Rotary Australia
World Community Service Activity
Participation in efforts to eradicate Malaria
In
Papua New Guinea
Rotary Club of Williamtown:
Club District 9670, March 2015 Initiative
Sponsor: Steve Carroll
Table of Contents
I. Executive Summary 3
Overview
Program we wish to support
Benefits
Proposal
Indicators of success
II. Description of Project 7
Overview
Life of Project
Project Management
Donation Management
Insurance
Target Project Budget
Ride management Plan
Supporter Membership Promotion / Facilitation
Rider Contribution
Promotional Material
Risk Assessment
III. Marketing Aspects 10
Market Segmentation
Web and Facebook
IV. Appendices 13
Outline of who is participating
➢ Names and contact details
➢ Who was contacted
➢ How the ride was promoted
➢ Local Segment Participation
Media Coverage
➢ Who has been contacted
➢ How and by whom each approach was made
➢ Regional Segment coverage
➢ Local Rotary media facilitators and area
➢ Copy of tailored media briefing Radio / Television / Print
Sponsorship.
➢ Regional Rotary representative
o Assistance Material
➢ Corporate Approaches
Indemnity Waiver
Itinerary for the Ride
Other Supporting / Technical Reference Material
➢ Latest Newsletter from RAM
➢ Speaker Notes for dinner presentations
➢ Press notes, Print / Radio / Television
➢ Other Relevant Material
Executive Summary
Overview
The World Health Organization (WHO) estimates that in 2013 alone Malaria killed 584,000 people. The most vulnerable were the young and those with compromised immune systems.
Malaria is transmitted by mosquito bite where a person infected with the Malaria parasite is bitten by a particular type of mosquito which then bites a second person. The first symptoms appear 10 to 15 days later and include fever, headache, chills and vomiting. As the parasite that was left by the mosquito infects its’ human host the symptoms can progress to severe joint pain, dehydration, organ failure and death.
Malaria is preventable and treatable. Control measures can dramatically reduce infection rates.
Parts of Papua New Guinea have significant Malaria infestation rates. The country is right on our doorstep and we have the chance to make a difference while recognizing links to the 2015 centenary year of Anzac.
Program we wish to support
Our focus is to extend the Rotarians Against Malaria (RAM) program already operating in Papua New Guinea to a new village or location.
This paper is not written as a medical précis on Malaria and treatment, overview and technical reference material can be found in the appendices.
The program we propose to support provides practical assistance in the fight against Malaria focusing on prevention, treatment and education. The work will be undertaken using the Rotarians Against Malaria (RAM) program and their guidance. Our umbrella organization is the Rotary Australia World Community Service (RAWCS).
The program involves:-
➢ Local Education on the cause, treatment, prevention and hygiene required for the local elimination of Malaria. Explanation of the role of personal protective measures such as domestic area spraying and how to identify potential mosquito breeding sites.
➢ The purchase and distribution of long lasting insecticidal nets that reduce transmission.
➢ Residual spraying to reduce the mosquito population and eliminate larval breeding sites.
➢ Purchase and distribution of medical supplies focused on test kits to identify infection where results can be available within 15 minutes and the use of oral antimalarial combined therapy drugs.
RAM is fully accredited to carry out programs in Papua New Guinea, firstly by PNG Health, the World Health organization (WHO) and the Department of Foreign Affairs and Trade (DFAT). That support is reflected in our ride being specifically granted individual tax deductibility status through the umbrella organization RAWCS. All donations for which receipts are issued are eligible for tax deductibility.
Benefits
➢ The program offers a chance to make an immediate impact on Malaria mortality rates and to progressively reduce the medical resources burden and cost that malaria creates.
➢ Malaria in some areas is the single largest drain on community productivity and economic advancement which our initiative will reverse.
➢ The program involves community education and training, skills acquisition and empowers the local community to influence their own destiny.
➢ Providing the initial tools for a local community to help itself people becomes self-sustaining through productivity and a cost shift from treatment to prevention.
➢ Does the program work? The answer is YES.
The World Malaria Report 2014 by the World Health Organization (WHO) indicates that Malaria eradication efforts are on track to be able to report a 75% reduction in the Malaria health burden by December 2015 since 2000. Further proof can be found in the WHO West African region, efforts have reduced the mortality rate by 54% but there is still 430,000 deaths a year in this region alone attributed to Malaria.
Our Project
Our project consists of two stages.
The first part is the actual ride, using the nate acronym of RRAAAM (Rotary Ride Around Australia Against Malaria) its objective is to create awareness of the Malaria problem on our national doorstep in a region where we share a debt of gratitude that dates from the Second World War and to raise funds to fight the problem.
It will consist of a small group of local motor cyclists from the hunter region who will commence a ride on Sunday the 1st March travelling north around Australia seeking financial support on behalf of RAM and sharing Malaria awareness across the Australian community. The ride will conclude at the Newcastle Civic Centre on the 24th April 2015.
Over the two months of the ride we will share with as many as possible, information regarding the pain, debilitating impact and cost of Malaria. In sharing this information we will focus on the particular difficulties faced by our close northern neighbor and the particular difficulties, lack of education, poverty and lack of infrastructure present to the Papuan people.
