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ANTC68 WINTER 2013 Week # 4: The persistent problem of Malaria – Addressing the Fundamental Causes of a Global Killer by Stratton et Al Abstract - Malaria is the most important vector born disease of our day and global eradication efforts have failed because they haven’t been looking at the environmental, economic and political dimensions of risk Introduction - Malaria is a parasitic infection caused by the Plasmodium parasite that is mainly transmitted by female Anopheles mosquitoes prevalent in Africa, Latin America and Asia - 900,000 deaths per year, mainly children – malaria epidemics mainly affect vulnerable sub populations such as those with comprised immune systems (children, seniors, immunodepresssed) and those with limited access to health care services (low income, rural, women, children) - Malaria increasing due to changes in population, demographics, land use, resurgence in areas in once controlled areas - Growing incidence of chloroquine-resistant Plasmodium falciparum infection, most lethal malaria strain Framework: Fundamental & Proximal Causes of Malaria - Socioeconomic development is fundamental determinant of the global distribution of morbidity and mortality for many health outcomes - Low income countries bear a disproportionately high burden of both infectious and chronic disease which decreases only with socioeconomic development - Poverty is the greatest risk factor for malaria – due to reduced access to social and material resources - Radical systems reform may not be feasible in the short term and it may be better to focus on lessening exposure and treating the disease but reducing poverty enhances the success rate and effectiveness of these interventions - A dynamic interplay of biological, social and environmental susceptibilities define malaria risk - Development projects have had the unintended effects of undermining malaria control by increasing parasite exposures, undermining local immunities and preventing populations from growing out of malaria - Environment, Behavior, & Malaria Risk - Super distal risk factor: underlying determinant from environmental risk to social inequality affects disease distributions - Malaria risk is strongly linked to environmental context including climatic factors and patterns of land use ANTC68 WINTER 2013 - WHO has said that 45% of the global malaria incidence is attributable to modifiable environmental factors such as land and water resource management - Population movement fueled in part by environmental degradation, famine and drought is reshaping the distribution of resistance as people move between malarious and nonmalarious regions and the borders between susceptible and infected populations disappear Climate Change - Global warming could affect the global distribution of malaria as increase in temperature make the breeding season of mosquitoes longer (better habitats) - Potential confounding factors due to changing drug resistance and malaria control activities which can play a larger role than climate itself - The world’s poorest countries are typically those most vulnerable to environmental risk and within these areas, the poorest persons may be at greater risk o Less access to nets, poor housing and crowding o - Poor contribute least to greenhouse gas emissions but they suffer more and have less capacity to adapt to altered climates - Ethnographic data is essential in ensuring malaria interventions are taken up Economic Inequality & Malaria Risk Global Inequalities - Poverty is an important determinant of malaria, disease also contribute to poverty by slowing down economic growth and poverty limiting health sector response (1% decline in annual economic growth can be attributed to malaria)(bi directional relationship) - HDI – Human Development Index is a rigorous measure of human wellbeing (composite of life expectancy, adult literacy, school enrollment and standard of living) - Rising HDI leads to downward trend in malaria burden - Malaria is more sensitive to incremental improvements in standard of living and education - Risk associated with indoor air pollution, unsafe water and sanitation is more resistant to incremental improvements in HDI - Income equality and GDP per capita are more powerful discriminants between high and low endemicity countries vs. geography and climate - The success of malaria reduction efforts have been inversely proportional to the initial prevalence of malaria in affected areas o Areas with the greatest reduction in malaria have occurred in lower endemicity areas - Degree of investment in public sanitation and public services led to successful eradication in tropical and sub-tropical regions
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