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Health Impact Research Paper

Malaria in Africa

Abigail Angell

Delaware Technical Community College

NUR 310 Global Health

Mrs. Dorothy Eyong

October 10, 2021

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Abstract

The topic that will be discussed is malaria in Africa, why it is so prevalent and ways to combat

this disease. First, the disease itself will be discussed and explained, then the application of the 5-

tier health impact pyramid will be used. Within the 5-tier health impact pyramid section evidence

will be provided on how other courtiers were able to almost completely eliminate malaria and

how this can be applied in Africa. Next, there will be a discussion on the health and cultural

beliefs in Africa and how as healthcare workers that would be incorporated into caring for those

who live in Africa. Last, there will be an explanation of how to go about working in the global

health field and what steps need to be taken and what research needs to be done in order to start a

career in global health.

Introduction to Topic

"According to the WHO (World Health Organization) the African region carries a

disproportionately high share of the global malaria burden. In 2019, the region was home to 94%

of malaria cases and deaths."(WHO fact sheet, para.9). Malaria is a disease that is caused by a

parasite that commonly infects a certain type of mosquito which feeds on humans. It is

sometimes difficult to recognize it as malaria, before the symptoms become very severe and life-

threatening. Once a person is bitten by an infected mosquito it may take a while for this person to

exhibit symptoms that are related to malaria and by then it may be too late. That is why it is

important to try to recognize and stop malaria worldwide because this disease can be very

serious and fatal if not caught and treated early on. This parasite and the mosquitoes are very

common in warmer regions around the world and according to WHO, in 2019 there were around
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229 million cases of malaria. (WHO, para.8) In many developed countries there are very few

cases per year because they have the resources and stability to focus on helping their citizens

within the country either have the resources available to prevent malaria or there are more

resources available to the citizens to treat malaria quickly before it becomes serious and fatal.

But, in Africa, which is a country that is still underdeveloped, malaria is still a big problem

because they have a lack of resources and political stability to create programs to help in the

prevention and treatment of malaria. Throughout the rest of this paper, there will be a continual

explanation as to why Africa may be struggling still with this disease and how they could

possibly improve.

Application of Malaria in Africa to the Health Impact Pyramid

“A 5-tier pyramid best describes the impact of different types of public health

interventions and provides a framework to improve health” (Frieden, pg. 1). This 5-tier pyramid

starts at the bottom with a focus on the population as a whole and as there is movement up to the

different levels in the pyramid there is an increasing focus on the individual. The goal of public

health should be to start at the bottom of the pyramid and slowly work up it because that bottom

will impact a bigger portion of the population and lead to the largest number of people receiving

the care they need. The 5-tiers that are within this pyramid starting at the bottom are

socioeconomic factors, changing the context to encourage healthy decisions, long-lasting

protective interventions, clinical interventions, and counseling and education interventions.

These 5-tiers will be analyzed and discussed in relation to malaria in Africa.

Socioeconomic Factors
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“The bottom tier of the health impact pyramid represents changes in socioeconomic

factors (e.g., poverty reduction, improved education), often referred to as social determinants of

health, that help form the basic foundation of a society” (Frieden, para.9). In countries where

malaria is extremely rare, the societies and governments are well developed, meaning that they

have low poverty rates, access to a good education, and their government is established. These

are important factors in not only decreasing the amount of malaria cases, but any other disease.

When there is stability nationwide and a government that is able and willing to help its citizens,

people are then able to focus on finding programs that are government funded to help them if

they are in need. In Africa most of the population is living below the poverty level and many of

the governments are weak and always changing, so the people don’t have any stability or access

to proper healthcare. But if they were able to have access to and receive proper healthcare it

would help tremendously in decreasing the number of fatalities that can occur from malaria.

Changing the Context to Encourage Healthy Decisions

“The second tier of the pyramid represents interventions that change the environmental

context to make healthy options the default choice, regardless of education, income, service

provision, or other societal factors” (Frieden, para.12). Something that would be easy to

introduce into communities would be “Sleeping under an insecticide-treated net (ITN) that can

reduce contact between mosquitoes and humans by providing both a physical barrier and an

insecticidal effect” (WHO, para.19). Using this net would help to reduce the amount of access

the mosquitoes would have to a person while they are sleeping, and these could be distributed at

doctors' offices or in schools. Another option that could help in reducing the number of

mosquitoes would be dumping any standing water, “Anopheles mosquitoes lay their eggs in

water, which hatch into larvae, eventually emerging as adult mosquitoes... Each species of
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Anopheles mosquito has its own preferred aquatic habitat; for example, some prefer small,

shallow collections of fresh water, such as puddles and hoof prints, which are abundant during

the rainy season in tropical countries” (WHO, para.13). This education could help in reducing

the amount water that is available for mosquitoes to lay and hatch their eggs. These ideas may

not be the easiest way to help the population default to these choices, but it will help in reducing

the amount of malaria cases, even if only some of the population participates.