The ride will reach Coffs Harbor on March 2nd for the first dinner speaking engagement, the ride will visit 42 towns, and includes 28 organized speaking engagements.
As we share our message with each of the Rotary clubs we will be asking that they take the information back to their members for discussion and further ongoing fund raising support.
While our aim is to raise at least $100,000 through a combined Rotary effort our objectives are to leave with members and the general public, a clear understanding of the practical on the ground strategy being followed and how funds raised would be applied
Our target is a modest $100,000.
The second part of our project will operate under the project name “Buzz Off”. In this stage RAM will extend its current program into a new location selected in conjunction with PNG Health. The size and scale of that operation will depend on the extent of funds raised.
The duration of the commitment to eradicate Malaria in this location is expected to last two years as it involves the recruitment and training of local resources and time for the team to address the logistics of supply and transport and the infrastructure and training aids needed for the educational aspect of the project.
The Williamtown Rotary club contribution to this endeavor is to lend its’ support and allow its name to be associated with the project. This in turn helps foster the involvement of a likely 26 regional Rotary clubs organizing related dinner and speaking engagements with the aim of speaking to as many Rotarians and members of the public as possible while raising a target $100,000 for the ongoing Papuan Malaria eradication effort.
Indicators of Success
The ride will be a success when follow up discussion with the clubs involved can highlight ongoing shared efforts from those inspired to participate.
Success will be reflected in media coverage that allows us to reach a far greater audience than those able to attend our functions.
Success will be reflected in helping make Malaria a political agenda item that leads to material assistance from government and corporate supporters. That support may be as varied as facilitating local government involvement, assisting with transport and logistics or even local accommodation and introductions to key facilitators.
Success on the close out of this project will be the stimulation of sufficient interest and a project of sufficient substance that Rotary Williamtown can consider options for taking the project to the Australian RSL community to further harness resources and support.
Description of Program
Overview
The Papuan program of RAM consists of Education, Prevention and Treatment.
➢ Education
The program involves improving the understanding of the Papuan people of how and what type of mosquito transmits the Malaria parasites. When this Mosquito strikes, seasonality and what symptoms to look for.
It covers the range of control measures available to minimize breading and mosquito numbers, the life cycle of the particular mosquito species and options to avoid being bitten and identification of likely Mosquito habitat.
The program being delivered in Papua goes on to discuss testing for the parasitic presence and medical treatment options.
➢ Prevention
The program involves the distribution of insecticidal netting and indoor residual spraying.
➢ Treatment
Malaria treatment varies from region to region as mosquitoes develop immunity to particular treatments. The medical treatment tends to be a cocktail of drugs to avoid Artemisinin resistance.
Life of Project.
The ride is not intended to displace existing Malaria information, control efforts or pretend to have discovered a significant issue on our national doorstep.
The project that begins with a round Australia ride in March / April will conclude in October 2015 with a last ring around to each of the Rotary clubs involved to check on progress and offer close out assistance.
The Project will officially close with an accounting to the Williamtown club for the work and effort involved and learnings from any shortcomings in process and delivery that might assist a subsequent team or event.
Project Management
The overall management of project delivery is in the hands of Steve Carroll.
Coordination of the actual ride will be managed by Grahme Rayner.
Stewardship of the project will be via monthly updates to the Williamtown Rotary Club monthly meeting.
Donation Management
Donations will be handled as follows;
➢ Donators will be asked to make cheques payable to Rotary Australia World Community Service (RAWCS).
➢ The process for online donations is already in place with donators directed to www.ramaustralia.org.au where menu prompts to help the donator through the process having already been tested by Steve Carroll and Grahme Rayner so that they can explain the process where necessary.
➢ Any cash received will be banked at the first available opportunity to the account of RAWCS who have been asked to provide BSB and Account details plus a receipt book prior to the ride commencing.
➢ Where the donator is not identified i.e. gold coin donations to a passed around bucket, a receipt will be issued to the local club to ensure proper accounting of proceeds.
All costs incurred by individuals participating in the ride are to be met by the individual, there is to be no draw against Rotary funds.
Insurance
The ride is to be held under the permission of the Williamtown Rotary Club and the Club Secretary has advised its’ insurers of the ride.
Each ride participant is to be registered with Steve Carroll who as part of the registration process will have the participants sign a liability wavier approved by the Williamtown Club secretary.
Financial Management or the ride
The financial management of the ride is clearly on the basis of no cost to Rotary and each participant meeting their individual expenses. Financial and cash management for the ride has been discussed with the Williamtown Club treasurer.
Target Project Budget
The operating budget for the local Island, village or community Malaria eradication project will be determined by RAM in conjunction with PNG Health. Considerations will include the ability of PNG Health to absorb the project site into their organization on an ongoing basis which in turn will involve consideration of site access, the deployment of experienced personnel and the transport logistics of getting teaching staff, support staff and material to the chosen location.
The care required in choosing the site requires the ability to look forward three years to the then existing infrastructure in a rapidly emerging nation hence the reliance on RAM and PNG Health.
