Malaria is a life-threatening disease caused by parasites transmitted through mosquito bites. Globally, malaria incidence and mortality rates have declined in recent years due to increased funding for prevention and treatment efforts. However, malaria remains a major public health problem in many developing countries, especially among young children in sub-Saharan Africa. Effective control relies on a combination of vector control strategies, prompt diagnosis and treatment, and community education.

2.  Malaria is a life-threatening disease caused by parasites
 Globally, 91 countries had ongoing malaria transmission (2015)
 Malaria is preventable and curable
 Globally, Malaria incidence & malaria mortality rates among
populations at risk fell by 21% and 29% respectively (2010-2015).
 Successes factors, including increased funding, effective vector
control, strengthening of health systems, improved case
management with more effective treatment regimens, and
improved case reporting and surveillance
(Cotter et al., 2013)
2

3.  Malaria is caused by Plasmodium parasites (5 species)
 In humans, P. Falciparum and P. Vivax – pose the
greatest threat, as it is responsible for most malaria-
related deaths globally
 P. Falciparum dominant in Africa and P. Vivax is
dominant outside of sub-Saharan Africa.
 Others – P. Ovale, P. Malariae and P. Knowlesi
3

4.  In 2015, nearly half of the world's population was at
risk of malaria.
 High risk groups;
 infants,
 children under 5 years of age,
 pregnant women,
 patients with HIV/AIDS,
 non-immune migrants, mobile populations and
travellers.
4

5.  More than 85% of malaria cases and 90% of malaria
deaths occur in sub-Saharan Africa, mainly in young
children
 Regions with tropical climate
Picture from Health24.com
5

6.  The increasing proportions of adults and men among
all malaria cases
 Due occupational and behavioral factors outside the
home that put these groups in contact with infective
vectors
 Plantation work, forest activities, charcoal producers,
and gold miners that expose them to outdoor biting
vectors
(Cotter et al., 2013)
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7. 7

8. 8

9.  P.Falciparum (29%) and P.Vivax (67%)
 The incidence rate has declined to less than 1 per 1,000
population since 1998.
 The mortality rate has been around 0.001 per 1,000
population since 2006.
(WHO) (MOH Malaysia)
Picture from PIXNIO.com
9

10.  As a result of
 environmental change
 reducing rates of the other human malaria species.
 the removal of habitat
 malaria control activities
 change in vector behaviour, or a vector shift, vector An.
Balabacensis appears to have been displaced by An. Donaldi
 In Sabah, P. Knowlesi is now the most common cause of malaria,
and based on current trends, is likely to become increasingly
dominant and may extend to previously unaffected districts
(William et al., 2013)
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11. 11

12. Picture from Wikipedia
12

13.  As the malaria parasites
enter the blood stream
they infect and destroy
red blood cells.
Destruction of these
essential cells leads to
fever and flu-like
symptoms, such as:
13

14.  These initial symptoms are non-specific: in other
words, they are self-reported symptoms that do not
indicate a specific disease process.
 The classic symptom of malaria is paroxysm a cyclical
occurrence of sudden coldness followed by shivering
and then fever and sweating, occurring every …
14

15.  The pattern of temperature
changes may occasionally hint
at the diagnosis: ???
intermittent
fever, D
15

16.  Appearance of the Patient
 The appearance of the patient depends on the stage of the
disease.
 The patient may be ill-looking, shivering and sweating. Fever
is often present.
 In more severe cases of the disease, the patient may
appear anemic, with jaundice or even coma.
 Temperature - A fever is often present
 Pulse Rate – Tachycardia may be present
16

17.  Blood Pressure - Hypotension may be present (severe
cases)
 Respiratory Rate – Tachypnea may be present
 Skin – either cyanosis, jaundice, pallor or petechiae may be
present
 Eyes – either icteric sclera or conjunctivae pallor may be
present
 Nose – alar flare, where there may be respiratory distress)
 Throat – may be erythematous 17

18.  Lungs – pulmonary edema may be present,
consolidation may be present, or intercostal retraction
 Abdomen – abdominal distention, hepatomegaly or
splenomegaly may be present
 Genitourinary – hematuria may be present (in severe
hemolysis)
18

19.  Extremities
 Cyanosis may be present (in severeanemia)
 Edema may be present (in severe disease, where
there may be renal failure)
 Neurologic
 Coma may be present (in cerebral malaria)
 Mental status may be altered
 Convulsion may occur
19

20. 20

21.  According to the WHO, there were 212 million new
cases of malaria worldwide in 2015 (range 148–304
million).
 The WHO African Region accounted for most global
cases of malaria (90%), followed by the South-East
Asia Region (7%) and the Eastern Mediterranean
Region (2%).
21

