CURRENT AND FUTURE IMPACTS OF CLIMATE CHANGE ON MALARIA IN
CENTRAL AND WESTERN AFRICA
by
Stephanie Lee Nara
BS, Utica College, 2011
Submitted to the Graduate Faculty of
Infectious Diseases and Microbiology
Graduate School of Public Health in partial fulfillment
of the requirements for the degree of
Master of Public Health
University of Pittsburgh
2013
UNIVERSITY OF PITTSBURGH
GRADUATE SCHOOL OF PUBLIC HEALTH
This essay is submitted
by
Stephanie Nara
on
May 3, 2013
and approved by
Essay Advisor:
Linda Frank, PhD, MSN, RN,
ACRN, CS, FAAN
Associate Professor
Infectious Diseases and Microbiology
Graduate School of Public Health
University of Pittsburgh
________________________________
Essay Reader:
Lee Harrison, MD, BS
_________________________________
Professor, Epidemiology and Medicine
Graduate School of Public Health and School of Medicine
University of Pittsburgh
Essay Reader:
Nicholas Preston, PhD
________________________________
Senior Research Scientist
EcoHealth Alliance
New York, New York
ii
Copyright © by Stephanie Nara
2013
ii
Linda Frank, PhD, MSN, RN, ACRN, CS, FAAN
CURRENT AND FUTURE IMPACTS OF CLIMATE CHANGE ON MALARIA
IN CENTRAL AND WESTERN AFRICA
Stephanie Nara, MPH
University of Pittsburgh, 2013
ABSTRACT
Temperature and climate change influence the transmission and life cycle of malaria. The
regions of central and western Africa are locations where malaria is a severe public health
problem. Published work has reviewed components of malaria, but there remains an incomplete
analysis of the severity of future climate change on malaria. This literature review examined key
research questions analyzing effected geographical locations of malaria, factors contributing to
climate change, current and future prevention methods and relevant research and gaps in research
services and policy. Primary academic literature was reviewed and chosen based on specific
inclusion and exclusion criteria. The results show an analysis of these research questions and
indicate an emphasis on research. Important findings found that advanced technology needs to
become a main factor in funding for prevention programs. Global education methods for health
professionals and the community need to become a priority to decrease the impact of climate on
disease. In addition, humans need to have a better understanding of how their actions impact the
earth’s climate and individual health. The public health importance of this review is critical not
only to African Regions, but for global health as a whole. It is a valuable educational tool that
highlights the need for additional research in the areas of climate change and vector response,
ii
environmental influences, prevention, policy, and contributes to the public health issue of
malaria in the fight for Central and Western African health.
ii
TABLE OF CONTENTS
PREFACE ................................................................................................................................. VIII
1.0
INTRODUCTION .........................................................................................................1
1.1 METHODS ....................................................................................................................5
2.0
1.1.1
Problem Statement ............................................................................................6
1.1.2
Research Questions ...........................................................................................7
FINDINGS/RESULTS ..................................................................................................8
2.1 WHAT AREAS IN THE WORLD ARE MOST AFFECTED BY CLIMATE
CHANGE AND INCREASE INCIDENCE OF MALARIA? ..................................................8
2.2 HOW DO ENVIROMENTAL FACTORS CONTRIBUTE TO CLIMATE
CHANGE?
..............................................................................................................................12
2.3 HOW DO PUBLIC HEALTH MEASURES AND RELATED RESEARCH
CONTRIBUTE TO THE CURRENT AND FUTURE PREVENTION AND CONTROL
OF MALARIA? ..........................................................................................................................14
2.4 WHAT GAPS IN RESEARCH AND POLICY ARE NEEDED FOR THE
FUTURE?