The cost of long term insecticidal netting is below $8 per unit while indoor residual spraying is totally dependent on area, infestation levels and risk assessments. Malarial test kits cost around $1 per unit while medication is generally oral for ease of administration.
Our point in respect of an operating budget is that the three year cost could be less than $100,000 depending on a range of factors not least of which is the transport logistics and ability of RAM to harness the resources of resident mining and production companies in return for the improving health, availability and reliability of their local workforce.
At a target funding level of $100,000 the combined efforts of Rotary get to make a material difference, save thousands of lives and over time help lift the burden on PNG Health resources while helping deliver a healthy workforce able to participate in the growth of the country.
Ride management Plan
The ride management plan is under the coordination of Grahme Rayner, a copy of the current status is included as an appendix.
The ride covers some 15,000 kms over a two month period and includes stops for pre-booked bike servicing opportunities, dealer repair locations, fuel stops and in-trip breakdown response. There is some limited capacity for the transport of accompanying material on behalf of individual riders although each rider will generally carry their own supplies.
The ride plan includes details of the itinerary, accommodation options and rest stops which will be revisited on a daily basis to address weather, heat and the progress requirements of scheduled speaking and meet and greet opportunities.
On a rider health support level the ride management program includes the address of each emergency services hospital on route and the contact phone numbers of other riders and the local ride segment coordinator. Ride management is also addressed below under the heading of Risk Assessment.
Supporter Membership Promotion / Facilitation
This program is an opportunity to showcase the community contribution of participating organizations.
At each speaking engagement the project speakers will introduce those organizations who have participated and provide an opportunity for those groups to speak to the assembled audience.
There are a number of community organizations both within and outside of Rotary that share the common goal of community service and these gathers should be seen as an opportunity for those groups to share with the audience some of the broader roles their organizations play.
Rider Contribution
Each rider is meeting all their personal expenses and committing 2 months of their time, the cost to each rider is likely to exceed $5,000 (Fuel and bike running costs, meals and some accommodation).
Any further donation is purely voluntary.
Promotional Material
The project will have for sale bandanas and Rotary World Community Service, supporter badges.
Speaking engagements and venues will be supported with pamphlets and signage, copies of which are included in the appendices.
Risk Assessment
A formal requirement of all business plans is that a risk analysis be undertaken to mitigate or identify exposures to participants and stakeholders. The following will continue to evolve throughout the process of finalizing the overall business plan.
Risk has been assessed under the headings; - Participants, Bikes Cars and Trailers, and Location.
Participants
The detail plan to mitigate the risk to riders and support group is addressed in the ride management plan.
Rider safety of Participants is addressed under the headings of accident response, hydration, and scheduled breaks programed into the Ride Management Plan.
As part of the rider enrolment process each rider is required to acknowledge that the organizers have suggested that each rider have available funds of $5,000 at ride commencement to fund; - fuel, meals, accommodation plus the maintenance and servicing of their bike or car given the ride will cover some 15,000 kms and two months of travel and visitation.
Riders are also reminded in the Ride Management Plan that while Telstra advise that the route has full mobile phone coverage blackout spots are expected and that no satellite phone is available to support the ride. Hence riders will be reminded in the daily briefings of the need to travel as a group, keep track of a buddy and the importance of using the frequent refueling and rest stops to check loads and ensure hydration.
The Bikes, Cars and Trailers have been considered in the Ride Management Plan in the form of scheduled maintenance locations and layover days, the riders will have the opportunity to pre book servicing with pre-arranged service providers and a trailer suitable for bike transport is part of the support group. No segment of the ride will involve continuous travel for more than 150kms or two hours ride.
The location organizers have been considered in so much as the program includes lay over days at four different points in the trip to enable catch up if heat, weather or road conditions dictate delay. Travelling with the group will be sufficient pamphlets and promotional material, while resupply locations and the relay of material by individuals has already been organized.
The rider support group will travel with discussion notes to ensure sponsors are mentioned in talks and those notes also provide for the introduction of local supporter club or group representatives to ensure the opportunity to promote local activities. Cash and donation management has also been addressed in detail to ensure funds are fully accounted for.
Marketing
Marketing for the ride to encourage physical participation is being managed by Grahme Rayner, Grahme’s outline of who is participating, who has been contacted and the means by which the ride has been promoted for local segment participation or broader participation is set out in appendix A.
Media participation is being managed by Steve Carroll, Steve’s list of who he has been contacted, how the approach was made, who is likely to cover the event in each medium is included in Appendix B. Also included is who in each of the clubs is being used as a local facilitator and the guidance provided to those individuals to ensure no gaps are left; i.e. forgetting to notify local radio in sufficient time for them to schedule interviews or provision of media briefings notes tailored to each medium.
Market Segmentation
The market has been defined on three levels, individuals, local community level businesses and corporate.
➢ Contact with Individuals and local community level business will be undertaken through the regional Rotary clubs to ensure local membership drives are not undermined and that funds raised are correctly seen as local efforts.
➢ Steve Carroll will have made contact with each club well in advance to provide material to support donation requests and invitations to attend dinner and speaking functions.
Competition in fund raising is well understood and this document forms part of promoting the opportunity to potential corporate sponsors. Sponsorship will be via direct contact with a limited number of targeted parties. Both Steve Carroll and Graham Rayner will share this task.
