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INTRODUCTION-

Malaria is a life-threatening mosquito-borne blood disease. The Anopheles mosquito transmits it to humans

Malaria is a disease caused by a parasite. The parasite is transmitted to humans through the bites of infected mosquitoes. People who have malaria usually feel very sick, with a high fever and shaking chills. Each year, approximately 210 million people are infected with malaria, and about 440,000 people die from the disease. Most of the people who die from the disease are young children in Africa.

While the disease is uncommon in temperate climates, malaria is still common in tropical and subtropical countries. World health officials are trying to reduce the incidence of malaria by distributing bed nets to help protect people from mosquito bites as they sleep. Scientists around the world are working to develop a vaccine to prevent malaria.

If you’re traveling to locations where malaria is common, take steps to prevent mosquito bites by wearing protective clothing, using insect repellants and sleeping under treated mosquito nets. Depending on the area you are visiting and your individual risk factors for infection, you may also want to take preventive medicine before, during and after your trip. Many malaria parasites are now resistant to the most common drugs used to treat the disease.

Malaria is a life-threatening disease. It’s typically transmitted through the bite of an infected Anopheles mosquito. Infected mosquitoes carry the Plasmodium parasite. When this mosquito bites you, the parasite is released into your bloodstream.

Once the parasites are inside your body, they travel to the liver, where they mature. After several days, the mature parasites enter the bloodstream and begin to infect red blood cells.

Within 48 to 72 hours, the parasites inside the red blood cells multiply, causing the infected cells to burst open.

The parasites continue to infect red blood cells, resulting in symptoms that occur in cycles that last two to three days at a time.

Malaria is typically found in tropical and subtropical climates where the parasites can live. The World Health Organization (WHO)Trusted Source states that, in 2016, there were an estimated 216 million cases of malaria in 91 countries.

In the United States, the Centers for Disease Control and Prevention (CDC) report 1,700 casesTrusted Source of malaria annually. Most cases of malaria develop in people who travel to countries where malaria is more common.

The parasites in mosquitos that spread malaria belong to the Plasmodium genus. Over 100 types of Plasmodium parasite can infect a variety of species. Different types replicate at different rates, changing how quickly the symptoms escalate, and the severity of the disease.

Five types of Plasmodium parasite can infect humans. These occur in different parts of the world. Some cause a more severe type of malaria than others.

Once an infected mosquito bites a human, the parasites multiply in the host’s liver before infecting and destroying red blood cells.

In some places, early diagnosis can help treat and control malaria. However, some countries lack the resources to carry out effective screening.

Currently, no vaccine is available for use in the United States, although one vaccine has a license in Europe.

In the early 1950s, advances in treatment eliminated malaria from the U.S. However, between 1,500 and 2,000 cases still occur each year, mostly in those who have recently traveled to malaria-endemic areas.

CAUSES-

Malaria can occur if a mosquito infected with the Plasmodium parasite bites you. There are four kinds of malaria parasites that can infect humans: Plasmodium vivax, P. ovale, P. malariae, and P. falciparum.

P. falciparum causes a more severe form of the disease and those who contract this form of malaria have a higher risk of death. An infected mother can also pass the disease to her baby at birth. This is known as congenital malaria.

• Uninfected mosquito. A mosquito becomes infected by feeding on a person who has malaria.
• Transmission of parasite. If this mosquito bites you in the future, it can transmit malaria parasites to you.
• In the liver. Once the parasites enter your body, they travel to your liver — where some types can lie dormant for as long as a year.
• Into the bloodstream. When the parasites mature, they leave the liver and infect your red blood cells. This is when people typically develop malaria symptoms.
• On to the next person. If an uninfected mosquito bites you at this point in the cycle, it will become infected with your malaria parasites and can spread them to the other people it bites.

Other modes of transmission

Because the parasites that cause malaria affect red blood cells, people can also catch malaria from exposure to infected blood, including:

• From mother to unborn child
• Through blood transfusions
• By sharing needles used to inject drugs

Malaria is transmitted by blood, so it can also be transmitted through:

• an organ transplant
• a transfusion
• use of shared needles or syringes

SYMPTOM-

A doctor would give this diagnosis when symptoms are present, but no symptoms occur that suggest severe infection or dysfunction of the vital organs.

