Malaria
Malaria threatening disease caused by parasites that are transmitted to humans through the bites of infected mosquitoes.
Malaria has claimed, in 2013, the lives of about 584 000 people (uncertainty range: from 367 000 to 755 000), most of them African children.
Malaria, a disease that can be prevented and cured.
Contribute to an increase of malaria prevention and control measures, to a large extent now, in reducing the burden of this disease in many countries.
Travelers who do not have immunity against malaria and coming from free areas at risk dramatically when exposed become infected.
According to the latest estimates, published in the December / December 2014, that the number of malaria cases stood at 198 million cases in 2013 (uncertainty range: from 124 million cases to 283 million cases) and the number of mortality amounted to nearly 584 000 deaths (uncertainty range: 367000 - 755000) in the same year. Malaria mortality rates have fallen by more than 47% globally since 2000, and by about 54% in the African Region of the World Health Organization.
It is worth mentioning that most of the die due to this disease are children living in Africa, where it does not pass only one minute and a child dies from malaria. The malaria mortality rates have declined among children in Africa by nearly 58% since 2000.
Malaria is caused by parasites of the species Plasmodium that are transmitted among humans through the bites of Anopheles mosquito species that carries her, which is called "malaria vectors", which bite people in the period between dusk and dawn the first place.
There are four types of Plasmodium that cause human malaria:
Plasmodium falciparum
P. vivax
Plasmodium malariae
P. ovale
Plasmodium falciparum and P. vivax is more common factions. However, Plasmodium falciparum is the most deadly to people factions.
As noted, in recent years, human cases of malaria caused by Plasmodium Alnolcih- which infect monkeys and malaria occur in some forest areas of Southeast Asia.
The entry into force of the disease
Malaria apply only through the bites of mosquitoes of the genus Anopheles. And the pace of entry into force depends on factors related to the parasite carrier and human Althwai and the environment.
There are about 20 different genera of Anopheles species that are important at the local level all over the world. It is worth mentioning that all the important races carrying the disease bites during the night. And multiply those races in the water and each has a favorite place for breeding; some of them prefer to reproduction, for example, in fresh shallow water, such as ponds and rice fields and the effects of hooves on the ground. It is noticeable that the pace of entry into force of the disease much in places where mosquitoes relatively long life of the carrier (which can complete the growth of the parasite inside the mosquito) or if preferred mosquito bites humans instead of animals. The length of life of the African vector species and tendencies cycle bites to humans strongly of the things that explain, for example, the reason for the occurrence of more than 90% of malaria deaths in Africa.
The validity of the disease also depends on weather conditions that may affect the number of mosquitoes and survival, such as precipitation patterns, temperature and humidity. Notably, in many places, that the validity of the disease and a seasonal peak during the rainy season and immediately after. And malaria epidemics can occur when help climatic conditions and other circumstances, suddenly, the validity of the infection in areas where people did not have little immunity to the disease, or they do not have immunity to it at all. As such epidemics can occur when people move from low immune to areas where the disease intensifies into force and to look for work, or for the purposes of asylum, for example.
HIV and represent one of the other important factors that affect the validity of malaria, especially among adults in areas where the disease into force moderately or intensely. And formed a partial immunity as a result of exposure to the disease for years, however it does not offer full protection against the disease, it contributes to the reduction of the infection to the development of severe illness. Therefore, the most malaria deaths recorded in Africa occur among young children, while noting displays all age groups at risk in areas where at least the entry into force of the disease and reduced the proportion of HIV.
Symptoms
Malaria acute febrile diseases. Show symptoms, in people who have no immunity against it, after seven or more days (10 days to 15 days in most cases) of exposure to pregnant mosquitoes bite him. Symptoms may be Alooly- fever, headache, vomiting and shivering light may be difficult to be attributed to malaria. And it can develop falciparum malaria, if not treated within 24 hours, to severe illness leading to death in many cases. And it appears on children with severe cases of one or more of the following symptoms: severe anemia, or respiratory distress as a result of the injury Bhmad metabolic, or cerebral malaria. Usually seen in adults also multiple members of their bodies exposed. , Partial immunity against the disease may appear in some people in areas where malaria is endemic, which explains the occurrence of asymptomatic cases.