Web and Facebook Promotion
A web site is under development as is the setup of a linked Facebook page.
Target date for completion of the verification of content, testing of links and approval for release is the 9th February 2015.
Development using external volunteer resources is being managed by Grahme Rayner, proof reading and testing sign off has been allocated to Judy McGowan, approval to release and use as part of the project promotional material rests with Steve Carroll.
Appendices.
Appendix A: Outline of who is participating
➢ Names and contact details
➢ Who was contacted
➢ How the ride was promoted
➢ Local Segment Participation
Appendix B: Media Coverage
➢ Who has been contacted
➢ How and by whom each approach was made
➢ Regional Segment coverage
➢ Local Rotary media facilitators and area
➢ Copy of tailored media briefing Radio / Television / Print
Appendix C: Sponsorship.
➢ Regional Rotary representative
o Assistance Material
➢ Corporate Approaches
o Copy of Information provided or update on discussions
Appendix D: Liability Waiver
Appendix E” Itinerary for the ride
Other Supporting Information.
➢ Latest Newsletter from RAM
➢ Speaker Notes for dinner presentations
➢ Press notes, Print / Radio / Television
➢ More detailed and / or Technical information
Rotarians Against Malaria
Part of
Rotary Australia World Community Service Ltd
With the Festive Season well and truly upon us it is certainly time for some more RAM good news.
The net delivery to the Timorese Expectant Mothers keeps moving along. To the end of October (last figures available) The Timorese MOH has distributed approximately 28,000 Long Life Insecticide Nets of the 42,700 supplied. The Rotary Global Grant acquittal should be finalized by the end of January 2015.
The Timorese National Malaria Control Program has been successful in their request in the next round of Global Fund in their pursuit of Malaria elimination. Please read the attached Vector Control Action Plan to understand how the Timorese NMCP is approaching the elimination of Malaria in Timor Leste. The real interest for RAM appears to be in the Other Vector Control Measures area. It certainly dovetails with our Healthy Villages Program and we will be exploring strategies with the NMCP in the New Year.
In early December we forwarded over $40.000.00 the Solomon Islands to allow a further 38 Villages to join the Healthy Village Program. Deputy Chair Dave Pearson is liaising with PDG Wayne Morris in Honiara on the best way for Australian Volunteers to be involved. It is hoped that this will be finalized early in the New Year to allow plenty of time to organize a volunteer team to be on the ground in the Solomon’s in late March, early April 2015 to assist with the distribution of Tools and their complementary Education program.
News on the RAM Post Graduate Scholarship is all good. On RAM’s behalf I have signed the agreement with JCU to provide a Post Graduate Scholarship in Vector Control through the Australian Institute of Tropical Health and Medicine. Details will be completed by the end of December and the call for applications will be made in January. The MOH and higher learning institutes in our neighbor countries of Timor, PNG, Solomon’s and Vanuatu will also be advised of the Scholarship. JCU and WEHI will also promote the scholarship to known graduate students in those countries.
Our Friends in PNG have finalized an enormous five year program to cover the whole country twice. This program culminated with the distribution of a total of over 6.094,000 LLINs. The decrease in financing from the Global Fund has forced RAM PNG to change the way nets are distributed. It has been proposed that household distribution will continue in remote and inaccessible areas.
In reasonable accessible areas an “under five” campaign will be introduced with the supply of extra-large nets. As nets sleep three adults or four children it will give coverage to 45-50% of the population.
A pilot program in NCD and Central Province is issuing nets to RDT positive cases of malaria. Their movement history for the three weeks prior is being recorded to facilitate the mapping of areas of malaria activity to allow remedial action to be taken.
Malaria Awareness Day flyers should be available from your Regional Chair from the end of next week.
Attachments.
➢ Speaker Notes for dinner presentations
➢ Press notes, Print / Radio / Television
More detailed and / or Technical information
Information provided by:
WebMD Medical Reference from Healthwise
Last Updated: January 23, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
Malaria
Topic Overview
Malaria is a serious disease that causes a high fever and chills. You can get it from a bite by an infected mosquito. Malaria is rare in the United States. It is most often found in Africa, Southern Asia, Central America, and South America.
Malaria is caused by a bite from a mosquito infected with parasites. In very rare cases, people can get malaria if they come into contact with infected blood. A developing foetus may get the disease from its mother. You cannot get malaria just by being near a person who has the disease.
Most malaria infections cause symptoms like the flu, such as a high fever, chills, and muscle pain. Symptoms tend to come and go in cycles. Some types of malaria may cause more serious problems, such as damage to the heart, lungs, kidneys, or brain. These types can be deadly.
Your doctor will order a blood test to check for the malaria parasite in your blood.
Medicines usually can treat the illness. But some malaria parasites may survive because they are in your liver or they are resistant to the medicine.
Get medical help right away if you have been in an area where malaria is present, were exposed to mosquitoes, and get symptoms that are like the flu. These include a high fever, chills, and muscle pain.
You may be able to prevent malaria by taking medicine before, during, and after travel to an area where malaria is present. But using medicine to prevent malaria doesn't always work. This is partly due to the parasites being resistant to some medicines in some parts of the world.
