6.

Factors that Affect Malaria

Transmission
Study Session 6 Factors that Affect Malaria Transmission...........................................3
Introduction................................................................................................................3
Learning Outcomes for Study Session 6....................................................................3
6.1 Climatic factors...................................................................................................3
6.1.1 Temerature..................................................................................................!
Temerature and arasite de"eloment..................................................................!
Temerature and mos#uito de"eloment...............................................................!
Altitude and temerature........................................................................................!
$#uatorial Africa....................................................................................................%
6.1.& 'ainfall.........................................................................................................6
6.1.3 'elati"e humidity.........................................................................................(
6.1.! Com)ining the effects of climatic factors....................................................(
6.& *on+climatic factors............................................................................................,
6.&.1 Malaria "ectors.............................................................................................,
6.&.& Malaria arasites........................................................................................1-
6.&.3 .ater de"eloment ro/ects.......................................................................11
6.&.! 0r)anisation...............................................................................................11
6.&.% 1oulation mo"ement and migration.........................................................1&
6.&.6 2uman host factors....................................................................................1!
6.&.( Insecticide resistance in "ectors.................................................................1%
6.&., 3rug resistance in malaria arasites...........................................................16
1
6.&.4 Interrution of control and re"ention measures.......................................16
Summary of Study Session 6...................................................................................16
Self+Assessment 5uestions 6SA5s7 for Study Session 6.........................................1(
SA5 6.1 6tests Learning Outcomes 6.1 and 6.37..................................................1(
SA5 6.& 6tests Learning Outcome 6.&7................................................................1(
SA5 6.3 6tests Learning Outcomes 6.& and 6.37..................................................1(
SA5 6.! 6tests Learning Outcome 6.!7................................................................1(
SA5 6.% 6tests Learning Outcome 6.%7................................................................1(
SA5 6.6 6tests Learning Outcome 6.%7................................................................1(
&
Study Session 6 Factors that Affect
Malaria Transmission
Introduction
As you learned in Study Session %8 the incidence of malaria "aries from lace to lace
and at different times. Such "ariations are "ery common in $thioia. There are areas
9here the incidence of malaria is high and other areas 9here the incidence is lo98 and
some areas are malaria free. In some communities8 malaria transmission lasts for
se"eral months or haens throughout the year8 and in other areas it is "ery )rief.
In this study session you 9ill learn a)out the factors that affect the transmission and
incidence of malaria. Climate affects the natural distri)ution of malaria in $thioia
and else9here in the 9orld. The three main climatic factors that directly affect malaria
transmission are temperature, rainfall and relative humidity 6the amount of moisture
in the air7. Se"eral non+climatic factors8 including differences )et9een human hosts8
human migration8 and de"eloment ro/ects8 can also affect the attern of malaria
transmission and the se"erity of the ro)lem.
Climatic means :relating to the climate;.
0nderstanding the climatic and non+climatic factors that affect malaria transmission
9ill hel you to understand the ris< of malaria in your "illage )etter. This <ind of
understanding 9ill also )e useful to you in monitoring8 re"enting8 or controlling
local malaria eidemics 6Study Session 1&7.
Learning Outcomes for Study Session 6
.hen you ha"e studied this session8 you should )e a)le to=
6.1 3efine and use correctly all of the <ey 9ords rinted in bold. 6SA5
6.176.& 3escri)e ho9 temerature affects the de"eloment of the arasite and the
"ector8 and e>lain the association )et9een temerature and the distri)ution of
malaria in $thioia. 6SA5s 6.& and 6.376.3 $>lain ho9 humidity influences malaria
transmission. 6SA5s 6.1 and 6.376.! $>lain the relationshi )et9een rainfall and
malaria transmission. 6SA5 6.!76.% 3escri)e ho9 imortant non+climatic factors
influence the attern and se"erity of malaria transmission. 6SA5s 6.% and 6.67
6.1 Climatic factors
Climatic factors greatly influence the attern and le"el of malaria transmission in
$thioia8 in Africa and the 9orld. The most imortant climatic factors that directly
affect malaria transmission are temerature8 rainfall and humidity. .e 9ill consider
these in turn. ?ou may find it useful first to loo< )ac< at Figure %.% to remind yourself
of the lifecycle of the malaria arasite.
