Malaria in Cambodia

Researchers recently announced that a strain of malaria parasite in Cambodia has become resistant to "arteminisnin-based drugs". This development "could put millions of lives at risk" (Resistance). "Artemisinin-based combination therapies are the recommended first-line treatments of falciparum malaria in all countries with endemic disease. There are recent concerns that the efficacy of such therapies has declined on the Thai-Cambodian border, historically a site of emerging antimalarial-drug resistance" (Dondorp).

"Choloroquine and sulfadoxine-pyrimethamine resistance in P.falciparum emerged in the late 1950s and 1960s on the Thai-Cambodian border and spread across Asia and then Africa, contributing to millions of deaths from malaria. "Since the first reports of chloroquine-resistant falciparum malaria in southeast Asia and South America...drug-resistant malaria has posed a major problem in malaria control. By the late 1980s, resistance to sulfadoxine-pyrimethamine and to mefloquine was also prevalent on the Thai-Cambodian and Thai-Myanmar (Thai-Burmese) borders, rendering them established multidrug-resistant (MDR) areas" (Wongsrichanalai).

"Artemisinins have been available as monotherapies in western Cambodia for more than 30 years, in a variety of forms and doses, whereas in most countries...they have been a relatively recent introduction." An "extended period of often-suboptimal use, and the genetic background of parasites from this region, might have contributed to the emergence and subsequent spread of these new artemisinin-resistant parasites in western Cambodia." "In contrast, artemisinin derivatives have been used almost exclusively in combination with mefloquine on the Thai-Burmese border, where parasitologic responses to artemisinins remain good, even after 15 years of intensive use" (Dondorp).

The recent study compared patients from Cambodia with those from Thailand. "Researchers (Wellcome Trust-Mahidol University Oxford Tropical Medicine Research Program) discovered that on average "patients in Thailand were clear of malaria parasites within 48 hours" but Cambodian patients averaged 84 hours" (Resistance). "These markedly different parasitologic responses were not explained by differences in age" and "adverse events were mild and did not differ significantly between the two treatment groups" (Dondorp). Dr Arjen Dondorp declared, "Our study suggests that malaria parasites in Cambodia are less susceptible to artemisinin than those in Thailand". Currently, artemisinin is used to "clear the parasites at an early stage, preventing them further maturing and reproducing" (Resistance). Since its introduction, "artemisinin-based combination therapies has reduced the morbidity and mortality associated with malaria" (Dondorp).

However, with the new emergence of resistant malaria parasites, the number of malaria related deaths is expected to rise. "Measures for containment are now urgently needed to limit the spread of these parasites from western Cambodia and to prevent a major threat to current plans for eliminating malaria"(Dondorp). "Sixty percent of Cambodia's landscape poses a malarial risk. One million Cambodians are infected with malaria each year" (Wongsrichanalai). "Malaria remains one of the primary causes of mortality in Cambodia... Sustained efforts through local and national malaria control will be necessary to contain Cambodia's malaria epidemic" (Wongsrichanalai).

Image from Donorp. Graph from comparative study between Cambodia and Thailand, and how well the drugs treat malaria.


Sources:
Dondorp AM, Nosten F, Yi P, et al. Artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 2009;361:455-467.
Population Reference Bureau. "Fewer Malaria Cases in Cambodia."
"Resistance to Malaria Drug Reported in Cambodia." US World News. 29 July 2009.
Wongsrichanalai C, Pickard AL, et al. Epidemiology of drug-resistant malaria. 2002 Apr.

Malaria in Bolivia

Travel websites warn tourists to "consider taking medication for malaria prophylaxis (cholorquine, doxycycline, or mefloquine)," particularly in the areas "surrounding Santa Cruz," where "yellow fever and malaria are two common mosquito-borne diseases" (MDTravel). The CDC indicates that "areas of Bolivia with Malaria" include "all areas <2,500 m" in the regions of "Beni, Chuquisaca, Cochabamba, La Paz, Pando, Santa Cruz, and Tarija." However, the CDC also warns that Chloroquine, commonly used to prevent and treat malaria, "is NOT an effective anti-malaria drug in Bolivia and should not be taken to prevent malaria in this region" (CDC). In reality, "none of the currently available prophylactic medications is 100% effective. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times" (MDTravel).