22.  In 2015, there were an estimated 429 000 malaria
deaths (range 235 000 – 639 000) worldwide. Most of
these deaths occurred in the African Region (92%),
followed by the South-East Asia Region (6%) and the
Eastern Mediterranean Region (2%).
 In 2016, there were an estimated 216 million cases of
malaria in 91 countries, an increase of 5 million cases
over 2015.
22

23.  Children under 5 are particularly susceptible to
malaria illness, infection and death.
 In 2015, malaria killed an estimated 303 000 under-
fives globally, including 292 000 in the African Region.
 Between 2010 and 2015, the malaria mortality rate
among children under 5 fell by an estimated 35%.
Nevertheless, malaria remains a major killer of under-
fives, claiming the life of 1 child every 2 minutes.
23

24.  In the period 1965 to 1990, countries where malaria
was common had an average per capita GDP that
increased only 0.4% per year, compared to 2.4%
per year in other countries.
 Poverty can increase the risk of malaria since those in
poverty do not have the financial capacities to prevent
or treat the disease. In its entirety, the economic
impact of malaria has been estimated to cost Africa
US$12 billion every year.
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25. 25

26. 26

27. 28

28. 29

29. https://www.youtube.com/watch?v=QwEkGCjbbJ8
30

30. Bites of female Anopheles mosquito (vector
transmission)
Mother to the growing
fetus (Congenital malaria)
Transfusion Malaria
Needle stick injury
31

31.  In most cases, malaria is transmitted through the
bites of female Anopheles mosquitoes.
 There are more than 400 different species
of Anopheles mosquito; around 30 are malaria
vectors of major importance.
 Mosquitoes are the definitive hosts for the malaria
parasite.
32

32. Source/Malaria site 2015 33

33. Congenital malaria, occurring as a result of vertical
transmission of parasites from mother to child during
pregnancy or prenatally during labor is a rare clinical
condition .
34

34.  Malaria can be transmitted by transfusion of blood from infected
donors. First reported in 1911, transfusion malaria is one of the most
common transfusion-transmitted infections today.
 The risk of transmission is higher in transfusion of fresh, whole blood,
particularly when the blood has been stored for less than 5 days and
the risk is considerably lesser after 2 weeks.
(malaria site 2015)
Needle stick
Cases of malaria transmission through needle-stick injuries, accidentally
among health care professionals or due to needle sharing among drug
addicts.
(malaria site 2015)
35

35. Modifiable
and non
modifiable
risk factors
Vectors factors
Environmental
factors
Human factors
36

36.  Temperatures between 16 and 40°C
Warm climates with temperatures
over 15C provides suitable breeding
ground for anopheles mosquito
 Humidity over 60%
 Rainfall
 Stagnant water
 Area of vegetation provide shade for
the mosquito to hide during the day
and digest the blood meal from the
night before
37

37.  Genetic Factors
Biologic characteristics present
from birth can protect against certain
types of malaria e.g., the prevalence of
hemoglobin-related disorders
(sickle cells anemia ,G6PD , Duffy
negative).
 Age
Younger children have risk of
getting severe malaria more than adults.
 Pregnant women
Are more likely than non
pregnant women to get severe
malaria.
38

38.  Immunity
 Individual with low immunity
(HIV) at high risk of getting
sever malaria than the normal
one.
 young children who live in
malaria areas and travelers to
these areas are especially at
risk for getting malaria
because they have not
developed immunity.
39

39.  Behavioral factors
 Agriculture
oIncrease in the number of irrigation
projects
ohas increased the risk of malaria as
it provides
oeven more breeding grounds for
mosquitoes
 Migration
 Urbanisation & Human
development
 Poverty the risk of infection
40

40. Man-vector contact and mosquito density determine the
transmission capacity of a vector /population
o A reduction in the lifespan of the mosquitoes will reduce
the sporozoite rate and hence the proportion of infective
bites.
o A reduction in the human/vector contact will decrease the
proportion of blood meals taken on human hosts.
o A reduction of vector density by decreasing the number of
adult or larvae will also reduce transmission intensity.
41

41. 42

42.  Worldwide, global malaria incidence decreased by 17%
and malaria-specific mortality rates reduced by 26%
from 2000- 2010. (WHO World Malaria Report)
 Most investments and efforts have been directed
towards high burden countries and impressive
accomplishment have been made in malaria-
eliminating countries including South Africa,
Mesoamerica, Central Asia and Asia Pacific region.
 Malaysia is one of the 34 malaria-eliminating countries
43