3
6.1.1 Temerature
The ranges of minimum and ma>imum temerature greatly affect the de"eloment of
the malaria arasite and its mos#uito "ector8 9hich determines malaria transmission.
Temerature and arasite de!eloment
Temerature affects the life cycle of the malaria arasite. The time re#uired for the
arasite to comlete its de"eloment in the gut of the mos#uito is a)out 1- days8 )ut it
can )e shorter or longer than that deending on the temerature. As the temerature
decreases8 the num)er of days necessary to comlete the de"eloment increases for a
gi"en Plasmodium secies. P. vivax and P. falciparum ha"e the shortest de"eloment
cycles and are therefore more common than P. ovale and P. malariae.
The time needed for the arasite to comlete its de"eloment in the mos#uito8
decreases to less than 1- days as temerature increases from &1@C to &(@C8 9ith &(@C
)eing the otimum. The ma>imum temerature for arasite de"eloment is !-@C.
Aelo9 1,@C8 the life cycle of P. falciparum in the mos#uito )ody is limited. The
minimum temeratures are )et9een 1!B14@C8 9ith P. vivax sur"i"ing at lo9er
temeratures than P. falciparum. Malaria transmission in areas colder than 1,@C can
sometimes occur )ecause the Anopheles often li"e in houses8 9hich tend to )e 9armer
than the outside temerature.
Temerature and mos"uito de!eloment
3e"eloment of the mos#uito lar"a also deends on temerature B it de"elos more
#uic<ly at higher temeratures. 2igher temeratures also increase the num)er of
)lood meals ta<en and the num)er of eggs laid )y the mos#uitoes8 9hich increases the
num)er of mos#uitoes in a gi"en area.
The minimum temerature for mos#uito de"eloment is )et9een ,B1-@CC the
otimum temerature is &%B&(@C8 and the ma>imum temerature for is !-@C.
Altitude and temerature
As you sa9 in Figure %.3 in the re"ious study session8 altitude 6ele"ation a)o"e sea
le"el7 is one of the most imortant factors that determines the attern of malaria
transmission in $thioia. Altitude in $thioia "aries from 1-- metres )elo9 sea le"el
to more than !8--- metres a)o"e sea le"el. Altitude influences the distri)ution and
transmission of malaria indirectly8 through its effect on temerature. As altitude
increases8 temerature decreases8 so highlands are colder and lo9lands are 9armer.
In the $thioian highlands8 9ith altitudes )et9een &8--- and &8!-- metres8 malaria
transmission occurs for short eriods only 9hen temeratures rise unusually high.
5uestion
Can you e>lain 9hy transmission occurs during these eriodsD
!
Ans9er
The increased temerature allo9s the de"eloment of arasites to occur in the
mos#uitoes8 and the mos#uito oulation also increases as the temerature rises.
$nd of ans9er
Aeyond &8!-- metres8 the temerature does not go high enough to suort malaria
transmission and these areas are free of malaria.
Addis A)a)a is free of malaria8 and most of the $thioian highlands a)o"e &8---
metres ha"e little or no locally transmitted malaria 6Figure 6.17. The most imortant
reason for this is that it is generally too cold in the highlands for mos#uitoes to
de"elo in large num)ers8 or for the malaria arasite to de"elo inside the "ector.