Long-Lasting Protective Interventions

“The third level of the pyramid represents 1-time or infrequent protective interventions

that do not require ongoing clinical care...” (Frieden, para.16). One-way other countries have

tried to reduce the number of diseases within their population is making certain vaccines and

check-ups necessary for children at different ages in life. For malaria there is a trial being done

on a vaccine for malaria, that has shown to reduce the amount of malaria cases and has reduced

the severity of malaria symptoms. This vaccine can be placed in with the other necessary

vaccines children get at their regular check-ups. Another way would be to offer it within schools

so parents wouldn’t have to worry about taking their child to a doctor’s office, if they don’t have

easy access to one. When this vaccine is ready to be used and distributed, hopefully it will

provide the long-lasting protection that is needed in places like Africa.

Clinical Interventions/Counseling and Health Education

Clinical interventions, counseling, and health education are all important, but they mostly

only affect one individual at a time. The reason behind this is because each person has different

risk factors and needs depending on what disease they are dealing with. For those at risk for

getting malaria there would need to be education on the use of antimalarial medications that
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would help in decreasing the chances of getting malaria or having severe symptoms associated

with malaria. Also, there would need to be education on the use of insect replant and the

prevention of being bitten by a mosquito. All these interventions are important, but they are not

as effective because you can only talk to one or a few people at a time about these different

interventions. While the previous tiers in the health impact pyramid can affect and reach more of

the population.

Cultural & Health Beliefs

Africa is filled with a rich history that contains many changes in religion and leadership.

According to a question asking Jacob Olupona, who grew up in Nigeria and then studied the

religion and culture in Africa, how he would define indigenous African religions “...refer to the

indigenous or native religious beliefs of the African people before the Christian and Islamic

colonization of Africa. Indigenous African religions are by nature plural, varied, and usually

informed by one’s ethnic identity, where one’s family came from in Africa” (Chlorazzi, para.8).

Those in Africa belief that their religion is a way of life, that religion and everyday life are not

separate things. For example, in the indigenous African worldview they believe that if they are

sick, it is not only an imbalance of the body, but also an imbalance in one's social life. Meaning

that the person that is experiencing a sickness may be having problems with a relationship in

their life, or a relationship with one of their ancestors. In order to fix this relationship and get rid

of their sickness, they need to make amends with whoever they may have wronged, in order to

do this for their ancestors they need to properly care for a shrine that is to their ancestors. In

order to be respectful of their beliefs as a healthcare worker, if they come in with malaria and

feel it is because they have a relationship they need to fix, it is the job of the healthcare worker to

recognize and discus with them ways to fix the relationship that may have caused their illness,
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but also suggest ways that would help them get better and ways to prevent future cases of

malaria. Those in Africa are receptive to modern medicine and some also follow Christianity

instead of indigenous African beliefs. So, if those caring for these people understand their values

and beliefs and try to incorporate that into their patients' care, they will be respecting them and

their culture as well as making sure they receive the proper care and treatment they need.

Professional Opportunities Available in the Global Health Field

“Careers in global health present the opportunity to work with people from different

backgrounds and help those in need around the world. Certain global health professionals work

with national leaders to shape healthcare within developing nations...” (Shulsinger, para.1).

Working in global health can be very rewarding, but also difficult because there is the ability to

help those in need, but at the same time there may not be enough resources to help everyone.

Even though a graduate education isn’t necessary, obtaining a Master of Science in Global

Studies and International Relations, will help someone in understanding the process better and

allow them to have experience and knowledge in dealing with those of a different culture and

country. As a nurse, there are many opportunities to apply for different non-profit organizations

that go to different parts of the world to help serve and provide care to those in need. There are

also opportunities to travel as a nurse educator to go about and educate the population on safe

practices and the different diseases that may be encountered in certain areas, an educator could

also work with hospitals or the government in finding ways to improve the healthcare that is

provided. There are many different options available to anyone who wants to make a difference

to those that are less fortunate and don’t have access to proper healthcare.
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References
Centers for Disease Control and Prevention. (2021, January 26). CDC - malaria - about malaria

- faqs. Centers for Disease Control and Prevention.

https://www.cdc.gov/malaria/about/faqs.html#:~:text=Malaria%20is%20a%20serious

%20and,humans%3A%20Plasmodium%20falciparum%2C%20P.

Chiorazzi, A. (2015, October 6). The spirituality of Africa. Harvard Gazette.

https://news.harvard.edu/gazette/story/2015/10/the-spirituality-of-africa/.

Frieden, T. R. (2010). A framework for public health action: The health impact pyramid.

American Journal of Public Health, 100(4), 590–595.

https://ajph.aphapublications.org/doi/10.2105/AJPH.2009.185652.

Shulsinger, T. (2020, January 3). Global Health Careers: How Can I Make a difference?

Northeastern University Graduate Programs.

https://www.northeastern.edu/graduate/blog/global-health-careers/.

Skolnik, R. (2021). Global health 101. Jones et Bartlett Learning.

World Health Organization. (2021, April 1). Fact sheet about malaria. World Health

Organization. https://www.who.int/news-room/fact-sheets/detail/malaria.