He spoke, in patients with active malaria and malaria ovale both clinical relapses after weeks or months of exposure to the first infection, even if the patient had left the area where the disease is valid. He spoke of those new episodes due to parasites "dormant" in the liver (not found in falciparum malaria, malaria malariae). It must be provided Special-treatment aimed at those stages Alqaibdih- to ensure full recovery.
Who are the high-risk groups?
Almost half the world's population faces the risk of malaria. Most cases and deaths occur in sub-Saharan Africa. However, Asia and Latin America, and to a lesser extent, the Middle East and parts of Europe are also experiencing the incidence of the disease. 97 countries and territories have witnessed the continuation in force of malaria in 2014.
And at-risk groups in particular are:
Young children living in areas where the disease is valid stable pace and who have not yet made up their immunity to protect them against the most severe forms of the disease.
Pregnant women who do not possess the necessary immune, since Malaria causes high rates of spontaneous abortion and can cause the death of the mother;
Pregnant women who do not possess a sufficient degree of immunity, in areas where the disease is strongly applies. And that malaria can lead to miscarriage and low birth weight, especially during the first pregnancy and the second pregnancy.
HIV-positive pregnant women who do not possess a sufficient degree of immunity, in areas where malaria apply a stable pace vulnerable, strongly, to the risk of infection during pregnancy whatever rank. As facing women with malaria infection in the placenta, more than others, the risk of transmission of HIV infection and to Danhen.
People with HIV infection and AIDS.
International travelers coming from areas that are not endemic malaria due to not having the necessary immunity.
Immigrants from malaria-endemic areas and their children who live in non-endemic areas and return to their countries of origin to visit friends and relatives are at a similar risk of disease as they maintained low immunity or not having any immunity at all.
Diagnosis and treatment
Diagnosis and treatment in the early stages contribute to the alleviation of disease and preventable deaths from him. Also contribute to the reduction of the effect.
The best treatment of the treatments available to fight malaria, especially falciparum malaria, artemisinin-based combination therapy in the artemisinin.
The World Health Organization recommends the need to ensure, before giving treatment, to confirm all cases of suspected malaria through diagnosis, which confirms the presence of the parasite (either by microscopy or rapid diagnostic test). We can make the results of that examination assertive within 15 minutes or less. It should not be given treatment based on symptoms only when they can not only make the diagnosis, which confirms the presence of the parasite. The Guidelines for the treatment of types of Malaria (second edition) more detailed recommendations. The updated edition will be published in 2015.
Resistance to anti-malarial drugs
The phenomenon of resistance to antimalarial medicines repeated problems. And become resistant Plasmodium falciparum previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine, spread on a large scale in the seventies and eighties of the last century, which contributed to undermining control efforts and reverse the gains made in the area of child survival.
In recent years, it has been reported to the parasite resistance to artemisinin drugs in 5 countries located in the Greater Mekong Subregion: Cambodia, Lao PDR, Myanmar, Thailand and Viet Nam. In spite of the possibility of a lot of factors that contribute to the emergence and spread of resistance, some believe that the use of drugs that contain only artemisinin mono as a treatment of the key factors in this regard. Patients have been tempted, when being treated with medicines that do not contain only artemisinin, to stop treatment after the early symptoms of the disease faded quickly. And lead the practice to the lack of treatment has been completed and the persistence of parasites in the blood of patients. And those able-resistant parasites, if not given a second drug in the context of addressing the synthesis (as they are in artemisinin-based combination therapy ACTs) framework, to survive and move on to a mosquito, and from there to another person.
If resistance to existing treatments to artemisinin evolved and moved to deploy to other large geographical areas, the public health consequences could be dire.