Furthermore, areas above 2,500 meters are not absent of the disease. "Malaria cases have been reported on the Bolivian high plateau, confirming scientists' predictions that mosquitoes have adapted to a colder climate." These cases "were found in Oruro, western Bolivia, around 3,710 metres above sea level". Researchers have "demonstrated that some anopheles mosquitoes" (the ones that carry malaria) "have adapted to living at altitudes between 2,520 and 3,590 metres--conditions very different from their usual environment: warm, tropical and subtropical regions below 2,600 metres." Some researchers postulate that "a new subspecies has emerged." Scientists have noticed that the tails "have become shorter" and the "mosquito can live in dirty water rather than the clean water it inhabits at lower levels. It can survive" nighttime temperatures "as low as eight degrees Celsius" (Pabon) This can be terrifying news for the residents of these high-altitude regions since many do not have access to adequate health care to combat malaria.

One case study, examines the village of Tuntunani, which is "situated at an elevation of 2,300 meters." This community "experienced its first malaria outbreak in 1998". "An investigation two years later indicated that the epidemic resulted from introduced transmission...58% of the people had been ill for three weeks or longer" as a result. "This outbreak demonstrates the vulnerability of highland populations with poor access to health care to introduced malaria" (Rutar 15).

It seems that malaria is spreading in a country where its effects are already devastating. "Malaria affects over 3.5 million people in Bolivia each year. The Amazon basin regions of Beni and Pando have the country's highest infection rates. In these regions, migratory worker populations, such as castaneros" (Brazil nut farmers) "run a high risk of malaria infection"
When these harvesters "are sick with malaria, the family income drops since workers do not earn their wages and family members stay home to care for them." Estimates indicate that "at least 15,000 families from rural areas depend on this market for survival" (USAID). USAid led a pilot study among the community of Brazil nut harvesters and found that one-third of the farmers tested positive for malaria.

Pregnant women in Bolivia are also at high risk for the disease. Malaria affects pregnant women and children drastically. The anemia and fever from malaria can cause birth defects and death. Furthermore, there is no approved treatment or avoidance measures for pregnant women to take in Bolivia. Many of the prophylactic medications that work against the Bolivian strain of malaria can cause birth defects or miscarriages during the first trimester. At this time, most women find that they can only use mosquito repellent and mosquito nets to avoid contracting malaria during pregnancy.

Map of regions in Bolivia where malaria is endemic

Sources:

CDC.gov/travel/destinations/bolivia.aspx
Pabon, Cristina. Malaria spreading on Bolivian High Plains. SciDevNet.
Rutar, Tina. Eduardo J Baldomar Salgueiro, James H Maguire. "Introduced Plasmodium Vivas Malaria in a Bolivian Community at an Elevation of 2,300 Meters."
TravelMD. Bolivia.
USAID Reducing Malaria in Migrant Populations

Malaria in Russia

Many people believe that it is impossible to contract malaria in countries that are far away from the tropics. Unfortunately, this is not the case. Even Russia is not immune to the threat of malaria.

"Dozens of people acquire malaria infections in Moscow annually". Most of these cases are "due to people who arrive in the city from southern countries", but surprisingly some people become "infected from home-grown strains of the disease" (Dmitriyev). In 2007, "128 incidents of malaria were registered in Russia. Two of the cases proved fatal. The average annual rate is 100 cases, with the bulk of them occurring in Moscow, Moscow Region and St. Petersburg" (Dmitriyev).

Because malaria is not as prevalent in Russia as it is in tropical regions of the world, "doctors in Russia often lack qualification to diagnose patients" with malaria "and provide the appropriate medical treatment in a timely fashion. Even more often, they fail to determine the exact form of the disease. This may lead to multiple after-effects resulting in the patient's death" (Dmitriyev).

Global climate change threatens to unleash new waves of malaria in Russia. From history, we can see how rises in malaria cases directly corresponds with warm years. For example, "extensive flooding in 1922 resulted in the creation of standing pools of water over wide areas of the upper Volga River basin, which resulted in an explosion of the population of ...mosquitoes" (Packard 7).

"Less than half of all malaria cases in Russia...are caused by guests from tropical countries" (Dmitriyev). Reservoirs, water-logged ditches, and stagnant ponds at parks and recreation areas provide breeding grounds for mosquitoes in Russia. In June of 2008, "the human welfare service successfully eradicated the bulk of the mosquitoes' larvae at several Moscow administrative districts" through regular spraying of these breeding areas (Dmitriyev).

