Epidemiology of the disease

Approximately 300 million people world-wide are affected by malaria and between 1 and 1.5 million people die from it every year. Previously extremely widespread, the malaria is now mainly confined to Africa, Asia and Latin America. Inadequate health structures and poor socio-economic conditions aggravate the problems of controlling malaria in these countries. The situation has become even more complex over the last few years with the increase in drug-resistant parasites (Greenwood, 1999).

Malaria is currently endemic in 91 countries with small pockets of transmission occurring in a further eight countries.

The significance of malaria as a health problem is increasing in many parts of the world. Epidemics are even occurring around traditionally endemic zones in areas where transmission have been eliminated. These outbreaks are generally associated with deteriorating social and economic conditions, and main victims are underprivileged rural populations. Demographic, economic and political pressures compel entire populations (seasonal workers, nomadic tribes and farmers migrating to newly developed urban areas or new agricultural and economic developments) to leave malaria free areas and move into endemic zones. Non-immune people are at high risk of severe disease. Unfortunately, these population movements and the intensive urbanisation are not always accompanied by adequate development of sanitation and health care. In many areas conflict, economic crises and administrative disorganisation can result in the disruption of health services. The absence of adequate health services frequently results in recourse to self-administration of drugs often with incomplete treatment. This is a major factor in the increase in resistance of malaria parasites to previously effective drugs (WHO, 1997).

Malaria is a complex disease but it is curable and preventable. Lives can be saved by early detection and adequate treatment of the disease. The actions that are necessary to prevent the disease and to avoid or contain epidemics and other critical situations are known. The technology to prevent, monitor, diagnose and treat malaria exists. It needs to be adapted to local conditions and to be applied through local and national malaria control programmes.