3.0
..............................................................................................................................17
IMPLICATIONS FOR PUBLIC HEALTH .............................................................19
3.1 RESEARCH ................................................................................................................19
3.2 POLICY.......................................................................................................................19
3.3 PUBLIC EDUCATION..............................................................................................20
3.4 HEALTH PROFESSIONAL EDUCATION ...........................................................20
4.0 DISCUSSION / CONCLUSION ..........................................................................................21
BIBLIOGRAPHY ........................................................................................................................23
ii
LIST OF FIGURES
Figure 1. Malaria Life Cycle ........................................................................................................... 2
Figure 2. Global distribution of relative risk of an EID event (2) .................................................. 8
Figure 3A. Temperature Change 1990-2012 (15)......................................................................... 10
Figure 3B. Temperature Change 1990-2012 (15)..........................................................................11
ii
PREFACE
This thesis essay would not be possible without the support of the following people:
Dr. Linda Frank: I would like to thank my primary advisor, Dr. Linda Frank for valuable
guidance and support throughout this literature review. Without your invaluable assistance,
motivation, and extensive knowledge, this review would not have been successful.
Dr. Lee Harrison: I would like to thank my committee member, Dr. Lee Harrison, for providing
general advice, reviewing drafts, and providing helpful comments.
Dr. Nicholas Preston: I would like to thank my committee member, Dr. Nicholas Preston, for
providing advice and extensive knowledge on the subject. I am highly indebted to Ecohealth
Alliance and your wiliness to take me on as an intern; I would not have found the motivation
behind this review.
ii
1.0
INTRODUCTION
Global climate change has become a main protagonist in many aspects of environmental and
ecology issues in the past 10 years. These issues have had effects on crops, local precipitation
changes, changing weather patterns and loss of polar ice caps (1). Its effects however may be on
a myriad of prokaryotic and eukaryotic life forms, ranging from ocean bacteriophages to
bacteria, algae, invertebrates and vertebrate life forms (1). In terms of infectious diseases, these
changes may also affect a wide range of vectors and hosts. An evolving area in which climate
changes may be inter-related to infectious diseases and pubic health are starting to be
investigated. Of the infectious diseases that could have serious public health implications,
understanding malaria and quantifying its effects on transmission and disease burden, is
significant for control and reduction.
Emerging infectious diseases (EIDs) are a significant burden on global economics and
public health (2). This preventable disease costs an estimated $12 billion dollars per year by
governmental agencies and infected individuals (3). Malaria is an infectious disease in which a
female Anopheles mosquito transmits a Plasmodium falciparum parasite into a human host. This
particular parasite is responsible for the most human deaths from malaria (4). Once the parasite
enters the human host it replicates in the liver and is than transmitted into red blood cells (5).
Once in the red blood cells, symptoms of malaria occur, which may differ depending on the
individual, but include a combination of fever, chill, sweats, headaches, body aches, vomiting,
1
and general malaise (4). The life cycle of malaria is continuous through the exchange of parasites
through its mosquito vector from the human host. During the red blood cell stage of human
malaria, the disease can be spread through a bite of a mosquito and injected into another human
(5).
Figure 1. Malaria Life Cycle
The World Health Organization (WHO) reported a total of 660,000 deaths globally in
2010 from malaria, with 90% of them derived from African regions, and over 40% from Niger,
Congo, and the Democratic Republic of Congo (6). Transmission of malaria can amplified
through factors such as mosquito intensity, temperature changes, and environmental influences.
2
In the rapidly urbanizing area of Sub-Saharan Africa, there are 10 Anopheles species responsible
for transmission, compared to only three main species in eastern Africa and the African Islands
(7). These additional species contribute to the public health epidemic in central and western
Africa by providing faster transmission of disease. Future climate change has an enormous
potential to evoke severe consequences with on human lives (8). Multiple studies have shown
that temperature is an additional driver of mosquito traits such as, transmission intensity,
mosquito development, incidence of biting and replication rate of parasites within the mosquito
(9). In lower latitudes areas where disease reporting is low, such as sub-Saharan Africa, climate
change is hypothesized to drive emergence of infectious diseases (2). Additionally, a recent
study on global trends in EIDs, presented additional that highlights the importance of
environmental factors on pathogen transmission (2). This study looked at 335 EID events from
1990-2004 and found that 71.8% of these occurred from wildlife, with a majority of vector-borne
pathogens occurring at lower latitudes. Over the specific time period, an increase in disease
emergence was correlated with ecological and environmental factors. Some of the anthropogenic
activity that has greatly influenced emergence is increased human population, deforestation,
changes in agriculture and burning of fossil fuels (10). Research has shown that similar
environmental factors have an influence of malaria transmission (9).