Figure 6.1 The temerature a)o"e &8!-- metres in the $thioian highlands is too lo9
for malaria transmission to occur. 61hoto= Aasiro 3a"ey7
#"uatorial Africa
*o9 loo< )ac< at the ma sho9ing the distri)ution of malaria in Africa 6Figure %.& in
the re"ious study session7. From your school geograhy education8 you may
remem)er that temeratures are higher around the e#uator and do not "ary much
through the year. Temeratures decrease rogressi"ely as you mo"e north or south of
the e#uator. The red art of the ma sho9s a "ery high le"el of transmission around
the e#uator and the light )lue colour reresents lo9er malaria transmission further
north and south of the e#uator. One of the reasons for high le"els of transmission near
the e#uator is the 9arm and relati"ely constant temerature in troical Africa.
%
6.1.$ %ainfall
As you learned in Study Session %8 anoheline mos#uitoes )reed in 9ater. So the right
amount of rainfall is often imortant for them to )reed. 3ifferent anoheline
mos#uitoes refer different tyes of 9ater )odies in 9hich to )reed. In $thioia8 9ater
collections that suort "ector )reeding aear mainly after the rains8 and therefore
malaria transmission is highest follo9ing the rainy season.
*ote that the anoheline mos#uitoes that transmit malaria do not )reed in foul+
smelling olluted 9ater.
Of course8 too much rainfall can flush a9ay )reeding ha)itats temorarily8 )ut
mos#uitoes start )reeding as soon as the rain stos. In most cases8 flushing has a
)igger imact on "ector )reeding ha)itats in the highlands and hilly areas than in the
lo9land lains. *ot all 9ater collections are suita)le for the mos#uito life cycle. In
$thioia8 rain 9ater collections are the most imortant )reeding ground8 as the
anoheline mos#uitoes refer to )reed in fresh 9ater collections created after the
rainy season. Such 9ater )odies may )e clear or muddy 6Figure 6.& on the ne>t age7
)ut they are not olluted.
Figure 6.& A muddy rain9ater collection can suort mos#uito )reeding if it is not
olluted. 61hoto= 3r 3addi Eima7
There are also laces 9here less rainfall and drought can fa"our mos#uito )reeding
and malaria transmission. Such laces are usually co"ered )y "egetation throughout
the year and streams and ri"ers often flo9 raidly. .hen the rains fail or are delayed8
the flo9 of streams is interruted and ooling occurs along the stream. 1ooling creates
6
a fa"oura)le en"ironment for mos#uito )reeding. Malaria "ectors mainly )reed in
stagnant 9ater collections8 rarely in slightly mo"ing 9aters and ne"er in raidly
flo9ing ri"ers and streams.
In drier areas8 rainfall can also affect malaria transmission indirectly through its effect
on humidity. Fegetation co"er increases after rainfall8 9hich in turn increases the
relati"e humidity of the en"ironment. The effect of humidity on malaria transmission
is considered )elo9.
6.1.& %elati!e humidity
%elati!e humidity refers to the amount of moisture in the air8 e>ressed as a
ercentageC 6-G humidity 9ould mean the air is comletely free of moisture and
1--G humidity 9ould mean the air is comletely saturated 9ith moisture7. 'elati"e
humidity affects malaria transmission through its effect on the acti"ity and sur"i"al of
mos#uitoes. ?ou may recall that mos#uitoes need to li"e at least ,B1- days to )e a)le
to transmit malaria.
5uestion
.hy is it imortant that mos#uitoes should li"e this long8 for the transmission of
malariaD
Ans9er
This is the length of time re#uired for the arasite to de"elo inside the mos#uito host.
If the mos#uito dies )efore the arasite has de"eloed8 then transmission of the
arasite cannot occur.
$nd of ans9er
Mos#uitoes sur"i"e )etter under conditions of high humidity. They also )ecome more
acti"e 9hen humidity rises. This is 9hy they are more acti"e and refer feeding
during the night B the relati"e humidity of the en"ironment is higher at night. If the
a"erage monthly relati"e humidity is )elo9 6-G8 it is )elie"ed that the life of the
mos#uito is so short that "ery little or no malaria transmission is ossi)le.