Russia is also contributing to the movement to eradicate malaria worldwide. In 2007, Russia "committed $US 20 MLN to the task" of fighting malaria in Africa. In response, Dr. Brian Chituwa (Zambian Minister of Health) said, "We are confident that this significant contribution will reduce malaria deaths and bring us closer to achieving our millennium development goals" (Russia).



Sources:
Dmitriyev, Sergey. "Malaria Threat." The Moscow News. 24 Jul 2008.

Packard, Randall M. The making of a tropical disease.

"Russia Joins the Fight Against African Malaria." Russia Today. 20 Oct 2007.

Malaria in Ghana

New Release: 24 July 2009 reports prevalence of fake drugs in Ghana

Despite increased prevention efforts, Ghana is struggling to control endemic Malaria. Major roadblocks include economic deterioration, reduced effectiveness of indoor spraying & bed nets, and the importation of fake drugs to treat malaria.

In early July, US President Obama visited Ghana and "reaffirmed the United States' commitment to fighting malaria and other pressing global health needs" (Malaria Policy, President). For Ghana, the fight against malaria is one of medical and economic concern. "One infected person can indirectly infect 100 others that is how efficient the malaria mosquito is" (Afiriyie). Malaria is detrimental to the population of Ghana and the economic standing of the country. All are effected by the "debilitating effects of malaria on adult victims...In addition to time and money spent on preventing and treating malaria, it causes considerable pain and weakness among its victims. This can reduce peoples' working abilities. The adverse impact of the disease on household production and gross domestic product can be substantial. Malaria therefore is not only a public health problem but also a developmental problem." Apart "from the negative effect of lost productivity on the major sectors of the economy, malaria has negative effects on the growth of tourism, investments and trade especially in endemic regions" (Asante 8).

Every year, "huge sums of money" are "spent on malaria" treatment "even though the disease could be prevented," with the establishment of well-funded programs (Joy). Some methods of malaria control include bed-nets (mosquito nets that drape the beds to prevent mosquito bites during the night) and indoor spraying. Unfortunately, there is some indication that "Indoor Residual Spraying will never eliminate malaria in Ghana". "Hayford Siaw, Executive Director of Volunteer Partnerships for West Africa (VPWA) has expressed concern" over the investments in bed-nets and indoor spraying, saying that "The indoor residual spraying is no more effective than the bed nets, about 25% effective". Effectiveness of indoor treatment is reduced by a "genetic pre-disposition of some malaria mosquitoes" to "only bite outdoors" (Afiriyie). Still, the bed nets and indoor spraying do reduce the number of malaria cases and should not be abandoned. Other methods of eradication should be used in tandem with indoor treatments in order to effectively eliminate malaria in the region.

Ghana is working to establish and maintain programs that will diminish the mosquito population that carries malaria. "Zoomlion, a waste management company that works to improve sanitation throughout the country and fight malaria," maintains "a total of 420 'spraying gangs'" that "periodically spray mosquito breeding sites in order to stop the spread of malaria." This agency "aims to educate communities on sanitation issues and to engage young people in the cause. Their efforts have greatly improved waste issues in the region." (Malaria Policy, Ghana).

The sanitation progress is a step in reducing the "more than 3 million cases of malaria" that "are reported every year in Ghana, more than 900,000 of those cases are young children" (USAID). "45 per cent of child mortality rate recorded nationwide" in 2008 "was caused by malaria" (Joy).

International programs and various governments have stepped up to provide support for Ghana's anti-malaria campaign. It is reported that in December of 2008, China provided "medical assistance to some health practitioners in the country" of Ghana, in order to support their education about anti-malaria practices (Ghana News). In 2006 & 2007, Cuba also donated to Ghana in order to help fund the country's eradication program. Other nations have continuously provided their support to Ghana.

But, news journals have recently revealed that some anti-malarial drugs entering Ghana are fake. "Quantities of a prescription medication used throughout the world for treating malaria have been identified as lacking any active ingredient and presumably counterfeit. These are being removed from the market in Ghana, where they were discovered recently and confirmed as fake last Friday" (Pierson).

The drug (sold as Novartis Coartem{R}) lacked the ingredients necessary to effectively treat malaria. "This drug is an artemisinin-based combination therapy" and it is "recommended by the World Health Organization (WHO) for treating "uncomplicated" malaria" (Pierson).

