The syllabus says
Geographic factors and impacts [of disease]
- Examine the geographic factors responsible for the incidence and spread of two diseases.
- Evaluate the geographic impact of these two diseases at the local, national and international scales.
- Evaluate the management strategies that have been applied in any one country or region for one of these diseases.
Key terms
Vector - living organisms that can transmit infectious diseases between humans or from animals to humans
ITN - Insecticide-treated bed nets
Malaria - a disease of fever, blood loss and vomiting caused by a parasite transferred by mosquitos
Water-borne disease - any illness that is transmitted through a population by water
Vector-borne disease - any illness that is spread through a vector e.g. mosquitos
Sexually transmitted disease - any illness that is spread through sexual contact between humans
SSA – Sub-Saharan Africa
ITN - Insecticide-treated bed nets
Malaria - a disease of fever, blood loss and vomiting caused by a parasite transferred by mosquitos
Water-borne disease - any illness that is transmitted through a population by water
Vector-borne disease - any illness that is spread through a vector e.g. mosquitos
Sexually transmitted disease - any illness that is spread through sexual contact between humans
SSA – Sub-Saharan Africa
Why malaria?
The study of malaria is of world importance. It is so significant it was identified as a key part of one of the Millennium Development Goals (6c).
Source: http://www.un.org/millenniumgoals/aids.shtml
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MDG Target 6C. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
The following data was taken from the UN site on the MDGs.
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Malaria in Kenya
This page largely focuses on a case study of Kenya. As the map to the right shows, Kenya experiences malaria all year round in some areas. The case study of malaria in Kenya can also relate to other parts of the course:
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Source: http://www.adventurebeyond.co.uk/expeditions/kenya-and-tanzania/essential-information-kenya-and-tanzania.html
The spread of malaria: How and why is it passed on from person to person?
Malaria has proved very difficult to eradicate for a number of reasons. One of them is the relative ease with which it is passed from person to person. The first half of the video below outlines how the disease works.
Impact at the international scale
The following information is taken from these sources:
http://www.who.int/topics/millennium_development_goals/diseases/en/
http://www.who.int/gho/malaria/en/
The impact is not just demographic. There are severe economic impacts too:
And, it is difficult to assess the social impacts. These include the inability to spend money on non-healthcare welfare strategies, education, days lost from school by infected children, and the emotional stress of losing family members.
http://www.who.int/topics/millennium_development_goals/diseases/en/
http://www.who.int/gho/malaria/en/
- 3.2 billion people worldwide are at risk of contracting malaria.
- In 2013, an estimated 198 million cases occurred, and the disease killed approximately 584 000 people
- On average, malaria kills a child every minute
- 207 million estimated cases in 2012
- 627,000 estimated deaths in 2012
The impact is not just demographic. There are severe economic impacts too:
- Countries with intensive malaria grew 1.3% less per person per year, and a 10% reduction in malaria was associated with 0.3% higher growth
- Direct costs (for example, illness, treatment, premature death) have been estimated to be at least US$ 12 billion per year
And, it is difficult to assess the social impacts. These include the inability to spend money on non-healthcare welfare strategies, education, days lost from school by infected children, and the emotional stress of losing family members.
The maps below show the world changes in malaria. It can be seen that most areas are significantly reducing the impact of malaria.
Source: http://www.who.int/gho/malaria/malaria_003.jpg?ua=1
Source: http://www.who.int/gho/malaria/malaria_008.pdf
The following information is taken from various sources:
http://www.who.int/topics/millennium_development_goals/diseases/en/
http://www.who.int/gho/malaria/en/
http://www.who.int/topics/millennium_development_goals/diseases/en/
http://www.who.int/gho/malaria/en/
- 20 of the 97 countries with ongoing malaria transmission are classified by WHO as being in either malaria pre-elimination or elimination phase
- Based on reported data, 59 out of 103 countries that had ongoing malaria transmission in 2000 are meeting the Millennium Development Goal (MDG) target of reversing the incidence of malaria.
- Of these, 52 are on track to meet Roll Back Malaria (RBM) and World Health Assembly targets of reducing malaria case incidence rates by 75% by 2015, including 8 countries of the WHO African Region.
National and local impacts: Kenya and Sub-Saharan Africa
Malaria in Kenya
The following information is taken from USAID's President's Malaria Initiative. The initiative itself is described later on this page.
The following information is taken from USAID's President's Malaria Initiative. The initiative itself is described later on this page.
- 2013 population 44.3 million people, with an estimated population growth of 2.7% per year
- Children under age five account for 16% and children under age 15 account for 42%.
- Kenya is ranked 147 out of 187 countries on the 2014 United Nation's Human Development Index
- Life expectancy in Kenya has seen an overall downward trend since the late 1980s but has recently increased to an estimated 62 years in 2013
- Expenditure on health increased slightly from 4.1% of the gross domestic product in 2004 to 4.5% in 2013
- Per capita health expenditures also rose from $19 in 2000 to $45 in 2013
- The mortality rate in children under five years of age has declined by 55% from 115 deaths per 1,000 live births in the 2003 Kenya Demographic and Health Survey (DHS) to 52 deaths per 1,000 observed in the 2014 DHS
Source: http://www.internewskenya.org/dataportal/categorylist/11
The local impacts of malaria in Kenya can be seen through infographics like these. Click on this link to see a wider variety of infographics that all describe the impact of malaria in Kenya.