This form can become severe malaria without treatment, or if the host has poor or no immunity.

Symptoms of uncomplicated malaria typically last 6 to 10 hours and recur every second day.

Some strains of the parasite can have a longer cycle or cause mixed symptoms.

As symptoms resemble those of flu, they may remain undiagnosed or misdiagnosed in areas where malaria is less common.

In uncomplicated malaria, symptoms progress as follows, through cold, hot, and sweating stages:

• a sensation of cold with shivering
• fever, headaches, and vomiting
• seizures sometimes occur in younger people with the disease
• sweats, followed by a return to normal temperature, with tiredness

In areas where malaria is common, many people recognize the symptoms as malaria and treat themselves without visiting a doctor.

Severe malaria

In severe malaria, clinical or laboratory evidence shows signs of vital organ dysfunction.

Symptoms of severe malaria include:

• fever and chills
• impaired consciousness
• prostration, or adopting a prone position
• multiple convulsions
• deep breathing and respiratory distress
• abnormal bleeding and signs of anemia
• clinical jaundice and evidence of vital organ dysfunction

Severe malaria can be fatal without treatment.

Some people who have malaria experience cycles of malaria “attacks.” An attack usually starts with shivering and chills, followed by a high fever, followed by sweating and a return to normal temperature. Malaria signs and symptoms typically begin within a few weeks after being bitten by an infected mosquito. However, some types of malaria parasites can lie dormant in your body for up to a year.

ACCORDING TO WHO

Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death.

Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ failure is also frequent. In malaria endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.

When to see a doctor

Talk to your doctor if you experience a fever while living in or after traveling to a high-risk malaria region. The parasites that cause malaria can lie dormant in your body for up to a year. If you have severe symptoms, seek emergency medical attention.

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RISK FACTOR-

The biggest risk factor for developing malaria is to live in or to visit areas where the disease is common. There are many different varieties of malaria parasites. The variety that causes the most serious complications is most commonly found in:

• African countries south of the Sahara Desert
• The Asian subcontinent
• New Guinea, the Dominican Republic and Haiti

ACCORDING TO WHO

In 2018, nearly half of the world’s population was at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, the WHO regions of South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas are also at risk.

Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National malaria control programmes need to take special measures to protect these population groups from malaria infection, taking into consideration their specific circumstances

Risks of more-severe disease

People at increased risk of serious disease include:

• Young children and infants
• Older adults
• Travelers coming from areas with no malaria
• Pregnant women and their unborn children

Poverty, lack of knowledge, and little or no access to health care also contribute to malaria deaths worldwide.

Immunity can wane

Residents of a malaria region may be exposed to the disease so frequently that they acquire a partial immunity, which can lessen the severity of malaria symptoms. However, this partial immunity can disappear if you move to a country where you’re no longer frequently exposed to the parasite.

COMPLICATION-

Malaria can be fatal, particularly malaria caused by the variety of parasite that’s common in tropical parts of Africa. The Centers for Disease Control and Prevention estimates that 91 percent of all malaria deaths occur in Africa — most commonly in children under the age of 5.

In most cases, malaria deaths are related to one or more serious complications, including:

• Cerebral malaria. If parasite-filled blood cells block small blood vessels to your brain (cerebral malaria), swelling of your brain or brain damage may occur. Cerebral malaria may cause seizures and coma.
• Breathing problems. Accumulated fluid in your lungs (pulmonary edema) can make it difficult to breathe.
• Organ failure. Malaria can cause your kidneys or liver to fail, or your spleen to rupture. Any of these conditions can be life-threatening.
• Anemia. Malaria damages red blood cells, which can result in anemia.
• Low blood sugar. Severe forms of malaria itself can cause low blood sugar (hypoglycemia), as can quinine — one of the most common medications used to combat malaria. Very low blood sugar can result in coma or death.

Malaria may recur

Some varieties of the malaria parasite, which typically cause milder forms of the disease, can persist for years and cause relapses.