"It has been estimated that up to 15% of all sold drugs are fake, and in parts of Africa this figure exceeds 50% , which paints a grim picture of health delivery in Ghana and elsewhere in Africa. China is emerging as a source country of counterfeit drugs. India and other Asian countries are" also "emerging as sources"(Ghanian).

"A major barrier in combating malaria throughout much of the developing world is the widespread presence of counterfeit and adulterated drugs, which undermines the public health. Not only do these drugs fail to deliver the appropriate treatment to individual patients--putting their lives at risk, but they contribute to the growth of drug-resistant strains of malaria, one of the greatest challenges to malaria control today" (Pierson).


"The FDB [Food & Drug Board] knows more than anyone that the drug counterfeit business is a multi-million dollar business globally, which is gaining roots in Ghana, the emerging gateway to everything...The production of substandard and fake drugs is a vast and under-reported problem, particularly affecting poorer countries. It is an important cause of unnecessary morbidity, mortality, and loss of public confidence in medicines and health structures" (Ghanian).

"Mr. Anthony Ofori, Brong Ahafo Regional Co-coordinator of Malaria Control," requests "effective collaboration between non-governmental organisations (NGOs), corporate bodies and the health authorities in the campaign against malaria in the country" (Joy). Malaria is endemic throughout the entire country (See map). Ghana is in dire need of positive international assistance in the war against malaria.

Note About Malaria:
"Malaria is integrally tied to maternal and child health in Africa." Each year pregnant women and children suffer and die from the infectious parasite. "Effective malaria control programs" are "vital to helping health systems adequately care for mothers and children," (Malaria Policy, President). "The effect of malaria on people of all ages is quite immense. It is however very serious among pregnant women and children because they have less immunity" (Asante 7).

A Note about Donations:
If you would like to donate to the cause, please visit the Malaria No More site.
At this time, Infectious Bite is not accepting donations. Please donate directly to a reputable agency.

Sources:
Afiriyie, Constance. Volunteer Partnerships for West Africa. "Indoor Residual Spraying will never eliminate malaria in Ghana."

Asante, Felix Ankomah. Kwadwo Asenso-Okyere. Economic Burden of Malaria in Ghana.

Ghanian Journal, The. "Let's do away with fake drugs". 24 July 2009.

Ghana News Agency (via fmprc.gov). China donates anti-malaria drugs to Ghana.

Joy Online. Ghana needs effective collaboration in malaria campaign.

Malaria Policy Center: President Obama Visits Ghana and Reaffirms U.S. Commitment to Fight Malaria.

Malaria Policy Center: Ghana fights malaria by improving sanitation.

Pierson, Francine. US Pharmacopeia. "Counterfeit Antimalarial Drug Discovered in Ghana with Aid of USP Drug Quality and Information Program". 22 July 2009.

USAID Press Release. USAID Administrator Tours Ghana Malaria Control Center.

Halting Malaria Transmission

Brought to my attention by @sarahsearle

"Researchers at the Johns Hopkins Malaria Research Institute have for the first time produced a malarial protein" that can "generate a significant immune response" and be used to create "a potential transmission-blocking vaccine" (Parsons). Antibodies produced in response to the protein, inhibit the "sexual development of the malaria-causing parasite, Plasmodium, as it grows within the mosquito".

"According to the study, a single-dose vaccine provided a 93 percent transmission-blocking immune response, reaching greater than 98 percent after a booster was given several months later" (Parsons).

Humans are on the verge of successfully creating a vaccine that may inhibit the spread of malaria. In the late 1980s, scientists understood the possibility of transmission-blocking immunity. They discovered that individuals can "develop immunity that suppresses the infectivity of the sexual stages of the parasite." This "immunity is antibody mediated and is directed against the parasites in the mosquito midgut shortly after ingestion of blood by a mosquito." In 1987, scientists declared that "This immunity could be expected to have significant effects on the natural transmission of P. vivax malaria" (Mendis).

"Development of a successful transmission-blocking vaccine is an essential step in efforts to control the global spread of malaria" (Kumar). This study indicates that "it is possible to gradually reduce malaria transmission to a point of almost eradication" (Parsons).

Sources:
Kumar, Nirbhay.

Mendis, K N. Y D Munesinghe, Y N de Silva, I Keragalla, and R Carter. Malaria transmission-blocking immunity induced by natural infections of Plasmodium vivax in humans. 1987 February.