The World Health Organization recommends monitoring antimalarial drug resistance routinely, it also supports countries to enable them to strengthen their efforts in this important area of work.
The Global plan for artemisinin resistance containment, launched by the World Health Organization in 2011, which, the most comprehensive recommendations in this regard. The organization has issued in 2013 for countries in the Greater Mekong subregion, a regional framework under the emergency response of resistance to artemisinin in the Greater Mekong Subregion address.
Prevention
Vector control is the main method to reduce the validity of malaria at the community level. It represents the only guarantor of intervention to reduce the entry into force of the disease from very high levels to levels close to zero.
As for individuals, the personal protection from mosquito bites represents the first line of defense for the prevention of malaria.
Two main interventions for vector control guarantee effectiveness in a variety of conditions, namely:
Insecticide-treated nets
The insecticide-treated nets long-acting within the preferred form of insecticide-treated nets that are distributed within the framework of the relevant public health treatment programs. The World Health Organization recommends ensuring comprehensive coverage of all people at risk, and in most places. And more cost-effective approach to achieve this is to provide insecticide-treated nets long-acting treatment so that each person's sleep, every night, under one of them.
Residual spraying insecticide indoors
The residual spraying insecticide indoors most powerful method to rapidly reduce the validity of malaria. And realized the full potential of this method when at least 80% of homes in the targeted areas are sprayed. And ensures the effectiveness over a period ranging between 3 months and 6 months, depending on the insecticide used and the type of surface on which it is sprayed pesticide spraying by this. And can, in some cases, that DDT ensure effectiveness over a period of 9 months and 12 months. It is being developed pesticides longer effect for use in indoor residual spraying indoors.
The drugs can also be used for the prevention of malaria. Can the passengers and protect themselves from the disease by chemoprophylaxis, which removes the blood stage of malaria infection and was able, therefore, to prevent infection. In addition, the World Health Organization recommends that IPT-based material Asalafadiuksyn - pyrimethamine for pregnant women living in areas where malaria intensifies into force, in the second and third trimester of pregnancy. It also recommends giving three doses of therapy for infants living in African regions where intense validity of this disease and to ensure, at the same time, the vaccinated routine vaccines necessary. In 2012, the organization recommended the implementation of seasonal chemoprophylaxis of malaria as an additional strategy to combat the disease in sub-Sahel regions of Africa. The strategy includes giving monthly decisions of amodiaquine plus Asalafadiuksyn - pyrimethamine (SP) to all children under the age of five during the season in which the validity of the disease intensifies.
Insecticide resistance
Much of the success that has been achieved so far in the fight against malaria has been thanks to the vector control. And vector control depends strongly on the use of pyrethroids (compounds that are used as pesticides for insects), which is the only class of pesticides currently used in insect mosquito nets or mosquito nets treated with long-lasting insecticide treated and untreated. I have observed in recent years, the emergence of resistance to pyrethroids by mosquitoes in some countries. It was unveiled, in some areas, for varieties resistant to all pesticides used four insects in the field of public health. Fortunately that did not Tze resistance to a decrease in effectiveness, and insecticide-treated nets and long-lasting residual spraying technique in the interior places of high efficiency means still in almost all the places.
However, there is serious concern about the countries in sub-Saharan Africa and India. Those countries characterized by high levels of validity and the spread of malaria and wide to resist pesticides. And the development of new alternative pesticides of the main priorities, there are several promising products under Creation. And priorities that are of particular importance to the development of new pesticides used in mosquito nets.
It should be disclosure about the phenomenon of insecticide resistance of the basic elements of all the efforts being made at the national level for vector control in order to ensure the use of more effective control methods. The choice of the appropriate residual pesticide to spray indoors decision should always be taken to observe local data and recent data on the sensitivity of the target vector.
