MALARIA

Forty percent of the world's population is stated to be at risk of Malaria with ninety percent of deaths from malaria occurring in the country of Africa, south of the Sahara desert. (Harvard School of Public Health, 2001; paraphrased) Malaria is reported by the Harvard School of Public Health to have been "eradicated in many countries, including the U.S., in 1950s..."(Harvard School of Public Health, 2001) However the malaria parasite has become extremely resistant to drug therapy. Furthermore, malaria not only causes terrible sickness but also has a potential to cripple "developing economies through the enormous cost in medical expenses and days of labor lost." (Harvard School of Public Health, 2001)

II. HISTORY of MALARIA

The work of DeAngelis and Zuccotti (2006) states that "Malaria is an ancient disease, with description of a disease resembling malaria that date back more than 4000 years." (DeAngelis and Zuccotti, 2006) in 1880, Laveran identified the parasite responsible for malaria and was awarded the 1904 Nobel Peace Prize. Measures for control of mosquitoes that are responsible for transmitting malaria as well as the antimalaria drug, chloroquine being discover in 1934 by Andersag have assisted in controlling the disease to come extent as well as has the use of dichlorodiphenyltrichlorethan (DDT) as an insecticidal agent, which started in 1939.

III. CONTEMPORARY CONTROLS

In recent years, less toxic forms of insecticide have been used for controlling malaria. Furthermore discovered has been "...other antimalarial drugs and drug combinations, including sulfadoxine-pyrimethamine, mefloquine, atovaquone-proguanic, quinine, and doxycycline." (DeAngelis and Zuccotti, 2006) Even though these advances have been made in this area, of health treatment and prevention millions of lives are lost each year and "3 billion people in 107 countries or territories are at risk... [with] more than 80% of deaths from malaria occur[ing] in Africa, 15% in Asia and Eastern Europe, and only a small fraction in the Americas." (DeAngelis and Zuccotti, 2006)

June 2008 report published by the 'Malaria Matters' foundation states that according to the press release of the United National "Malaria cases are dropping..." (Brieger, 2008) Brieger states that the Malaria Matters fund has "delivered 50 million bed nets impregnated with insecticide to families at risk of catching malaria, almost double the number that were issued a year ago." (2008) in fact, according to the executive direction, Michel Kazatchkine "there is now clear evidence that mortality rates from the disease among children younger than five years of age had fallen sharply in 10 sub-Sahara countries, and, in Zanzibar, malaria had been almost eradicated as a public health problem." (Breiger, 2008)

Four key components of success have been identified as follows:

1) a catalytic moment;

2) Demand for universal coverage;

3) Pragmatic donor response, and 4) Innovative problem-solving. (Breiger, 2008)

Brieger (2008) further reports in the work entitled: "IRS in Uganda - a Call for Monitoring Resistance" that it has been reported by the National Academy of Sciences that the government in Uganda "recently started spraying insecticides in homes and settlements to combat mosquitoes that spread malaria, the country's leading cause of death." (Brieger, 2008) it is reported that the committee which met for identifying best practices in malaria vector resistance to insecticides used for indoor residual spraying in Uganda toward maximizing the effectiveness of DDT and for identifying "contextual issues that would have a bearing on successful implementation of the 'best practices'.

IV. MEDICINES for MALARIA VENTURE (MMV)

The "Comment by the Medicines for Malaria Venture:- for Web-Based Public Hearing of World Health Organization in View of Meeting of Intergovernmental Working Group on Public Health, Innovation and Intellectual Property" states that it welcomed "the work of Intergovernmental Working Group on Public Health, Innovation and Intellectual Property" and states that the Medicines for Malaria Venture (MMV) has as its' mission the discovery, development and delivery of "new antimalarial drugs through effective public-private partnerships." (Medicines for Malaria Venture, 2008)

MMV is a public-private partnership which was created by the World Health Organization (WHO) in 1999 with the World Bank, as well as leading foundations, bi-lateral donor governments and representatives of the research branch of the pharmaceutical industry for replenishing and sustaining the "global pipeline of new antimalarial drugs." (Medicines for Malaria Venture, 2008) the following statement of the MMV relates critical information about the goals of the MMV:

For MMV, the public health goal does not end at the development of new antimalarial drugs. MMV's responsibility extends to the delivery of those drugs, which means ensuring access to them by people that need them in malaria-endemic countries. This means that MMV has to consider the analytical, policy, funding (including drug pricing issues) and organizational issues that comprise delivery. This requires detailed planning for registration, launch and roll-out of the new drugs and the development of individual, product specific global access plans to ensure that the drugs we develop will achieve maximum health impact." (Medicines for Malaria Venture, 2008)

The threat that is identified as the greatest to these public-private partnerships and the "pipeline of vaccines, microbicides and drugs for neglected diseases currently under development" is the lack of funding that is "sufficient and sustainable." (Medicines for Malaria Venture, 2008)

The work of Azarian, Kay and Smith entitled: "Malaria Among Recently Arrived Burundian Refugees: A Public Health Response" states that the Duval County Health Department (DCHD) was notified on July 6, 2007 and provided information regarding an EP-X report sent out by the "Centers for Disease Control and Prevention (CDC) regarding undocumented and/or insufficient pre-departure therapy for malaria among East African refugees resettling in the United States. In addition, these refugees came from a region in Africa where chloroquine resistance is common. This posting was intended to inform local health authorities of the potential public health risk and suggest recommendations for presumptive treatment of refugees who had recently emigrated from East Africa." (Azarian, Kay and Smith, 2008)

V. POINTS of ENTRY and DEPARTURE

Monitoring at country borders is of primary importance in fighting Malaria health issues. One example of how this is being addressed is reported in the state of Florida in an area where Burmese individuals enter the country and Malaria is a public health issue that is closely monitored as individuals enter the United States. The work of Azarian, Kay and Smith entitled: "Malaria Among Recently Arrived Burundian Refugees: A Public Health Response" states that the Duval County Health Department (DCHD) was notified on July 6, 2007 and provided information regarding an EP-X report sent out by the "Centers for Disease Control and Prevention (CDC) regarding undocumented and/or insufficient pre-departure therapy for malaria among East African refugees resettling in the United States. In addition, these refugees came from a region in Africa where chloroquine resistance is common. This posting was intended to inform local health authorities of the potential public health risk and suggest recommendations for presumptive treatment of refugees who had recently emigrated from East Africa." (Azarian, Kay and Smith, 2008) a meeting was held for members of both the DCHD Epidemiology Program and the Department of Communicable Disease, which identified issues that were critical as follows:

specimen collection;

Initial refugee follow-up health visits;

Contacts for agencies sponsoring refugees in Jacksonville;

The availability of a Kirundi (interpreter);

Documentation of pre-departure antimalaria; and the availability of Malarone, which is the preferred treatment for people who have acquired malarial infections due to Plasmodium falciparum in areas where chloroquine resistance has been documented." (Epi Update, 2008)

Additionally the decision that was made that incoming… READ MORE