Parsons, Tim. Vaccine Blocks Malaria Transmission in Lab Experiments. 22 July 2009.

Malaria in China

China has seen a resurgence of Malaria in recent years. "China reported about 24 million malaria cases in the 1970s, the number of cases declined to several hundred thousand by the late 1990s. However, the disease recently has "re-emerged" in China's central and southern provinces, possibly as a result of insufficient prevention work" (Global).

China suffers from Falciparum malaria which "is the most deadly among the four main types of human malaria. Although great success has been achieved since the launch of the National Malaria Control Programme in 1955, malaria remains a serious public health problem in China" (Lin). "Falciparum malaria was endemic in two provinces of China during 2004–05" (Lin). "The 'level one' areas have an annual malaria incidence of more than one case per 10,000 people, while the 'level two' regions have an annual incidence of less than one per 10,000 people" (Global).


Map provided by Travax

"Imported malaria was reported in 26 non-endemic provinces. Annual incidence of falciparum malaria was mapped at county level in the two endemic provinces of China: Yunnan and Hainan. The sex ratio (male vs. female) for the number of cases in Yunnan was 1.6 in the children of 0–15 years and it reached 5.7 in the adults over 15 years of age" (Lin).

The recent resurgence of malaria in China has prompted "China's Ministry of Health" to draft a "plan to eliminate malaria from the country by 2015" (Xinhuanet). "Central and local governments will provide funding for the malaria control programs, an unnamed official from the health ministry's disease control department said." "The plan aims to reduce malaria incidence to less than one case per 10,000 people in high-burden regions and to no cases in low-burden regions between 2010 and 2015" (Global).

Sources:
Global Health Reporting. "Malaria | China Develops Nationwide Malaria Eradication Plan". 10 April 2009.

Lin, Hualiang. Liang Lu, Linwei Tian, Shuisen Zhou, Haixia Wu, Yan Bi, Suzanne C Ho, Qiyong Liu. Spatial and temporal distribution of falciparum malaria in China.

Xinhuanet. "China lays out plans to quell malaria" http://news.xinhuanet.com/english/2009-04/10/content_11163891.htm 10 April 2009.

Malaria in Libya

Malaria is rare in the desert regions, but Libya has reported some cases of Malaria outbreaks and fears the invasion of mosquitoes carrying the deadly disease.


Map provided by Wikimedia Commons

For the most part, the natural climate of Libya protects it from Malaria outbreak. Libya "is an extremely arid North African country extending southwards from the Mediterranean into the Sahara" (Ramsdale). "Many Libyan oases, like those in other parts of the Sahara, have a history of occasional outbreaks of malaria involving Plasmodium vivax" (Grassi and Feletti) and P. farcipamm (Welch). "The latter species of malaria parasite has been eradicated from the Mediterranean basin but still predominates in Africa south of the Sahara" (Ramsdale).

Although Libya is safe within the Mediterranean basin and sheltered by the Sahara, it is still at risk for malaria. "In Libya, a continuing influx of foreign workers, many from highly malarious parts of the world, ensures the maintenance of a parasite reservoir probably larger than at any time in the past" (Ramsdale). "Malaria was endemic in libya until 1973 where it was declared by WHO to be a country free of malaria" (Kraza). "The situation continued like this until 1976 where there was an epidemic of febrile illness among petroleum company workers ...blood slides of all" cases "were positive for falciparum malaria, reconfirmed in a referral lab" (Kraza). In 2004, cases of malaria were again discovered in Libya. "All cases" were "confirmed microscopically" and were considered "imported, except for one case thought to be introduced" from an imported case (Kraza). The National Center for Infectious Diseases Prevention and Control cites the mission purpose "to prevent reemergence of malaria transmission in the country and to control imported malaria" (Kraza).

The potential for introduction of the fatal malaria parasite is possible in Libya. The feeling of safety against malaria that has developed in Libya in recent years may be dangerous. It is important to remain vigilant in diagnosing new cases and educating the populace about malaria avoidance.

Sources:
Kraza, Ibrahim. "Malaria in Libyan Jamahirya during 2004". National Center For Infectious Diseases Prevention and Control. Damascus 2005.
Ramsdale, C.D. Mosquito Systematics. "Anopheles: Mosquitoes and Imported Malaria in Libya." Vol 22, No.1.
Wikimedia Commons. Location Libya.