Malaria: Half of the world’s population is at risk — and climate change threatens to expand its reach

April 25, 2019
Written by Megan Christensen
Photo by Peter Caton

While Africa has a disproportionately high burden of global malaria cases and is traditionally thought of as a hotspot for malaria transmission, our changing climate could soon put millions more at risk worldwide.

According to the World Health Organization, last year there were 219 million cases of malaria, a preventable but potentially fatal illness that is mainly transmitted through the bite of the female Anopheles mosquito between nightfall and the early morning hours. Each year over 90% of malaria deaths occur in Africa, but rising temperatures and changing climate patterns may soon alter this narrative.

Malaria kills one child nearly every minute. That’s approximately 1,200 children every day.

In fact, the storyline is already being rewritten. Vector-borne illnesses such as the Zika virus, Dengue Fever, and West Nile virus are emerging in areas where they were previously unknown. And it’s not just about atmospheric conditions: as rural people rapidly migrate to urban areas to escape the effects of climate change, they are introducing new diseases to densely populated and overcrowded communities that lack immunity.

Florence Mutungi (32) with six-month-old twin daughters Blessings and Precious

Florence Mutungi (32) with six-month-old twin daughters, Blessings and Precious. Florence and her daughters live in the Mukuru slum in Kenya’s capital city, Nairobi. The family’s Community Health Volunteer has encouraged them to use the mosquito net provided when the girls were born to protect them against malaria. Photo: Peter Caton

Half of the world is now at risk for contracting malaria, and with warmer temperatures and variations in rainfall, researchers from the University of Florida expect that malaria vulnerable areas will change and the total transmission zone will expand. As malaria arrives in new areas, this presents a significant risk to populations never exposed to the malaria parasite; these people lack protective immunity and epidemics are likely when changing weather conditions foster transmission.

Infants, children under five, and pregnant women are particularly vulnerable to severe malaria illness. So, too, are people who are immunocompromised, those who lack protective immunity such as non-immune migrants and mobile populations including travelers, and refugees who are returning to endemic zones. In fact, United Nations Children’s Fund (UNICEF) estimates that malaria — which I want to reiterate is preventable — kills one child nearly every minute. That’s approximately 1,200 children every day.

The world is poised to gain an estimated $270 billion and save countless lives by eliminating malaria in Sub-Saharan Africa.

Malaria in pregnancy can lead to miscarriage, stillbirth, low birth weight, and prematurity, as well as other congenital infections and abnormalities, and early newborn death. Moreover, malaria perpetuates poverty. Malaria can be debilitating to the point that those infected are unable to work, and reoccurring episodes are costly in terms of accessing treatment and loss of income due to missed work. Such illness traps families in a cycle of suffering, poverty, and illness.

For the past 20 years, Concern has been on the frontlines of the fight against malaria, working alongside other international partners and national ministries of health. In many Sub-Saharan African countries, malaria is the leading cause of illness and death in young children. Families have insufficient access to health facilities and face high opportunity costs and out-of-pocket expenditure for seeking care. Unsurprisingly, there are often delays in seeking timely and appropriate medical attention.

Janviere, 38, travels to the home of CHW Christianne

Janviere traveled to the home of Community Health Volunteer Christianne to treat her 36-month-old daughter, Emmerence, who had a fever. Malaria meds were administered. Gasambu village, Rwanda, 2013. Photo: Esther Havens

Nearly two decades ago, Rwanda responded. Just six years after the genocide, bold and ambitious steps were taken by bringing treatment for malaria to the front doorsteps of homes. Volunteers within villages were identified and trained on how to test for malaria, identify danger signs, and treat positive cases of malaria. Rather than caregivers having to spend hours on foot walking to a health facility when they or their children become sick, people were treated right in the homes.

Over the next decade, the Ministry of Health in Rwanda worked with international partners and more than 7,000 volunteers. Collectively, these efforts covered 20% of Rwanda’s population and over 600,000 cases of fever in children were managed. This model, now known as Integrated Community Case Management, was so successful that it was expanded to include other illnesses such as diarrhea, pneumonia, and malnutrition, and was scaled-up throughout Rwanda. As such, this experience demonstrated significant reductions in child deaths — one of the first studies of its kind.

But progress wasn’t limited to Rwanda. Throughout Sub-Saharan Africa, I’ve witnessed symbiotic efforts between the international community and national governments to tackle malaria head-on by investing in communities and health systems and testing innovative solutions to defeat this millennia-old issue.

Little Adamou, a healthy two year old, and his mom Hassana Salouhou.

Little Adamou is now a healthy two-year-old, but at 13 months old, he became moderately malnourished and fell ill with malaria. He weighed just 15 pounds — much less than a healthy child his age. After receiving advice from a community health worker and treatment from a health center supported by Concern, Adamou recovered and gained weight. Kossoma, Tahoua, Niger. Photo: Darren Vaughan

In Niger, research showed that with proper training low-literacy and illiterate mothers could identify, test, and treat children with malaria in their communities. Indeed, these mothers were able to successfully treat over 5,000 children in a 13 month period, resulting in a 20 fold increase in appropriate treatment for malaria and almost double the number of children regularly sleeping under a treated mosquito net. Similar approaches — where communities, with some support and investment, are saving their children’s lives — have been replicated in Burundi, South Sudan, and Sierra Leone, among other countries worldwide.

Since 2000, UNICEF estimates malaria deaths have decreased by 40%.

In Tanzania, we learned that a locally available plant, Lantana camara, which grows in much of Sub-Saharan Africa, is a natural mosquito repellent. Our experience of working with community members to introduce the plant yielded remarkable results: the homes with Lantana camara had over 55% fewer malaria transmitting mosquitoes, aiding in malaria prevention. By planting these around homes, people’s lives are now being saved.

A close up of the malaria-fighting Lantana plant.

Concern found that homes with Lantana camara planted around them had as much as 55% fewer malaria-carrying mosquitoes.

Since 2000, UNICEF estimates malaria deaths have decreased by 40%. Concern Worldwide is proud to contribute to the robust progress toward reducing the malaria burden and salutes partners who are championing cutting-edge approaches and technology like the development of a vaccine to eliminate malaria.

However, this progress is not without expense: management of malarial illness cost Sub-Saharan Africa $300 million per year and 1.3% of overall GDP in Africa. And despite such investments, climate variations are increasing and weather-related events are becoming more frequent and severe, threatening progress made toward elimination of malaria and posing a global public health risk.

Vector-borne diseases are already emerging in new areas and the time is now to invest in defeating preventable illnesses such as malaria, before they spread further. Considered by UNICEF as a best buy in global health, the return on investment is high: the world is poised to gain an estimated $270 billion and save countless lives by eliminating malaria in Sub-Saharan Africa.

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