The natural history of the epidemiology of malaria, in combination with several human
and environmental impacts, has contributed to climate change, resulting in enormous impacts on
the incidence and prevalence of malaria (11). Studies have concluded that a portion of natural
factors that significantly contribute to malaria transmission are temperature and precipitation
(12). On the opposite end of the spectrum anthropogenic factors that aid in climatic change
3
include burning of fossil fuels, deforestation, and changes in agricultural practice (13). These
factors contribute to negative health impacts of malaria in Central and Western African areas.
The preventative measures for malaria must consider the future implications of this
disease. Developing technology such as modeling and genomic sequencing, could greatly impact
public health preventative measures. The use of modeling techniques provide the ability to
provide predictive measures involving complex aspects of the life cycle of malaria and climate
change. Additionally, through genetic sequencing, new drug targets and proteins involved in
malaria can be identified for preventative interventions in pathogenicity (4). Large scale genomic
variation studies could assist in efforts to eliminate malaria in the future (14).
Technology coupled with additional emphasis on educational prevention on can help to
diminish the effect of malaria and climate change. The public health importance of this review is
critical not only to African Regions, but for global health as a whole. It is a valuable educational
tool that highlights the need for additional research in the areas of climate change and vector
response, environmental influences, prevention, policy, and contributes to the public health issue
of malaria in the fight for Central and Western African health and potential global health in the
future.
4
1.1
METHODS
An initial online search was conducted to analyze the impacts of climate change globally through
the National Aeronautics and Space Administration’s global climate online resource. Data was
collected on global temperature change and precipitation rates. Information was then gathered
through online search databases on the locations where malaria incidence and prevalence rates
were the highest. These databases included Google Scholar, PubMed, the University of
Pittsburgh’s digital library (PittCat), and through Columbia University’s digital library.
References were also collected from an online library through an open source tool titled Zotero.
This library was comprised during the summer of 2012 during a practicum experience at
EcoHealth Alliance. Additional information was collected from the Government affiliated
websites, The World Health Organization (WHO) and Centers for Disease Control (CDC)
websites were used to gather credible information on malaria. Western and Central African were
locations identified as regions where malaria is endemic, research was then focused on that
location and climate change was then assessed in those areas.
A search strategy was then conducted through keywords and phrases. These included
terms such as “global climate change’, “epidemiology of malaria”, “sub-Saharan Africa and
malaria”, “malaria transmission rates”, “public health policy and malaria”, “malaria prevention”,
“predictive modeling and malaria”, “temperature change and malaria”,
“implications of
temperature change and health”, “prevention and malaria”, “surveillance response and malaria”.
After using those search terms and specified databases over 2000 references were identified and
an inclusion and exclusion criteria was used. The years published must have been from 2000present, (with the exception of Ronald Ross reference), must be full-text products, and peer
reviewed journal articles. References were then evaluated based on importance and pertinence.
5
Evaluation criteria were based on inclusion and exclusion criteria that would provide the most
recent and credible sources. After all search criteria was assessed, 30 papers were reviewed
specifically, which provided gaps in research and information for the literature review. The
review of the literature collectively accumulated past and present research efforts to assess and
answer research questions related to the public health burden of malaria in central and western
Africa. Collected articles were stored in Zotero and Endnote was used for formatting the
bibliography.
One of the limitations of this literature review was that minimal information was
available for the surveillance and predicative tools regarding malaria prevention. Technology is
currently developing in these areas, thus providing limited search results. Another limitation was
a lack of literature on developing policy regarding interventions and preventative measures. New
policies will be based on emerging epidemiological evidence from modeling, causing limited
information to review. Previous implemented policy measures were therefore included.
The results of the literature search and search criteria created a quality problem statement
of high public health significance and relevance.