6.1.' Combining the effects of climatic factors
*o9 thin< of your "illage in terms of its suita)ility for malaria transmission. 2o9
many 6if any7 malaria cases occur each monthD 3oes the num)er "ary )et9een
monthsD .hen do you see the highest num)erD .rite do9n the reasons you thin< are
resonsi)le for the "ariation in the num)er of malaria cases in your community. Then
ans9er the follo9ing #uestions.
5uestion
.hat factors do you thin< are resonsi)le for the high malaria incidence in some
monthsD Consider the follo9ing factors and decide 9hich of them 9ould aly to
your "illage
(
1. Immediately follo9ing the rainsC if so8 9hyD
&. .hen the temerature is hotC if so8 9hyD
3. .hen the rains fail and there is droughtC if so8 9hyD
!. .hen the fields are co"ered 9ith "egetationC if so8 9hyD
Ans9er
Of course8 9e don;t <no9 the climatic attern in your "illage8 )ut malaria
transmission could )e high=
1. Immediately following the rains, )ecause there 9ill )e lenty of 9ater
collections for "ector )reeding after the rainy season.
&. .hen the temperature is hot, )ecause temerature seeds u "ector and
arasite de"eloment.
3. When the rains fail and there is drought, )ecause ri"ers and small streams
slo9 do9n into ools8 creating stagnant 9ater collections for "ector )reeding.
!. When the fields are covered with vegetation, )ecause 9hen the "egetation
co"er is high the humidity increasesC higher humidity hels the mos#uito to li"e
longer and transmit malaria.
$nd of ans9er
6.$ (on)climatic factors
Factors that affect malaria transmission8 )ut 9hich are not related to the climate8 are
called non)climatic factors. The tye of "ector8 the tye of arasite8 en"ironmental
de"eloment and ur)anisation8 oulation mo"ement and migration8 the le"el of
immunity to malaria in the human hosts8 insecticide resistance in mos#uitoes8 and
drug resistance in arasites8 all ha"e a role in affecting the se"erity and incidence of
malaria. .e 9ill loo< at each of these in turn.
6.$.1 Malaria !ectors
,
Figure 6.3 The Anopheles mos#uito B the malaria "ector.
As you learned in the Study Session %8 not all mos#uitoes transmit malaria B only
Anopheles mos#uitoes 6Figure 6.37 can carry the malaria arasite. In $thioia there
are a)out !- different secies of Anopheles mos#uitoes8 )ut only four of them are
<no9n to transmit malaria arasites8 and /ust one of them8 Anopheles arabiensis8 is
resonsi)le for more than 4%G of malaria transmissions.
3ifferent secies of Anopheles mos#uitoes differ in their caacity to transmit malaria.
This deends on the )iology and )eha"iour of the mos#uitoes. Mos#uitoes in the
Anopheles gambiae grou 69hich includes A. arabiensis)8 are the most efficient
malaria "ectors in the 9orld. These mos#uitoes are found only in Africa. In fact8 the
higher incidence of malaria in Africa comared to other arts of the 9orld is mainly
due the efficiency of these mos#uitoes in transmitting the arasites.
Mos#uitoes need a )lood meal to de"elo and reroduce. They can ta<e their )lood
meal either from humans or animals. Mos#uitoes that mainly feed on humans are
more efficient carriers of malaria than those that feed on animals.
One reason 9hy mos#uitoes in the A. gambiae grou are "ery good "ectors of malaria
is that they refer to )ite humans more than animals. Mos#uitoes that feed on humans
and animals e#ually are much 9ea<er "ectors of malaria. Others feed e>clusi"ely on
animals and are not malaria "ectors. Therefore8 the tye of Anopheles mos#uitoes and
their feeding )eha"iour influence the intensity of transmission in an area.