Cause
A bite from a parasite-infected mosquito causes malaria. There are five species of Plasmodium (P.) parasites that infect people.
Infection with P. falciparum
• P. falciparum is found mostly in the tropics and subtropics (near the equator).
• Infection with P. falciparum can lead to life-threatening complications after the first few days.
• P. falciparum is often resistant to a popular antimalarial medicine (chloroquine) and needs treatment with other medicines.
Infection with P. vivax, P. malariae, P. ovale, or P. knowlesi
• P. vivax and P. malariae occur all over the tropical regions of the world. P. ovale is found in western Africa, and P. knowlesi is found in Southeast Asia.
• Infection with P. vivax, P. malariae, or P. ovale is usually not life-threatening, and a person may recover in a month without treatment. But infection with P. knowlesi may be fatal.
• P. vivax, P. malariae, P. ovale, and P. knowlesi are generally not as drug-resistant as P. falciparum.
• P. vivax, P. ovale, and P. knowlesi may stay in the liver, requiring further treatment with medicine to prevent relapses.
How the disease spreads
Malaria is spread when an infected Anopheles mosquito bites a person. This is the only type of mosquito that can spread malaria. The mosquito becomes infected by biting an infected person and drawing blood that contains the parasite. When that mosquito bites another person, that person becomes infected.
In the United States, people who develop malaria almost always got infected while traveling in parts of the world where malaria is common. For more information, see the topic Travel Health.
Malaria
Symptoms
When symptoms appear
Malaria can begin with flu-like symptoms. In the early stages, infection from P. falciparum is similar to infection from P. vivax, P. malariae, and P. ovale. You may have no symptoms or symptoms that are less severe if you are partially immune to malaria.
The time from the initial malaria infection until symptoms appear (incubation period) typically ranges from: 2
• 9 to 14 days for Plasmodium (P.) falciparum.
• 12 to 18 days for P. vivax and P. ovale.
• 18 to 40 days for P. malariae.
• 11 to 12 days for P. knowlesi.
Symptoms can appear in 7 days. And the time between exposure and signs of illness may sometimes be as long as 8 to 10 months with P. vivax and P. ovale.
The incubation period may be longer if you are taking medicine to prevent infection (chemoprophylaxis) or because you have some immunity due to previous infections.
Variation in symptoms
In regions where malaria is present, people who get infected many times may have the disease but have few or no symptoms.3 Also, how bad malaria symptoms are can vary depending on your general health, what kind of malaria parasite you have, and whether you still have your spleen.
Common symptoms of malaria
In the early stages, malaria symptoms are sometimes similar to those of many other infections caused by bacteria, viruses, or parasites. Symptoms may include:
• Fever.
• Chills.
• Headache.
• Sweats.
• Fatigue.
• Nausea and vomiting.
Symptoms may appear in cycles. The time between episodes of fever and other symptoms varies with the specific parasite you are infected with. Episodes of symptoms may occur:
• Every 48 hours if you are infected with P. vivax or P. ovale.
• Every 72 hours if you are infected with P. malariae.
P. falciparum does not usually cause a regular, cyclic fever.
The cyclic pattern of malaria symptoms is due to the life cycle of malaria parasites as they develop, reproduce, and are released from the red blood cells and liver cells in the human body. This cycle of symptoms is also one of the major signs that you are infected with malaria.
Other common symptoms of malaria
Other common symptoms of malaria include:
• Dry (non-productive) cough.
• Muscle or back pain or both.
• Enlarged spleen.
In rare cases, malaria can lead to impaired function of the brain or spinal cord, seizures, or loss of consciousness.
Infection with the P. falciparum parasite is usually more serious and may become life-threatening.
There are other conditions with symptoms similar to a malaria infection. It is important that you see your doctor to find out the cause of your symptoms.
Malaria
What Happens
When you're bitten by a malaria-infected mosquito, the parasites that cause malaria are released into your blood and infect your liver cells. The parasite reproduces in the liver cells, which then burst open. This allows thousands of new parasites to enter the bloodstream and infect red blood cells. The parasites reproduce again in the blood cells, kill the blood cells, and then move to other uninfected blood cells.
After the early stages, life-threatening complications may develop rapidly with P. falciparum and P. knowlesi. If the infected person is not treated, serious complications or death can occur.
But you may recover in a week to a month (or longer) after being infected with P. vivax, P. malariae, or P. ovale, even without treatment.
Malaria can be a very serious disease for a pregnant woman and her developing fetus, for people without a spleen, and for young children. Medicine choices are limited for a pregnant woman or a child. Infection with P. falciparum can lead to death for a pregnant woman and her fetus. For these reasons, a pregnant woman should not travel to an area where she could get P. falciparum malaria. Visit the CDC website (www.cdc.gov/malaria/travelers/index.html) to find out whether malaria is a problem in the country where you will be traveling.
Malaria recurrences
Malaria caused by P. falciparum may come back (recur) at irregular intervals for up to 2 years if treatment is not complete.
Malaria caused by P. vivax and P. ovale may recur at irregular intervals for up to 3 to 4 years, but medicine can prevent relapses.