1.1.1
Problem Statement
Malaria is a current public health burden for central and western Africa and has the
potential to become an increased problem with future climate change. This infectious disease
affects all individuals in these areas regardless of age, sex, or socio-economic status. Quantitative
analysis of research is needed to have a better understanding of prevention methods, impacts of
predictive modeling for climate on vector transmission, and how policy has contributed to the
6
fight against malaria. These components have the potential to provide insight on new control
and reduction methods with a strong emphasis on future climate changes. This literature review
emphasizes the need for research in these areas and highlights the high public health significance
of malaria and climate change in central and western Africa.
1.1.2
Research Questions
1.)
What geographical areas in the world are most affected by climate change
and possible increases of malaria?
2.)
How do public health measures and related research contribute to the
current and future prevention and control of malaria?
3.)
How do environmental factors contribute to climate change?
4.)
What gaps in research and policy are needed for the future?
7
2.0
2.1
FINDINGS/RESULTS
WHAT AREAS IN THE WORLD ARE MOST AFFECTED BY CLIMATE
CHANGE AND INCREASE INCIDENCE OF MALARIA?
EIDs continuously affect individuals globally through different paths of transmission. In a global
distribution of relative risk of EID events, African countries have shown the largest volume of
vector-borne disease in a concentrated area (2).
Figure 2. Global distribution of relative risk of an EID event (2)
[Green (lower risk) to red (higher risk).]
8
Of these infectious diseases, malaria is a preventable and treatable one that continues to burden
many parts of the world annually. The 2012 malaria report states that there are currently 104
endemic countries where malaria is a burden (6). Of the 25 countries that make up Central and
Western Africa, 23 of those are part of malaria endemic areas. The populations in these areas are
continuing to grow at a rapid rate, which enables transmission to thrive in urban areas. Robert et
al. reported that the populations in sub-Saharan Africa were estimated at 784 million individuals
and by 2025 estimates are approximated to be more then 1.2 billion. This is equivalent to a 2%
increase in urbanization in the last 30 years, doubling every 37 years. Population factors impact
transmission in terms of increased pollution which has effects on larval habits, life cycles and
vector capacity of Anopheles mosquitoes (7). The public health significance of this problem is
apparent in the hospital admissions rates, in which more then 15% are due to malaria (7). These
large populations are not exclusively the cause of the high malaria incidence in these areas, but
coupled with changing climate, it makes for a lethal combination.
The global climate has been steadily changing over the past years in multiple aspects
including temperature and precipitation. Over the years of 2009-2012 alone, there was a 13.6degree increase in land and ocean temperatures (15). Western and Central Africa have felt the
effects of these changes and experienced major natural disasters that have contributed to optimal
malaria conditions. One of the most important factors in Anopheles breeding is temperature and
humidity, where higher temperatures and stagnant water sources accelerate parasite growth in the
mosquito (5). In 2012, Western Africa experienced severe flooding during the months of July
through September. According to the National Oceanic and Atmospheric Administration, 2012
was also reported as the 10th warmest year since 1880, marking the 36th consecutive year that
global temperatures were above the average. Previously, the years 2010, and 2011 recorded the
9
highest precipitation to date and 2010 manifested the warmest year to date. In 2010, there was
the biggest shift in the El Nino-Southern Oscillation, which has a large influence on temperature
precipitation globally (15). This shift has resulted in wetter-than-normal conditions in Western
Africa, and drier than normal conditions over equatorial Central and East Africa (16). These
climate anomalies have and will continue to impact malaria transmission rates unless drastic
prevention methods are incorporated across Western and Central Africa (9).
Figure 3A. Temperature Change 1990-2012 (15)
10
Figure 3B. Temperature Change 1990-2012 (15)
Prevention methods have been put in place and positive results are being observed in certain
areas. In the previous 5 years there has been a decline of an average of 50-70% in incidence in
the areas of African Islands and Southern Africa. Although in terms of Central and Western
Africa deteriorating conditions are occurring and there has not been significant decline in malaria
incidence (10). With increasing climate conditions and decreasing effectiveness of prevention
programs, malaria is a public health emergency in Western and Central African regions.
11
2.2
HOW DO ENVIROMENTAL FACTORS CONTRIBUTE TO CLIMATE
CHANGE?