4
?our <no9ledge and ractical s<ills in identification of imortant )reeding ha)itats in
your "illage 9ill )e "ery helful in your malaria re"ention acti"ities.
Mos#uitoes adated to )reeding close to human settlements8 and a)le to )reed in a
9ide range of en"ironments8 are also )etter "ectors of malaria than mos#uitoes that
)reed a9ay from human ha)itation. Some mos#uitoes )reed in small ools that are
artially or comletely e>osed to the sun8 9hile others refer to )reed in shaded
stagnant ools. A. gambiae mos#uitoes )reed in a 9ide range of ha)itats8 including
small 9ater collections such as hoof+rints8 9ater+filled holes in roc<s and trees8 as
9ell as dams8 ri"er )eds and la<e shores. Aecause A. gambiae "ectors can )reed in so
many different ha)itats8 they are resonsi)le for much of the malaria transmission in
Africa.
The main "ector of malaria in $thioia8 A. arabiensis8 can )e found in a "ariety of
9ater collections8 mainly closer to human ha)itations. 2o9e"er8 stagnant 9ater
collections in )orro9 its8 onds8 micro+dams8 ools in small ri"ers8 and streams
created immediately after the rainy season8 are the most imortant )reeding ha)itats
for this "ector.
6.$.$ Malaria arasites
?ou learned in Study Session % that there are four tyes of malaria arasite that can
infect eole. They are single+celled rotoHoa that can only )e seen if "ie9ed under a
microscoe 6Figure 6.!7.
Figure 6.! 3e"elomental stages of malaria arasites 6Plasmodium secies7 in the
)lood8 stained to ma<e them "isi)le 9hen magnified )y a microscoe. 6Source= .2O8
14418 Basic alaria icroscopy, Part !" #earner$s %uide8 &nd edition7
5uestion
Can you recall the t9o forms of malaria that are most common in $thioia8 and 9hich
one of them is more dangerousD
Ans9er
P. vivax is resonsi)le for around !-G of cases and P. falciparum is resonsi)le for
around 6-G of cases of malaria in $thioia. P. falciparum causes the most dangerous
1-
tye of malaria and often <ills untreated atients. P. vivax 6and the other t9o rare
forms7 can ma<e eole "ery sic<8 )ut are not usually <illers.
$nd of ans9er
In some areas of $thioia falciparum malaria is more common8 9hile in other areas
vivax malaria is more common. &alciparum malaria is more common in Africa than in
other arts of the 9orld8 and this is one reason 9hy there are more deaths from
malaria in Africa than else9here.
6.$.& *ater de!eloment ro+ects
Aig and small 9ater+related de"eloment ro/ects8 such as irrigation channels8 dams
and onds8 can increase the incidence of malaria in "illages that are located near such
ro/ects.
5uestion
2o9 can 9ater de"eloment ro/ects affect malaria transmissionD
Ans9er
They create more "ector )reeding ha)itatsC more "ectors mean more malaria
transmission.
$nd of ans9er
?ou 9ill learn a)out en"ironmental management to reduce the )reeding sites for
mos#uitoes in Study Session 4 of this Module.
Agricultural de"eloment8 articularly 9ith the use of irrigation8 creates )reeding sites
for malaria mos#uitoes8 leading to increased malaria transmission. For instance8 the
use of irrigation to flood agricultural land during rice culti"ation has long )een
associated 9ith an increase in the num)er of "ectors and a corresonding increase in
the )urden of malaria. Irrigated farming and rice agriculture is )ecoming more
common in the lo9lands of $thioia.
6.$.' ,rbanisation
The incidence of malaria is generally lo9er in ur)an areas than in rural areas. There
are a num)er of reasons for this=
.hile there is lenty of sace for "ector )reeding in rural "illages8 mos#uito
)reeding sites in ur)an areas are limited )ecause more sace is co"ered )y
houses.