P. malariae can remain in the blood of an infected person for more than 30 years, usually without causing any symptoms.
Malaria
What Increases Your Risk
Risk factors (things that increase your risk) for getting malaria include:
• Living or traveling in a country or region where malaria is present.
• Traveling in an area where malaria is common and:
• Not taking medicine to prevent malaria before, during, and after travel, or failing to take the medicine correctly.
• Being outdoors, especially in rural areas, between dusk and dawn (night time), when the mosquitoes that transmit malaria are most active.
• Not taking steps to protect yourself from mosquito bites.
Your risk of getting malaria depends on your age, history of exposure to malaria, and whether you are pregnant. Most adults who have lived in areas where malaria is present have developed partial immunity to malaria because of previous infections and so almost never develop severe disease. But young children who live in these areas and travellers to these areas are especially at risk for malaria because they have not developed this immunity.
Pregnant women are more likely than non-pregnant women to get severe malaria, because the immune system is suppressed during pregnancy.
Also, pregnant women, young children, older adults, and people with other health problems are more likely to have serious complications if they get malaria.
You can take measures to reduce the risk of malaria if you live in areas where the disease is present or if you are traveling in these areas.
Malaria is more severe in people who have had their spleen removed (splenectomy).
Malaria
When To Call a Doctor
Call a doctor immediately if you have been in an area where malaria is present, were exposed to mosquitoes, and develop flu-like symptoms (such as fever, chills, headache, and nausea).
Watchful waiting
Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.
Do not wait to call a doctor if you think you have malaria. Call a doctor immediately.
For people who live for many years in countries where malaria is common and have some immunity to malaria, watchful waiting is okay for mild malaria symptoms. Flu-like symptoms may also be caused by many other diseases or health conditions. Watchful waiting is not appropriate for most travellers. If you have a question about your symptoms, call your doctor.
Malaria Insectical Nets
Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells.
Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.
Key interventions to control malaria include: prompt and effective treatment with artemisinin-based combination therapies; use of insecticidal nets by people at risk; and indoor residual spraying with insecticide to control the vector mosquitoes.
Extract from the World Malaria Report by the World Health Organization
Dr Margaret Chan
Director-General
World Health Organization
The findings in this year’s World Malaria Report demonstrate that the world is continuing to make impressive progress in reducing malaria cases and deaths. Each year, more people are being reached with core malaria interventions, and as a result, more lives are being saved. The malaria target under Millennium Development Goal 6 has been met, and 55 countries are on track to reduce their malaria burden by 75%, in line with the World Health Assembly’s target for 2015.
In 2013, we saw a major expansion in the use of diagnostic testing and the deployment of artemisinin-based combination therapies (ACTs). For the first time, more diagnostic tests were provided at public health facilities in Africa than ACTs distributed, indicating a prominent shift away from presumptive treatment. Major progress has been documented in vector control as well: in 2014, a record number of long-lasting insecticidal nets were delivered to endemic countries in Africa.
The report shows that malaria mortality rates decreased by an impressive 47% between 2000 and 2013 globally, and by 54% in the WHO African Region. It also reveals that these trends are accompanied by a gradual and substantial reduction in parasite prevalence rates across Africa. This means that every year, fewer people get infected or carry asymptomatic infections – a sign that malaria interventions have an even larger impact than previously thought.
These tremendous achievements are the result of improved tools, increased political commitment, the burgeoning of regional initiatives, and a major increase in international and domestic financing. WHO is grateful for the engagement and long-standing commitment of the global health community, and inspired by the growing desire to accelerate efforts towards malaria elimination.
But we must not be complacent. Most malaria-endemic countries are still far from achieving universal coverage with life-saving malaria interventions; many biological and systemic challenges threaten to slow us down.
Available funding is far less than what is required to protect everyone at risk. An estimated 278 million people in Africa still live in households without a single insecticide-treated bed net, and about 15 million pregnant women remain without access to preventive treatment for malaria. Malaria is still responsible for over 430 000 child deaths in Africa every year. Emerging drug- and insecticide-resistance continues to pose a major threat, and if left unaddressed, could trigger an upsurge in deaths.
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All global health efforts will benefit from a strengthening of health systems, including efforts to control and eliminate malaria. Such investments will help us close the coverage gap, strengthen disease surveillance and research, and support the development and roll-out of new tools and approaches. They will make malaria and other public health responses more effective and more sustainable.
Recent progress in reducing the human suffering caused by malaria has shown us that, with adequate investments and the right mix of strategies, we can indeed make remarkable strides against this complicated enemy. We should act with urgency and resolve, and remain focused on our shared goal: to create a world in which no one dies of malaria, a world entirely clear of this scourge.
WHO World Malaria Report 2014 - Summary
The World malaria report 2014 summarizes information received from 97 malaria-endemic countries and other sources, and updates the analyses presented in 2013. It assesses global and regional malaria trends, highlights progress made towards global targets, and describes opportunities and challenges in controlling and eliminating the disease. Most of the data presented in this report are for 2013.