TRANSMISSION-

In most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. There are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. All of the important vector species bite between dusk and dawn. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.

Anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a blood meal to nurture their eggs. Each species of 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.

Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why approximately 90% of the world’s malaria cases are in Africa.

Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.

Lifecycle

The natural history of malaria involves cyclical infection of humans and female Anopheles mosquitoes. In humans, the parasites grow and multiply first in the liver cells and then in the red cells of the blood. In the blood, successive broods of parasites grow inside the red cells and destroy them, releasing daughter parasites (“merozoites”) that continue the cycle by invading other red cells.

The blood stage parasites are those that cause the symptoms of malaria. When certain forms of blood stage parasites (gametocytes, which occur in male and female forms) are ingested during blood feeding by a female Anopheles mosquito, they mate in the gut of the mosquito and begin a cycle of growth and multiplication in the mosquito. After 10-18 days, a form of the parasite called a sporozoite migrates to the mosquito’s salivary glands. When the Anopheles mosquito takes a blood meal on another human, anticoagulant saliva is injected together with the sporozoites, which migrate to the liver, thereby beginning a new cycle.

Thus the infected mosquito carries the disease from one human to another (acting as a “vector”), while infected humans transmit the parasite to the mosquito, In contrast to the human host, the mosquito vector does not suffer from the presence of the parasites.

The malaria parasite life cycle involves two hosts. During a blood meal, a malaria-infected female Anopheles mosquito inoculates sporozoites into the human host

. Sporozoites infect liver cellsand mature into schizonts, which rupture and release merozoites. (Of note, in P. vivax and P. ovale a dormant stage [hypnozoites] can persist in the liver (if untreated) and cause relapses by invading the bloodstream weeks, or even years later.) After this initial replication in the liver (exo-erythrocytic schizogony), the parasites undergo asexual multiplication in the erythrocytes (erythrocytic schizogony). Merozoites infect red blood cells. The ring stage trophozoites mature into schizonts, which rupture releasing merozoites. Some parasites differentiate into sexual erythrocytic stages (gametocytes). Blood stage parasites are responsible for the clinical manifestations of the disease. The gametocytes, male (microgametocytes) and female (macrogametocytes), are ingested by an Anopheles mosquito during a blood meal. The parasites’ multiplication in the mosquito is known as the sporogonic cycle. While in the mosquito’s stomach, the microgametes penetrate the macrogametes generating zygotes. The zygotes in turn become motile and elongated (ookinetes)which invade the midgut wall of the mosquito where they develop into oocysts. The oocysts grow, rupture, and release sporozoites, which make their way to the mosquito’s salivary glands. Inoculation of the sporozoitesinto a new human host perpetuates the malaria life cycle.

DIAGNOSIS-

Your doctor will be able to diagnose malaria. During your appointment, your doctor will review your health history, including any recent travel to tropical climates. A physical exam will also be performed.

Your doctor will be able to determine if you have an enlarged spleen or liver. If you have symptoms of malaria, your doctor may order additional blood tests to confirm your diagnosis.

These tests will show:

• whether you have malaria
• what type of malaria you have
• if your infection is caused by a parasite that’s resistant to certain types of drugs
• if the disease has caused anemia
• if the disease has affected your vital organs

PREVENTION-

Vector control is the main way to prevent and reduce malaria transmission. If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.

WHO recommends protection for all people at risk of malaria with effective malaria vector control. Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying – are effective in a wide range of circumstances.

Insecticide-treated mosquito nets

Sleeping under an insecticide-treated net (ITN) can reduce contact between mosquitoes and humans by providing both a physical barrier and an insecticidal effect. Population-wide protection can result from the killing of mosquitoes on a large scale where there is high access and usage of such nets within a community.

In 2018, about half of all people at risk of malaria in Africa were protected by an insecticide-treated net, compared to 29% in 2010. However, ITN coverage has been at a standstill since 2016.

Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is another powerful way to rapidly reduce malaria transmission. It involves spraying the inside of housing structures with an insecticide, typically once or twice per year. To confer significant community protection, IRS should be implemented at a high level of coverage.