43. 44

44.  Reported malaria cases from these 34 countries has
decreased by 85% from 2000 to 2010 (from 1.5 million
cases to 232 000)
 In the same period 25 countries reduced the cases by
more than 70% while another 17 countries reduced the
cases by 90%
REGION REDUCTION IN MALARIA
CASELOAD
Asia Pacific 79%
Latin America 86%
Sub-Saharan Africa 92%
Middle East, Europe, Central
Asia
96%
(WHO World Malaria Report) 45

45. (Feachem RG et al 2010)
46

46. (WHO World Malaria Report 2010)
47

47.  Increased funding -up to $8.5 billion :(Funding by
WHO,Global Fund and other partners)
 Effective vector control
 Strengthening health system
 Level of investment in countries with malaria
 Improve case management with improved case reporting
 Improved surveillance
 Biological determinants: attack remaining parasite
reservoir
 Social determinants: urbanisation and improved housing
 Political and economic factor: ( on average,there was an
increase in GDP of 3.5% annually in the 34 countries)
48

48.  Active and passive surveillance
 Diagnostic- new and sensitive methods are needed to
detect all Plasmadia species infections
 Mass drug administration (MDA)- widely used in China
and Russia, but little evidence of its efficacy and no
guidelines
 Occupation-based vector control
 GAVI Alliance
 Similarly, a focused campaign led by The Global Fund to
Fight AIDS, Tuberculosis and Malaria (Global Fund),
increased funding for malaria elimination by more than 18-
fold between 2000 and 2011, contributing to a significant
reduction in the incidence of malaria in 34 endemic
countries 49

49.  Case control studies
 Genotyping
 Use of network
 Promotion of changes of receptivity
 Multicountry and regional effort – E8 and APMEN
 Vaccines in elimination setting
(Chris Cotter et al 2013)
50

50.  Migration and imported malaria ( example
reintroduction of Malaria to Greece, stringent border
control South Korea vs North Korea)
 Poor access to remote areas
 Diversity of vectors (varying biting and breeding
behaviours)
51

51.  P Vivax infection (P Falciparum has been control but P
Vivax is still a challenge and causes morbidity and
mortality)
 Other Plasmodium infections (Plasmodium knowlesi
has a macaqey monkey reservoirs in Borneo and other
parts of South East Asia). Frequently misdiagnosed as
P malariae
 Increased cases of malaria among adult and men (due
to occupational reasons and outdoor activities)
(Yangzom T et al 2012, Abeyasinghe RR t al 2012)
 Asymptomatic and low-density infections
52

52. Pictures from hubpages.com
53

53. 0
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100000
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1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Malaria Cases
Malaria Cases
Malaysian
Malaria
Eradication
Programme
1961-
1981
National
Malaria
Control
Programme
1982-
2004
National
Malaria
Elimination
Plan,
2011–2015
54

54. 243870
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0
50000
100000
150000
200000
250000
300000
1961
1965
1970
1975
1980
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Malaria Cases
Malaria Cases
Mandatory
notification-
Prevention and
Control of
Infectious
Disease Act of 1988
1990-
Adopted
Primary
Health
Care
Approach
to malaria
control
1995
-ITN
distribution
with
retreatment
every six
months
1998-
transitioned
from DDT to
pyrethroid
insecticides for
IRS
2000 -
eVekpro &
eNotifikasi
2003- National
Anti-malarial
Drug Response
Surveillance
programme
55

55. 56
Increased Indoor residual spraying
(IRS) with
Dichlorodiphenyltrichloroethane
(DDT)
Improvements in passive case
detection

56. 57
Indoor residual spraying (IRS) with pyrethroid insecticides
Distribution of insecticide treated nets (ITN)
Mass blood screenings
Entomological surveillance
Geographic reconnaissance
Health education
Collaborates with endemic countries
Monitoring and evaluation systems - eVekpro & eNotifikasi

57. 58
building strong surveillance systems
vector control using the Integrated Vector Management
(IVM) approach
early detection of infection and prompt treatment
preparedness and outbreak response
communication and social mobilization
capacity building
operational research
ZERO local transmission in West Malaysia
by 2015, and in Sabah and Sarawak by 2020

58. Picture from thedrum.com
59

60.  Most collected malaria incidence data is from
government health facilities while data from a wide
variety of other known sources are often not included
in national surveillance databases.
 In particular, there needs to be a concerted regional
effort to support inclusion of data on mobile and
migrant populations and the private sector.
 There should also be an emphasis on electronic
reporting and data harmonization across
organizations.
61