The public health challenge posed by malaria
Malaria transmission occurs in all six WHO regions. Globally, an estimated 3.2 billion people are at risk of being infected with malaria and developing disease, and 1.2 billion are at high risk (>1 in 1000 chance of getting malaria in a year). According to the latest estimates, 198 million cases of malaria occurred globally in 2013 (uncertainty range 124–283 million) and the disease led to 584 000 deaths (uncertainty range 367 000–755 000).
The burden is heaviest in the WHO African Region, where an estimated 90% of all malaria deaths occur, and in children aged under 5 years, who account for 78% of all deaths.
Expansion of malaria funding
International and domestic funding for malaria control and elimination totaled US$ 2.7 billion in 2013. Although this represented a threefold increase since 2005, it is still significantly below the estimated US$ 5.1 billion that is required to achieve global targets for malaria control and elimination. Total malaria funding will only match resource needs if international and domestic funders prioritize further investments for malaria control.
Overall, funding for countries in the WHO African Region accounted for 72% of the global total. Between 2005 and 2013, international disbursements for malaria for this region increased at an annual rate of 22%. During the same period, the average annual rate of increase for domestic funding in the region was 4%.
Globally, domestic funding for malaria was estimated to be US$ 527 million in 2013. This represents 18% of the total malaria funding in 2013. In regions outside Africa, the annual rate of domestic funding has not increased in recent years.
Progress in vector control
During the past 10 years, coverage with vector control interventions increased substantially in sub-Saharan Africa. In 2013, almost half of the population at risk (49%, range 44–54%) had access to an insecticide-treated mosquito net (ITN) in their household, compared to 3% in 2004. An estimated 44% (range 39–48%) of the population at risk were sleeping under an ITN in 2013, compared to 2% in 2004. Pregnant women and children were more likely than the general population to sleep under an ITN.
In terms of long-lasting insecticidal net (LLIN) delivery, 2014 has been the strongest year so far. A total of 214 million nets are projected to be delivered to countries in sub-Saharan Africa by the end of 2014, bringing the total number of LLINs delivered to that region since 2012 to 427 million.
Globally, 123 million people were protected from malaria through the use of indoor residual spraying. This represents 3.5% of the global population at risk. In the WHO African Region, 55 million people, or 7% of the population at risk, were protected. This has decreased from 11% in 2010; the decline is due to a withdrawal or downsizing of spraying programs in some countries.
In sub-Saharan Africa, the proportion of the population protected by at least one vector control method has increased in recent years, and it reached 48% in 2013 (range 44–51%). Globally, 38 countries reported the use of larval control to complement core vector control methods.
Insecticide resistance in malaria vectors has been reported in 49 of 63 reporting countries around the world since 2010. Of these, 39 have reported resistance to two or more insecticide classes. The most commonly reported resistance is to pyrethroids, the most frequently used insecticide in malaria vector control.
WHO has established a system to track insecticide resistance globally, and recommends annual monitoring. In 2013, some 82 countries report undertaking insecticide resistance monitoring. However, only 42 of these countries provided WHO with resistance data for 2013, suggesting that many countries do not monitor insecticide resistance annually.
Trends in the administration of preventive therapies
The proportion of women who receive intermittent preventive treatment in pregnancy (IPTp) for malaria has been increasing over time, although the levels remain below program targets. IPTp has been adopted in 37 countries and 57% of pregnant women in those countries received at least one dose of IPTp in 2013. However, only nine of those countries have reported to WHO on the recommended number of three or more doses of IPTp, and within those countries, only 17% of pregnant women received three or more doses.
In most countries, attendance rates at antenatal care services are much higher than current levels of IPTp administration. This suggests that there are missed opportunities to expand access to this life-saving intervention.
The adoption and implementation of preventive therapies for children aged under 5 years and for infants has been slower than expected. As of 2013, six of the 16 countries recommended by WHO to adopt seasonal malaria chemoprevention for children aged under 5 years have done so. Only one country has adopted intermittent preventive treatment for infants, but has not yet implemented the treatment.
Scaling up diagnostic testing
The proportion of patients suspected of having malaria who receive a malaria diagnostic test has increased substantially since 2010, when WHO recommended testing of all suspected malaria cases. In 2013, 62% of patients with suspected malaria in public health facilities in the WHO African Region received a diagnostic test, compared to 40% in 2010.
The total number of rapid diagnostic tests (RDTs) distributed by national malaria control programs increased from fewer than 200 000 in 2005 to more than 160 million in 2013. Of these, 83% were delivered to countries in the WHO African Region. The quality of RDTs has improved substantially since the start of the RDT product testing program in 2008. In the latest round of product testing, nearly all tested products met WHO standard of detection at parasite levels commonly seen in endemic areas.
In 2013, the number of patients tested by microscopic examination remained unchanged from the previous year, at 197 million. The global total of microscopic examinations is dominated by India, which accounted for over 120 million slide examinations in 2013.
In 2013, for the first time, the total number of diagnostic tests provided in the WHO African Region in the public health sector exceeded the number of artemisinin-based combination therapies (ACTs) distributed. This is an encouraging sign and, given that fewer than half of patients tested will require treatment, the ratio of diagnostic tests to ACTs should eventually reach two to one.