Globally, IRS protection declined from a peak of 5% in 2010 to  2% in 2018, with decreases seen across all WHO regions, apart from the WHO Eastern Mediterranean Region. The declines in IRS coverage are occurring as countries switch from pyrethroid insecticides to more expensive alternatives to mitigate mosquito resistance to pyrethroids. 

Antimalarial drugs

Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. For pregnant women living in moderate-to-high transmission areas, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine, at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended, delivered alongside routine vaccinations.

Since 2012, WHO has recommended seasonal malaria chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season.

Insecticide resistance

Since 2000, progress in malaria control has resulted primarily from expanded access to vector control interventions, particularly in sub-Saharan Africa. However, these gains are threatened by emerging resistance to insecticides among Anopheles mosquitoes.  According to the latest World malaria report, 73 countries reported mosquito resistance to at least 1 of the 4 commonly-used insecticide classes in the period 2010-2018. In 27 countries, mosquito resistance was reported to all of the main insecticide classes.

Despite the emergence and spread of mosquito resistance to pyrethroids, insecticide-treated nets continue to provide a substantial level of protection in most settings. This was evidenced in a large 5-country study coordinated by WHO between 2011 and 2016.

While the findings of this study are encouraging, WHO continues to highlight the urgent need for new and improved tools in the global response to malaria. To prevent an erosion of the impact of core vector control tools, WHO also underscores the critical need for all countries with ongoing malaria transmission to develop and apply effective insecticide resistance management strategies.

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Advice for travelers

While malaria is not endemic to the U.S., travel to many countries around the world entails a risk.

The Centers for Disease Control advise travelers to take the following precautions:

• find out what the risk of malaria is in the country and city or region they are visiting
• ask their doctor what medications they should use to prevent infection in that region
• obtain antimalarial drugs before leaving home, to avoid the risk of buying counterfeit drugs while abroad
• consider the risk for individual travelers, including children, older people, pregnant women, and the existing medical conditions of any travelers

TREATMENT –

Treatment aims to eliminate the Plasmodium parasite from the bloodstream.

Those without symptoms may be treated for infection to reduce the risk of disease transmission in the surrounding population.

The World Health Organization (WHO) recommends artemisinin-based combination therapy (ACT) to treat uncomplicated malaria.

Artemisinin is derived from the plant Artemisia annua, better known as sweet wormwood. It rapidly reduces the concentration of Plasmodium parasites in the bloodstream.

Practitioners often combine ACT with a partner drug. ACT aims to reduce the number of parasites within the first 3 days of infection, while the partner drugs eliminate the rest.

Expanding access to ACT treatment worldwide has helped reduce the impact of malaria, but the disease is becoming increasingly resistant to the effects of ACT.

In places where malaria is resistant to ACT, treatment must contain an effective partner drug.

The WHO has warned that no alternatives to artemisinin are likely to become available for several years.

ACCORDING TO WHO

Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission. The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT).

WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 30 minutes or less. Treatment, solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible. More detailed recommendations are available in the third edition of the “WHOGuidelines for the treatment of malaria”, published in April 2015.

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum malaria parasites to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival.

Protecting the efficacy of antimalarial medicines is critical to malaria control and elimination. Regular monitoring of drug efficacy is needed to inform treatment policies in malaria-endemic countries, and to ensure early detection of, and response to, drug resistance.

In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong subregion (GMS), a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all populations at risk of malaria. But even as this work was under way, additional pockets of resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings. A new approach was needed to keep pace with the changing malaria landscape.

At the World Health Assembly in May 2015, WHO launched the Strategy for malaria elimination in the Greater Mekong subregion (2015–2030), which was endorsed by all the countries in the subregion. Urging immediate action, the strategy calls for the elimination of all species of human malaria across the region by 2030, with priority action targeted to areas where multidrug resistant malaria has taken root.With technical guidance from WHO, all countries in the region have developed national malaria elimination plans. Together with partners, WHO is providing ongoing support for country elimination efforts through the Mekong Malaria Elimination programme, an initiative that evolved from the ERAR

Surveillance

Surveillance entails tracking of the disease and programmatic responses, and taking action based on the data received. Currently, many countries with a high burden of malaria have weak surveillance systems and are not in a position to assess disease distribution and trends, making it difficult to optimize responses and respond to outbreaks.