The main "ectors of malaria in $thioia and else9here in Africa8 are
mos#uitoes in the A. gambiae grou8 9hich )reed in clean 9aterC most 9ater
collections in ur)an settlements are olluted and unfa"oura)le for mos#uito
)reeding.
11
1eole in ur)an areas may ha"e more access to health care and malaria
re"ention strategies than eole in rural "illages.
2o9e"er8 raid ur)anisation of areas 9ithin or on the outs<irts of ur)an centres is
commonly done in an uncontrolled fashion 9ithout thought or lanning 6Figure 6.%7.
The settlers are mainly migrant 9or<ers from rural "illages. Conditions are cro9dedC
housing is often of oor #uality or is of temorary constructionC and the ro"ision of
health care and sanitation is often inade#uate.
Figure 6.% 'aid unlanned ur)an de"eloment can create many ne9 )reeding
grounds for malaria "ectors. 61hoto= Aasiro 3a"ey7
Settlers tend to dig se"eral its to e>tract stone and soil for house construction8
creating numerous )reeding grounds for mos#uitoes. This can lead to e>losi"e
gro9th of mos#uito "ectors8 increased e>osure of the oulation to "ectors due to
oor housing8 and amlification of disease to eidemic roortions through lac< of
effecti"e treatment.
?our main resonsi)ility as a rural 2ealth $>tension 1ractitioner is mainly to ro"ide
care and set u re"enti"e measures in rural communities. 2o9e"er8 some semi+ur)an
settlements at the erihery of ur)an centres could fall under the rural classification
and )e art of your catchment area. 'emem)er that eole li"ing in such semi+ur)an
centres can )e at a higher ris< of malaria than tyical rural communities.
6.$.- .oulation mo!ement and migration
1oulation mo"ements ha"e significant imlications for malaria transmission. The
ma/ority of the oulation mo"ements in $thioia in"ol"e eole mo"ing from the
highlands to the malaria+endemic lo9lands as seasonal la)ourers. These eole are
often emloyed as daily la)ourers in the cro fields during the lanting and har"esting
seasons 6Figure 6.678 9hen malaria transmission is at its ea<. The oor li"ing
conditions and inade#uate health care in such agricultural ro/ects often 9orsen the
ro)lem of malaria. Migrants from malaria+free highlands lac< immunity against the
1&
disease8 as 9ell as the aroriate <no9ledge of the transmission rocess and ho9 to
a"oid )eing )itten )y mos#uitoes.
Figure 6.6 Migrant la)ourers from malaria+free areas are at increased ris< of malaria
during har"esting in lo9land malaria+endemic areas.
61hoto= Aasiro 3a"ey7
Migration for the urose of ermanent settlement in a ne9 area is also common in
$thioia and is a ma/or factor associated 9ith malaria transmission. Migration is often
from densely oulated highlands to malaria+endemic lo9lands8 9here the oulation
density is lo9 and the soil is more fertile. Ma/or en"ironmental transformations li<e
deforestation8 and ne9 construction etc8 ta<e lace during resettlement8 enhancing the
roliferation of mos#uito )reeding sites8 and resulting in ma/or malaria out)rea<s.
1oulation mo"ements and migration also ma<e the malaria ro)lem 9orse in the
areas from 9hich the migrants came. Temorary migrant 9or<ers often )ring the
arasites )ac< to the malaria+free highlands and local transmission can )e readily
esta)lished as many of these communities could suort "ector )reeding. Such
soradic eidemics could affect a large num)er of eole8 as the oulation in
malaria+free areas is generally non+immune.
?ou 9ill learn a)out drug+resistance 9hen 9e descri)e malaria case management in
Study Session ,.
Large oulation dislacements can also occur raidly due to causes li<e 9ar and ci"il
unrest8 or natural causes li<e drought and famine8 flooding and earth#ua<es8 etc.
