ESSENTIALS

OF PUBLIC PUBLIC HEALTH

ONGOING DISEASE PRIORITY AREAS

PAST – PRESENT - FUTURE
ONGOING PRIORITY (DISEASE) AREAS IN GPH

Malaria
HIV TB
NT/IDs

Dedicated programs, funding, organisations

GREAT UP TO DATE DATA
IN REPORTS CURATED BY WORLD HEALTH ORGANISATION
PRESENT - FUTURE
EMERGING PRIORITY (DISEASE/FOCUS) AREAS IN GPH

Antimicrobial Non-communicable
Health - Climate Road Accidents
Resistanc (AMR) diseases

Mental Health /
Aging populations Global surgery Zoonotic pandemics…
Trauma

…..
… increased awareness …. but dedication?
PAST – PRESENT - FUTURE
ONGOING PRIORITY (DISEASE) AREAS IN GPH

Malaria
HIV TB
NT/IDs

Guest lecture: Guest lecture: Guest lecture:

Michael Knappik Emily MacLean Daniela Fusco

Dedicated programs, funding, organisations

ESSENTIALS
OF PUBLIC PUBLIC HEALTH

MALARIA
WORLD MALARIA REPORT

https://www.who.int/teams/global-malaria-programme/reports/world-
malaria-report-2021
BASIC FACTS ABOUT MALARIA

1. Life threatening disease if untreated

2. 4 different species cause malaria
• P. falciparum
• P. vivax
• P. ovale
• P. malaria
• (P. knowlsei – a monkey species, not recognized as human malaria)
3. In 2020 nearly half of the worlds population was at risk of malaria
4. 241 million cases of malaria in 2020 with an estimated 627000 death
5. Africa carries disproportionate burden: 95% of cases and 96% of death
6. Majority of death in children under 5 years of age
7. Distinguish between uncomplicated and severe malaria, both require care
https://ourworldindata.org/malaria#the-history-of-malaria

MALARIA EPIDEMIOLOGY - IN THE PAST

 MALARIA EPIDEMIOLOGY – IN 2020

1. 85 endemic countries
2. 241 million cases (increase from 227million in 2019)
3. 29 countries accounted for 96% malaria cases globally
4. Nigeria, DRC, Uganda, Mozambique, Angola, Burkina
Faso account for 55% of cases
5. Case incidence decreased steadily from 2000->2019,
increased again in 2020 due to service disruption
6. Malaria cases in SEA reduced by 78% since 2000; India
accounts for 83% of cases in the region
7. Cases in Americas reduced by 58% in 20y

Ref: Malaria Report 2021

 P. VIVAX EPIDEMIOLOGY

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198891/
 FALCIPARUM AS TRUE CAUSE OF FEVER

file:///Users/sdittrich/Downloads/elife-29198.pdf
 WHAT CAUSES MALARIA – LIFE CYCLE

Protozoa - parasite

https://www.cdc.gov/malaria/about/biology/index.html
WHAT CAUSES MALARIA –BLOOD STAGES
TRANSMISSION OF THE PARASITE
ANOPHELES MOSQUITOS

• Anopheles mosquitos are vectors

• Temperature and humidity support vector populations
• Changing temperatures mean changing malaria vector
populations
• Standing water, source of mosquito larvae
• More sources for vector growth in areas associated with
poverty (open water/sewage, lack of closed structures,
open windows for air circulation vs AC)
INTERVENTIONS FOR MALARIA CONTROL
UTILISING MALARIA ”COMMODITIES”

Treatment Testing Bed nets Vector control

 DIAGNOSTIC – TEST AND TREAT

= Malaria = Antimalarial drugs

- In reality: not all fevers are malaria

- Not knowing who has malaria and who has other causes of fever is critical to treat
appropriately
- Particularly with successful malaria control measures, malaria cases are reducing but fevers
stay the same
- Diagnostid is critical to ensure the right person gets treatment for malaria and other causes
of fever (typhoid, dengue, cold, flu….. )
- IN 2010 WHO ESTABLISHED TEST-TREAT-TREAT POLICY = treatment only after
positive dx
DX TESTS FOR MALARIA

Microscopy:
-Gold standard
-Sensitivity >20 parasites/ul
-Differentiation of all species
-Requires laboratory set-up and
trained microscopists

Rapid Diagnostic Tests (RDTs):

-Easy to use and faster
-Sensitivity >50 parasites/ul
-Detect all Plasmodium species
and some specific for P. falciparum
and P. vivax
QUALITY MALARIA TESTING HAD AN IMPACT
Improved performance of tested RDTs

P. falciparum

Field evaluations in Lao PDR,

Uganda, Kenya and Tanzania

P. vivax

J. Cunningham, WHO/GMP
- 195 unique RDT products have been evaluated since 2008
- Results are WHO/PQ evaluation and the basis for
WHO/GMP and Global Fund procurement recommendations
TREATMENT FOR P. FALCIPARUM
ARTEMISININ COMBINATION THERAPIES

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://apps.who.int/iris/bitstream/handle/10665/352687/WHO-UCN-GMP-
2022.01-Rev.1-eng.pdf?sequence=1&isAllowed=y
 MALARIA DRUG RESISTANCE

https://www.nejm.org/doi/full/10.1056/NEJMp1403340

https://www.science.org/content/article/drug-resistant-
malaria-spreading-experts-clash-over-its-global-risk
TREATMENT FOR P. VIVAX
SLEEPING UNDER A NET
AVOIDING BITES – BY FORMING A PHYSICAL BARRIER
VECTOR CONTROL

https://parasitesandvectors.biomedcentral.
com/articles/10.1186/s13071-020-04170-7
MALARIA VACCINE
THREATS TO ELIMINATING MALARIA shorturl.at/dwzCX