To ensure a coordinated and timely global response to the risk of insecticide resistance to what the World Health Organization is working with a wide range of stakeholders in order to prepare the Global Plan for the management of insecticide resistance in malaria vectors, which issued in May / May 2012. progress of the Global Plan to manage insecticide resistance has been in malaria vectors strategy with five pillars calls for the fight against global malaria community to:
Planning and implementation of strategies for the management of insecticide resistance in malaria-endemic countries;
Ensure monitoring and monitoring of insecticide resistance properly and in a timely manner, and manage data effectively;
The development of new and innovative tools for vector control;
Bridging the gaps of knowledge on insecticide resistance mechanisms and the impact of approaches currently used pesticide resistance management;
Ensure the establishment of mechanisms enabling (the call, as well as human and financial resources).
Surveillance
Tracking progress raises a major challenge in the field of control. In 2012, it did not reveal malaria surveillance systems only about 14% of all cases of the estimated global number. It needs urgently to stronger malaria surveillance systems in order to allow a timely and effective response to malaria in endemic areas, and prevent the emergence of outbreaks or re-emerge, and track progress, and the accountability of governments and the global community to combat malaria.
Disposal
To get rid of malaria known as a local stop flow of malaria transmitted Balbaawwad in a specific geographic area, any decline in the number of local infection cases to zero. The eradication of malaria is defined to reduce the number of cases of malaria infection caused by a specific factor to zero permanently at the global level; that is, it applies to a particular type of malaria parasites.
Based on the cases reported for the year 2013, there are 55 countries on the way to reducing the incidence of malaria rates by 75%, in line with the objectives of the World Health Assembly in 2015. It is worth mentioning that the adoption of the strategies recommended by the World Health Organization on a large scale and the use of the tools available Currently, the strengthening of national commitments and coordinated efforts with partners of the things that will enable more countries-especially the countries that experience a decline in the volatile Almlria- validity of the rates of progress towards elimination of this disease.
In recent years, it got four countries on the certification director-general of the World Health Organization that it got rid of malaria, and those countries are the United Arab Emirates (2007) and Morocco (2010) and Turkmenistan (2010) and Armenia (2011).
Vaccines against malaria
There is currently no licensed vaccine for malaria or any other parasite infects humans. Vaccines are the most advanced in terms of Creation experimental vaccine against Plasmodium falciparum called RTS, S / AS01 stages. This vaccine has undergone an evaluation and by a large clinical trial conducted in seven countries in Africa, and submitted to the European Medicines Agency under Article 58 for review organization. The organization will depend to prepare a recommendation on the use of the vaccine on the final results from a large clinical trial he underwent Over the positive review from the regulatory point of view. And it is expected, in late 2015, a recommendation that the addition of the vaccine or not to add it to the means currently available to fight malaria.
WHO's response
It means the WHO Global Malaria Programme draw against malaria and disposal path through the following:
Policy formulation and evidence-based strategies, determine the rules, standards and technology policies and strategies based on the evidence, and reporting and to promote adoption;;
The adoption of the principle of autonomy in assessing global progress;
Developing approaches to build capacity and enhance systems and surveillance;
Identify threats to malaria control and disposal, as well as new areas of work.
The global program to fight malaria lead role of the secretariat of the Advisory Committee in the field of malaria policies, a group that includes 15 of the global malaria experts were appointed following a nomination process open. The progress of this committee, which meets twice a year, independent advice to the organization regarding the preparation of recommendations to combat malaria and disposal. The mandate of the Commission, the provision of strategy and provide technical inputs, all aspects of the fight against malaria and disposal advice, as part of a process aimed at policies and transparent, credibility and capacity to respond to the needs of the situation.
The Organization of the bodies, which also participated in the founding of the Roll Back Malaria partnership and now holds such a partnership, which represents the global framework to implement coordinated action against malaria hosting. The partnership seeks to mobilize the necessary resources to carry out the work and to reach consensus in partners. The partnership includes more than 500 partners, including malaria-endemic countries, development partners, private sector, non-governmental organizations and community-based organizations, foundations, research and academic institutions....