61.  Mercado,Ekapirat, Dondort & Maude (2017)
 2015–2016, a short questionnaire on malaria surveillance
was distributed to 22 country National Malaria Control
Programmes (NMCP) in the Asia Pacific
 Malaysian is one of the country that participate in the
research
 The findings were used to produce recommendations for
the regional heads of government on improving malaria
surveillance to inform regional efforts towards malaria
elimination.
 Most of the malaria incidence data collected by NMCPs
originated from government health facilities, while many
did not collect comprehensive data from mobile and
migrant populations, the private sector or the military
62

62. 63

63.  The surveillance tools -mix of routine reporting systems
 website and mobile phone based (mHealth) solutions that would
enable resource constrained environments to provide real-time data
for immediate action
 Mobile phone programmes
 serve as the access point for entering patient data into
national health information systems, and
 as remote information tools that provide information to
healthcare clinics, home providers, and health workers in the
field
 Using simple coding but deliver same message
 Empowerment of village health worker
64

64. eHEALTH (EXCLUDING MOBILE
DEVICES)
mhealth
Very few people have access to
PC/web/email
Most people have access to a mobile
phone
Users more educated and affluent Users not defined by education or
wealth
Easier to create applications harder to create applications
Not dependent on communications
people
Very dependent on communications
people and telecoms companies
Trendy and exciting ten years ago The next big thing
65

65. 66

66. 67

67.  Change of conventional method
 Snow ball sampling, hard to reach population
 Respondent drive sampling
 Identify, treat and prevent infections that would
otherwise unaddressed
68

68.  strengthen multi-agency collaboration
 Informal and formal
 Enhanced Interagency collaboration and PHC
volunteers participation in Malaria control and
prevention activities
 Broader sector not only focus on plantation only
 mining, deforestation and construction
69

69.  continue fostering strong relationships with nearby
countries’ NMCPs, particularly Indonesia, the
Philippines and Myanmar
 Increased lesson sharing to tackle common challenge
and direct co-operation with neighbouring countries
to address specific border issuer
 Better gather information about migration routes and
patterns and develop more targeted border screening
techniques for high risk groups
70

70.  Malaria eliminating country, malaria case become rare,
difficult to diagnose, and affect specific population
 Health care worker need continual training to maintain
knowledge regarding malaria
 Occupational-based vector control
 through indoor residual spraying and Insecticide-treated net
– protect the household
 Tropical repellent such as N, N-diethy-3-methylbenzamide
(DEET), botanicals, citronella
 Insecticide- treated hammock – Vietnam
 Policy making
 Implement employer policies to screen and treat employees
for malaria before they can obtain work permit
71

71. Picture from REUTERS/Paulo Whitaker 72

72.  Cotter, C., Sturrock, H. J. W., Hsiang, M. S., Liu, J., Phillips, A. A., Hwang, J., …
Feachem, R. G. A. (2013). The changing epidemiology of malaria elimination:
New strategies for new challenges. The Lancet, 382(9895), 900–911.
 Malaria Consortium. (2013). Moving towards malaria elimination Developing
innovative tools for malaria surveillance in Cambodia, 1:28.
 Malaria Site https://www.malariasite.com
 Mercado, C. E. G., Ekapirat, N., Dondorp, A. M., & Maude, R. J. (2017). An
assessment of national surveillance systems for malaria elimination in the Asia
Pacific. Malaria Journal, 16(1), 127.
 Ministry of Health Malaysia. (2013). Management Guidelines Of Malaria In
Malaysia. Ministry of Health Malaysia, 1–59.
73

73.  Nani Mudin, R. (2013). Malaria: Battling Old Disease with New Strategies. 5th Perak
Health Conference, (October).
 Natacha,P, Wim,V, Niko, (2009) Ranking Malaria Risk Factors to Guide Malaria Control
Efforts in African Highlands
 WHO. (2015). Eliminating. Eliminating Malaria: Case Study 8. Progress towards
Elimination in Malaysia, 78.
 WHO. (2016). World Malaria Report. World Health Organization.
 William, T., Rahman, H. A., Jelip, J., Ibrahim, M. Y., Menon, J., Grigg, M. J., … Barber, B.
E. (2013). Increasing incidence of Plasmodium knowlesi malaria following control of P.
falciparum and P. vivax malaria in Sabah, Malaysia. PLoS Neglected Tropical Diseases,
7(1), e2026.
 World Health Organization, W. (2015). Eliminating Malaria. Progress Towards
Elimination in Malaysia, 1–61. 74