3islaced eole from areas 9ith malaria can introduce or reintroduce malaria into
areas that are malaria free8 and in some cases sread drug+resistant malaria. 3islaced
oulations can in some cases )e at a higher ris< of getting sic< or dying from malaria
)ecause=
13
3islaced eole may not ha"e roer housing.
They often cam near 9ater )odies that ser"e as mos#uito )reeding sites.
They could )e non+immune8 if mo"ing from malaria+free to malaria+endemic
areas.
Malnutrition can 9orsen the malaria ro)lem.
The health care system can )e o"er)urdened8 so there may )e "ery limited
malaria care and re"enti"e measures.
Though the chance of large scale oulation dislacement due to social and natural
disasters is rare in $thioia8 it is imortant for you to <ee in mind that dislacement
can 9orsen the ro)lem of malaria.
6.$.6 /uman host factors
3ifferences in human hosts also affect the attern of malaria transmission and the
se"erity of the disease. .hen it comes to malaria8 eole are either immune8 or non+
immune. Immune eole often ha"e a )etter chance of tolerating the effects of malaria
and sur"i"ing the disease than non+immune eole. In highly endemic areas8 children
under fi"e years of age and regnant 9omen are the most at ris< 6Figure 6.(78 )ecause
they ha"e 9ea< immunity to malaria infection. Immunity to malaria de"elos slo9ly
after se"eral infections and children need at least fi"e years to de"elo their immunity.
1regnant 9omen ha"e less immunity to malaria due to their regnancy.
1!
Figure 6.( 1regnant 9omen and children under fi"e years of age are most at ris< of
malaria due to their 9ea<ened immunity.
61hoto= 0*IC$F $thioiaIIndrias Jetache97
Certain oulation grous can )e infected )y some tyes of malaria arasites8 )ut not
)y others. For e>amle most Africans south of the Sahara can get infected )y
falciparum malaria8 )ut not )y vivax malaria. This is another reason 9hy most of the
disease and deaths due to malaria occur in Africa8 )ecause falciparum malaria is the
deadliest form of malaria and is highly re"alent in the continent.
6.$.0 Insecticide resistance in !ectors
In Study Sessions 48 1- and 118 you 9ill learn ho9 some insect+<illing chemicals
6insecticides7 are used to <ill mos#uitoes and rotect communities from mos#uito
)ites. *o 6or lo9 num)ers of7 mos#uito )ites mean no or less ris< of malaria.
2o9e"er8 after reeated alication of these chemicals8 the mos#uitoes de"elo
insecticide resistance8 9hich means that they are no longer <illed )y the insecticides.
This means a large num)er of mos#uitoes 9ill sur"i"e in the community8 and the ris<
of malaria infections rises and many eole can )e affected.
1%
6.$.1 2rug resistance in malaria arasites
?ou 9ill learn a)out the medicines used to treat malaria in Study Session ,. These
drugs <ill the malaria arasite inside the human )ody. 2o9e"er8 similar to the
insecticide resistance mentioned a)o"e8 after reeated use of an anti+malaria
medicine8 the arasite can de"elo resistance to that articular drug or to similar
medicines. As a result8 the arasites inside the human )ody can no longer )e <illed
and atients cannot )e cured unless ne9 drugs are de"eloed for treatments. If drug)
resistant malaria arasites are not cleared )y treatment from infected indi"iduals8
they are easily ic<ed u )y "ector mos#uitoes8 and transmitted to ne9 susceti)le
indi"iduals 9ho then de"elo drug+resistant malaria. Moreo"er8 more eole 9ho are
not getting cured )y drug treatment means that more 9ill die of malaria.