Effective surveillance is required at all points on the path to malaria elimination. Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable.

In March 2018, WHO released a reference manual on malaria surveillance, monitoring and evaluation. The manual provides information on global surveillance standards and guides countries in their efforts to strengthen surveillance systems.

Elimination

Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures are required to prevent re-establishment of transmission. Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites as a result of deliberate activities. Interventions are no longer required once eradication has been achieved.

Globally, the elimination net is widening, with more countries moving towards the goal of zero malaria. In 2018, 27 countries reported fewer than 100 indigenous cases of the disease, up from 17 countries in 2010.  

Countries that have achieved at least 3 consecutive years of 0 indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. Over the last decade,  10 countries have been certified by the WHO Director-General as malaria-free: Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Algeria (2019) and Argentina (2018). The WHO Framework for Malaria Elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination.

Vaccines against malaria

RTS,S/AS01 (RTS,S) is the first and, to date, the only vaccine to show that it can significantly reduce malaria, and life-threatening severe malaria, in young African children. It acts against P. falciparum, the most deadly malaria parasite globally and the most prevalent in Africa. Among children who received 4 doses in large-scale clinical trials, the vaccine prevented approximately 4 in 10 cases of malaria over a 4-year period.

In view of its public health potential, WHO’s top advisory bodies for malaria and immunization have jointly recommended phased introduction of the vaccine in selected areas of sub-Saharan Africa. Three countries – Ghana, Kenya and Malawi – began introducing the vaccine in selected areas of moderate and high malaria transmission in 2019. Vaccinations are being provided through each country’s routine immunization programme.

The pilot programme will address several outstanding questions related to the public health use of the vaccine. It will be critical for understanding how best to deliver the recommended 4 doses of RTS,S; the vaccine’s potential role in reducing childhood deaths; and its safety in the context of routine use.

This WHO-coordinated programme is a collaborative effort with Ministries of Health in Ghana, Kenya and Malawi and a range of in-country and international partners, including PATH, a non-profit organization, and GSK, the vaccine developer and manufacturer.Financing for the vaccine programme has been mobilized through a collaboration between 3 major global health funding bodies: Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid.

WHO response

WHO Global technical strategy for malaria 2016-2030 

The WHO Global technical strategy for malaria 2016-2030 – adopted by the World Health Assembly in May 2015 – provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The Strategy sets ambitious but achievable global targets, including:

• reducing malaria case incidence by at least 90% by 2030;
• reducing malaria mortality rates by at least 90% by 2030;
• eliminating malaria in at least 35 countries by 2030;
• preventing a resurgence of malaria in all countries that are malaria-free.

This Strategy was the result of an extensive consultative process that spanned 2 years and involved the participation of more than 400 technical experts from 70 Member States.

The Global Malaria Programme

The WHO Global Malaria Programme coordinates WHO’s global efforts to control and eliminate malaria by:

• setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;
• keeping independent score of global progress;
• developing approaches for capacity building, systems strengthening, and surveillance; and
• identifying threats to malaria control and elimination as well as new areas for action.

The Programme is supported and advised by the Malaria Policy Advisory Committee (MPAC), a group of global malaria experts appointed following an open nomination process. The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy-setting process. 

“High burden high impact approach”

At the World Health Assembly in May 2018, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, called for an aggressive new approach to jump-start progress against malaria. A new country-driven response – “ High burden to high impact” – was launched in Mozambique in November 2018. 

The approach is currently being driven by the 11 countries that carry a high burden of the disease (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania). Key elements include: 

1. political will to reduce the toll of malaria; 
2. strategic information to drive impact; 
3. better guidance, policies and strategies; and 
4. a coordinated national malaria response. 

Catalysed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be prevented and diagnosed, and that is entirely curable with available treatments.

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