Is Malaria a neglected disease? And will the world be free from malaria by 2040?

According to the World Health Organization (WHO), there is an estimated one billion people in 149 countries suffering from neglected tropical disease.[1] A total of 17 diseases are classified under this category and malaria is not included. Isn’t this surprising?

So what is the definition for neglected disease? 

Any disease affecting a large number of people, especially in developing nations, who receive little attention from governments, medical researchers, and pharmaceutical companies. Examples of neglected diseases include Chagas disease, leishmaniasis, malaria, malnutrition, sleeping sickness, and tuberculosis.

Source: Medical Dictionary, ©2009 Farlex and Partners

Key Statistics from 2016 World Malaria Report[2]

  • In 2015,  there was an estimated 212 million cases of malaria worldwide and 429,000 deaths.
  • Of the discovered malaria cases, 90% occurred in WHO Africa Region, 7% in WHO Southeast Asia Region and the remaining 2% in WHO Eastern Mediterranean Region.

The number of infected cases already speaks for itself. To add-on to these figures, we see that malaria affects mainly the developing countries.[3] Malaria is indeed a neglected disease.

Will the world be free from malaria in 2040?

Although between the year 2010-2015, malaria contraction has decreased by 21% globally,[2] the numbers are still worrying.

malaria-worldmap
Countries endemic for malaria in 2000 and 2016. Source: 2016 World Malaria Report.[2]
If we are to refer to the green coloured part of the world map above, we can see that from 2000-2016, only a few countries have managed to eradicate malaria. A country is declared free from malaria if there is no reported indigenous cases for a consecutive three years.[2]

At the rate things are going, it is still a question mark whether the world can achieve its target of becoming malaria-free by 2040.

Challenges

Absence of vaccine[4]

There is no vaccine against malaria and there are only two ways to protect yourself from malaria:

Prevent getting bitten by mosquitoes.[4] From my own experience, I have found it extremely difficult to avoid mosquitoes. Even when I wear long sleeves and put on mosquito repellent, I still get bitten by mosquitoes very frequently. I believe a number of readers here will agree with me!

(Note: mosquitoes in some parts of the world have become resistant to permethrin and deltamethrin insecticides.)[5]

Chemoprophylaxis.[4] Chemoprophylaxis was found to be effective only when taken regularly and previous studies have indicated poor compliance which could have been attributed to peer pressure or adverse reaction to the drug.

Funding

An estimated US $2.9 billion was poured into malaria control and elimination in 2015.[2] Although the amount of funding compared to that in 2003 has increased substantially,[6] additional investments would still be required to reach the milestone of 2040 in achieving a completely malaria-free world.

Lack of standardised recommendations, controversies and misconceptions[4]

The lack of standardised recommendations posed a serious health hazard for travellers travelling to malaria-infected countries. In recent years, Latin America has seen a decline in malaria cases and some travellers to the region were not recommended Chemoprophylaxis as a preventive drug.

In Brazil, controversies exist where recommendation for Chemoprophylaxis is dependent on a case-by-case basis where the guideline states that the risk of adverse reaction to this drug must be lower than the risk of becoming ill from a certain strain of malaria (P. falciparum).

Misconceptions such as developing resistance to malaria by the constant taking of Chemoprophylaxis has also emerged in Brazil.

Climate[7]

Malaria is endemic in tropical and subtropical regions. Countries particularly susceptible to malaria are in Africa South of the Sahara and in parts of Oceania such as Papua New Guinea. 

Tropical and subtropical regions encourage risk high incidence rate of malaria because the climate supports 1) the survival and multiplication of Anopheles mosquitoes,[8] and 2) the “growth cycle[9] of malaria parasites.

With the mounting challenge posed by malaria, it remains to be seen whether the world can achieve its status of being malaria-free in 2040. In my opinion, the goal will be sustainable if everyone works together in terms of funding and research, as well as develop a vaccine to rid malaria once and for all.

References:

  1. Neglected tropical diseases. World Health Organization; 2017 [cited 2017 Feb 12]. Available from:http://www.who.int/neglected_diseases/diseases/en/
  2. World Malaria Report 2016. Geneva: World Health Organization; 2016.
  3. Impact of Malaria. Centers for Disease Control and Prevention; 2016 [cited 2017 Feb 12]. Available from:https://www.cdc.gov/malaria/malaria_worldwide/impact.html
  4. Chaves TdSS, Monteiro WM, Alves JR, Lacerda M, Lopes MH. Pre-travel malaria chemoprophylaxis counselling in a public travel medicine clinic in São Paulo, Brazil. Malaria Journal. 2017;16(1):64.
  5. Malaria – Prevention. WebMD; 2015 [cited 2017 Feb 12]. Available from:http://www.webmd.com/a-to-z-guides/tc/malaria-prevention#1
  6. World Malaria Report 2009. Geneva: World Health Organization; 2009.
  7. Where Malaria Occurs. Centers for Disease Control and Prevention; 2010 [cited 2017 Feb 12]. Available from:https://www.cdc.gov/malaria/about/distribution.html
  8. Anopheles Mosquitoes. Centers for Disease Control and Prevention; 2015 [cited 2017 Feb 12]. Available from:https://www.cdc.gov/malaria/about/biology/mosquitoes/index.html
  9. Biology. Centers for Disease Control and Prevention; 2016 [cited 2017 Feb 12]. Available from:https://www.cdc.gov/malaria/about/biology/index.html
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