Expanding access to treatment
By the end of 2013, ACTs had been adopted as national policy for first-line treatment in 79 of 88 countries where Plasmodium (P.) falciparum is endemic. Chloroquine was being used in 9 Central American and Caribbean countries where it remains efficacious.
The number of ACT courses procured from manufacturers – for both the public and private sectors – rose from 11 million in 2005 to 392 million in 2013. This increase has been largely driven by procurements for the public sector.
Public health facilities had enough ACT in 2013 to treat more than 70% of patients with malaria who presented for care. However, the estimated proportion of all children with malaria who received ACTs was estimated at between 9–26% this is because a substantial proportion of these patients do not seek care, and not all those who seek care receive antimalarial treatment.
Antimalarial drug resistance
P. falciparum resistance to artemisinin has been detected in five countries of the Greater Mekong sub region: Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam. In many areas along the Cambodia–Thailand border, P. falciparum has become resistant to most available antimalarial medicines.
The number of countries that allow marketing of oral artemisinin-based monotherapies has declined rapidly. As of November 2014, only eight countries allow the marketing of oral monotherapies. However, 24 pharmaceutical companies, mostly in India, continue to market oral monotherapies. Therapeutic efficacy studies remain the gold standard for guiding drug policy, and should be undertaken every 2 years.
Studies of first- or second-line antimalarial treatments were completed in 72% of countries where P. falciparum efficacy studies were feasible.
Gaps in intervention coverage
Despite impressive increases in malaria intervention coverage, it is estimated that, in 2013, 278 million of the 840 million people at risk of malaria in sub-Saharan Africa lived in households without even a single ITN, 15 million of the 35 million pregnant women did not receive even a single dose of IPTp, and between 56 and 69 million children with malaria did not receive an ACT. Poverty and low levels of education are significant determinants of lack of access to these essential services. More can be done to ensure all those at risk receive appropriate preventive measures, diagnostic testing and treatment.
Changes in malaria incidence and mortality
Reported malaria cases Of the 106 countries that had ongoing malaria transmission in 2000, reported data in 66 were found to be sufficiently complete and consistent to reliably assess trends between 2000 and 2013.
Based on an assessment of trends in reported malaria cases, a total of 64 countries are on track to meet the Millennium Development Goal target of reversing the incidence of malaria. Of these, 55 are on track to meet Roll Back Malaria and World IV | world malaria report 2014
Health Assembly targets of reducing malaria case incidence rates by 75% by 2015. In 2013, two countries reported zero indigenous cases for the first time (Azerbaijan and Sri Lanka), and eleven countries succeeded in maintaining zero cases (Argentina, Armenia, Egypt, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay, Turkmenistan and Uzbekistan). Another four countries reported fewer than 10 local cases annually (Algeria, Cabo Verde, Costa Rica and El Salvador).
The 55 countries that recorded decreases of >75% in case incidence accounted for only 13 million (6%) of the total estimated cases of 227 million in 2000. Only five countries with more than 1 million estimated cases in 2000 (Afghanistan, Bangladesh, Brazil, Cambodia, and Papua New Guinea) are projected to achieve a reduction of 75% or more in malaria case incidence. This is partly because progress has been faster in countries with lower numbers of cases, but also because of poorer quality surveillance data being submitted by countries with larger estimated numbers of cases, particularly in sub-Saharan Africa.
Malaria infections
A new analysis of data reveals that the prevalence of malaria parasite infection, including both symptomatic and asymptomatic infections, has decreased significantly across sub-Saharan Africa since 2000. In sub-Saharan Africa, average infection prevalence in children aged 2–10 years fell from 26% in 2000 to 14% in 2013 – a relative decline of 48%.
Although declines in malaria parasite infection were seen across the African continent, they were particularly pronounced in Central Africa. Even with a large growth of populations in stable transmission areas, the number of infections at any one time across Africa fell from 173 million in 2000 to 128 million in 2013 – a reduction of 26% in the number of people infected.
Estimated malaria cases and deaths
Between 2000 and 2013, estimated malaria mortality rates decreased by 47% worldwide and by 54% in the WHO African Region. They are estimated to have decreased by 53% in children aged under 5 years globally, and by 58% in the WHO African Region.
If the annual rate of decrease that has occurred over the past 13 years is maintained, then by 2015 malaria mortality rates are projected to decrease by 55% globally, and by 62% in the WHO African Region. In children aged under 5 years, by 2015 they are projected to decrease by 61% globally and by 67% in the WHO African Region.
Estimated malaria cases and deaths averted
It is estimated that, globally, 670 million fewer cases and 4.3 million fewer malaria deaths occurred between 2001 and 2013 than would have occurred had incidence and mortality rates remained unchanged since 2000. Of the estimated 4.3 million deaths averted between 2001 and 2013, 3.9 million (92%) were in children aged under 5 years in sub-Saharan Africa. These 3.9 million averted deaths accounted for 20% of the 20 million fewer under 5 deaths that would have occurred between 2001 and 2013 had under-5 mortality rates for 2000 applied for each year between 2001 and 2013. Thus, reductions in malaria deaths have contributed substantially to progress towards achieving the target for MDG 4, which is to reduce, by two thirds, the under-5 mortality rate between 1990 and 2015
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