6.$.3 Interrution of control and re!ention measures
Malaria is a cura)le disease if the arasites remain susceti)le to a"aila)le treatments8
and it can )e re"ented )y using se"eral methods. 2o9e"er8 long+term and sustained
imlementation of re"ention and control measures is necessary to significantly
reduce or eliminate the ro)lem from a country or a secific geograhic area. As a
result of long+term successful inter"entions8 a local oulation can lose their
immunity to malaria in an area 9here it has )een reduced to a lo9 le"el for some
time. 'emem)er that reeated infections are necessary to de"elo immunity to
malaria. Immunity gets lo9er or is lost if a erson mo"es out of a malaria endemic
area8 or is rotected from infection for se"eral years. Therefore8 if control and
re"enti"e measures are stoed )efore the disease is eliminated8 malaria can surge
)ac< and affect more eole8 and affect them more se"erely than )efore.
Summary of Study Session 6
In Study Session 68 you ha"e learned that=
1. Malaria transmission is directly affected )y different climatic factors.
&. There is an otimal range of temerature that is )est for the de"eloment of
the "ector and the arasite.
3. Temerature greatly influences the distri)ution of malaria in $thioiaC most
highlands in $thioia ha"e "ery little or no malaria due to lo9 temerature.
!. Altitude is the most imortant factor that determines the distri)ution of
malaria. Altitude and temerature are closely related in $thioia. Lo9lands are
9arm 6good for malaria transmission78 highlands are too cold for malaria
arasites and "ectors to de"elo.
%. 2igher humidity ma<es the "ector li"e longerC malaria is transmitted )y
"ectors that li"e ,B1- days so the arasites ha"e time to de"elo.
6. The main malaria transmission in $thioia is after the rainy season )ecause
rainfall creates many "ector )reeding grounds.
16
(. Se"eral non+climatic factors affect the se"erity and incidence of malaria
transmission8 including the tye of "ectors and arasites8 en"ironmental
de"eloments and ur)anisation8 oulation mo"ement and migration8 the le"el
of immunity in the human hosts8 insecticide resistance in mos#uitoes8 and drug
resistance in arasites.
Self)Assessment 4uestions 5SA4s6 for Study Session 6
*o9 that you ha"e comleted this study session8 you can assess ho9 9ell you ha"e
achie"ed its Learning Outcomes )y ans9ering these #uestions. .rite your ans9ers in
your Study 3iary and discuss them 9ith your Tutor at the ne>t Study Suort
Meeting. ?ou can chec< your ans9ers 9ith the *otes on the Self+Assessment
5uestions at the end of this Module.
SA4 6.1 5tests Learning Outcomes 6.1 and 6.&6
Imagine that the relati"e humidity of your "illage is !-G in Fe)ruary and ,-G in
Setem)er. 3escri)e ho9 this could affect malaria transmission in your "illage. Start
)y e>laining the effect of humidity on the "ector.
SA4 6.$ 5tests Learning Outcome 6.$6
Imagine that the a"erage daily temerature in your "illage is 1&@C and you rarely see
malaria cases. 3escri)e the reason 9hy there is no malaria transmission in your
"illage.
SA4 6.& 5tests Learning Outcomes 6.$ and 6.&6
Imagine that your "illage is located at 18--- metres a)o"e sea le"el and is co"ered
9ith "egetation throughout the year. Se"eral ne9 malaria cases are occurring e"ery
month. .hat could )e the factors causing the high malaria rate in your "illageD
SA4 6.' 5tests Learning Outcome 6.'6
Most of the malaria cases in your "illage come in the t9o months follo9ing the rainy
season. Fery fe9 cases occur in the dry season. $>lain the reason 9hy so many cases
occur after the rainy season.
SA4 6.- 5tests Learning Outcome 6.-6
Anopheles arabiensis refers to )ite humans more than animals. Another Anopheles
mos#uito8 An. pharoensis8 feeds more on animals than humans. .hich one of them
9ill )e a )etter "ector of malaria and 9hyD
SA4 6.6 5tests Learning Outcome 6.-6
1(
In "illage A8 most of the malaria cases are due to falciparum malaria. In "illage A8
vivax malaria is more common than falciparum malaria. .hich "illage 9ill ha"e more
deaths due to malaria and 9hyD
1,