Source: http://www.internewskenya.org/dataportal/categorylist/11
National impacts are similarly large. The impact of business is estimated by the Global Competitiveness Report in the graph below.
Intervention strategies
The graphic below is taken from the World Malaria Report 2015. It shows the strategies used in Kenya to combat malaria. Note the number of strategies that are not used; this is either because of a lack of money to invest, or the insufficient staffing.
The graphic below is taken from the World Malaria Report 2015. It shows the strategies used in Kenya to combat malaria. Note the number of strategies that are not used; this is either because of a lack of money to invest, or the insufficient staffing.
Source: http://www.who.int/malaria/publications/country-profiles/profile_ken_en.pdf
The figures for malaria are very difficult to ascertain because of the remote and poor nature of many of the communities that suffer malaria. However, there are many strategies that have been shown to work:
- Bed nets - these prevent being bitten while asleep, which is the most common time as the person isn't moving. However, in 2001 fewer than 2 percent of African children sleep under protective bed nets (see graph below)
- Drugs - there are several anti-malarial drugs, but chloroquine-resistant malaria is increasing requiring a new approach
- Drugs packaging - often the drugs in the past contained instructions that were difficult to understand. New packages have easier labelling and encourage the drug to be taken correctly
- Roll Back Malaria - a global partnership, aiming to bring together the best strategies in a comprehensive framework. It includes targets to reduce the impact of malaria. It includes the awareness-raising World Malaria Day
Source: http://www.un.org/millenniumgoals/2014%20MDG%20report/MDG%202014%20English%20web.pdf
National scale intervention: USAID and The President's Malaria Initiative (PMI)
The following information is sourced from the USAID PMI.
A major change in the provision of malaria prevention and treatment has been from a 'top down' to a 'bottom up' approach. In 2013 Kenya began a process of devolution removing the reponsibility for malaria from two government departments to eight provincial authorities. These more closely reflect the varying levels of malaria found in different parts of Kenya. However, the government has operated a National Malaria Control Strategy since 2009 which feeds into the Kenya Malaria Strategy, with the current plan operating from 2014-18.
The following information is sourced from the USAID PMI.
A major change in the provision of malaria prevention and treatment has been from a 'top down' to a 'bottom up' approach. In 2013 Kenya began a process of devolution removing the reponsibility for malaria from two government departments to eight provincial authorities. These more closely reflect the varying levels of malaria found in different parts of Kenya. However, the government has operated a National Malaria Control Strategy since 2009 which feeds into the Kenya Malaria Strategy, with the current plan operating from 2014-18.
The Kenya Malaria Strategy involves several interventions:
Vector Control
Vector Control
- target of 80% of the at-risk population using appropriate malaria prevention interventions, including ITNs and IRS by 2018.
- universal ITN coverage (i.e., one net for every two people) for all groups at in malaria-endemic and epidemic-prone counties through regular ITN distribution campaigns, carried out every three years in targeted geographic areas, routine distribution through antenatal care clinics, social marketing of nets particularly in designated rural counties, and commercial sales of ITNs in the private sector.
- ensure that 100% of all suspected malaria cases receive a diagnosis and effective treatment with the
- community health volunteers receive training and supervision for case management of malaria, prevention, behavior change communication, record keeping and reporting
- increase utilization of all malaria control interventions by at-risk communities in Kenya to at least 80%
- emphasis will be placed on using interpersonal communication approaches by volunteers, community-based organizations and special interest groups to target hard-to-reach populations
- traditional channels of communication (e.g., television, radio, print, mobile phones) will be used
- Surveillance, monitoring and evaluation and operational research are vital for tracking the progress of malaria prevention and control activities.
Local scale intervention: Millennium Villages Project in Sauri, western Kenya
Source: http://www.nytimes.com/2010/03/09/world/africa/09kenya.html?_r=0
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The management strategies applied in Kenya can be seen through the example of Millennium Development Villages, a project that aims to reduce the wide ranging problems that are associated with poverty one village at a time. This video outlines how healthcare has been improved in the area of Sauri, shown on the map (left).
The village is in the warm, humid part of Kenya which makes malaria a year-round feature. The MVP (Millennium Villages Project) in Sauri covers 11 villages covering 132 square kilometers. When the MVP started operating in Sauri, almost 80% of the population earned less than $1 per day, and 59% of children under five exhibited stunting, a sign of chronic malnutrition. Through the changes made to not just malaria intervention, but also poverty reduction efforts, malaria in Sauri reduced from 50% to 8% between 2000 and 2012 (check figures!). |
Partly this has been due to the improvement in treatment and testing. Rapid Diagnostic Tests (RDTs) have been introduced which allow around 100 tests to be done per day by one technician, instead of 30-40 prior to 2011.
Has it worked?
One of the biggest problems is collecting data in Kenya. As a result, figures are hard to come by. The graphs below show information that is available.
One of the biggest problems is collecting data in Kenya. As a result, figures are hard to come by. The graphs below show information that is available.
What needs to happen?
The Gates Foundation has spent millions on malaria reduction in Africa. The video below outlines Bill Gates' view on the progress that is being made, and the links with education.