Understanding the factors that assistant in climate change will help malaria prevention initiatives
in the future. The human population is largely responsible for contributing to changes in
anthropogenic land use and human ecology for emerging infectious diseases in terms of climate.
One study found that a rise in emergence and re-emergence of infectious disease is related to
climate anomalies beginning in the 1990’s and found supporting evidence that climate change
drives the emergence of diseases that have sensitive vectors to environmental conditions, such as
temperature and rainfall (2). The Anopheles mosquito vector is particularly sensitive to
fluctuations in temperature. One study found that in addition to average temperature, daily
changes affect the rate of parasite growth and increase virulence (17). Adapting to these
fluctuations make it possible for transmission to occur at lower mean temperature levels,
therefore increasing transmission rates (17). Data from the project, mapping malaria risk in
Africa (MARA) determined projections of potential transmission changes due to predicted
changes in climate. By the 2080’s scientist have predicted the number of people at risk for
flooding to increase from 75 million to 200 million, with increased ambient temperatures to
follow (18). Researchers have predicted that without an increase in population, which is
inevitable, there will be a 16-28% increase in people exposed each month to malaria (18).
Changes in human activities such as; deforestation, burning of fossil fuels, human
expansion, etc. are directly involved in the surge of infectious disease and climate change. The
primary cause of anthropogenic change is due to the greenhouse effects caused by the burning of
fossil fuels and clearing of forests. Humans have enhanced the natural green house effect by
adding halo-carbons, particularly Chlorofluorocarbons (CFC), CFC11 and CFC12 to the
12
atmosphere, which do not naturally occur in nature (19). CFCs are nontoxic, nonflammable
chemicals, used in the manufacturing of aerosol sprays, and packing materials (20). They destroy
the ozone layer in the stratosphere and enhance the natural greenhouse effect (21).
The normal green house effect is the warming of the earth’s surface to balance absorbed
energy from the sun (22). Human involvement boosts this process and increases evaporation
rates, in turn adding water vapors to the atmosphere (19). With the increase of human activity
there have been several studies focused on understanding the potential effects on the global
climate.
Global climate models have predicted the effects of atmospheric concentrations and
concluded an average global warming between 2.7-10.4 degrees Fahrenheit with an increase of
precipitation from 5-15% by the end of the century (13). These factors directly have and will
continue to have an influence on malaria for years to come. These predicted global changes only
increase the need to focus on prevention and policy for the public health fight against malaria.
13
2.3
HOW DO PUBLIC HEALTH MEASURES AND RELATED RESEARCH
CONTRIBUTE TO THE CURRENT AND FUTURE PREVENTION AND CONTROL
OF MALARIA?
Prevention efforts for malaria essentially began in 1910 when Sir Ronald Ross published The
prevention of Malaria (23). He deemed this disease a political disease that effects the welfare of
entire countries and that prevention should be a significant part of public administration (23). It
was not until the 1940’s that control efforts had shown an effect in which malaria was practically
eliminated from North America, Europe and Asia. These prevention methods bypassed Central
and Western Africa, where transmission intensity is much larger (11). The use of
dichlorodiphenyltrichloroethane (DDT), has been used since 1940 which kills the mosquito
vector, interfering with the host environment relationship. Since this prevention method has been
in place Anopheles mosquitos have developed a physiological resistance, making DDT an
inferior prevention method in African regions with this primary vector (24). Since the discovery
of this resistance the CDC and WHO have implemented the following prevention methods:
insecticide- treated bed nets, Artemisinin containing combination therapies, and indoor spraying
of homes (3). These prevention methods are currently apart of the Scale up for Impact, the
national malaria control standard in Africa. This initiative is supported through the roll back
malaria (RBM) initiative developed by the World Health Organization. The RBM program
includes funding from over 500 partners from private sectors, nongovernmental and community
based organizations, foundations, and research and academic foundations (25).
The current and future impacts of climate continue to make malaria prevention of
primary concern. One study concluded that there is evidence that suggest that malaria eradication
in Africa is a feasible goal with the combined use of current interventions and future vaccines
14
(26). A current vaccine, RTS,S/AS01, is undergoing the third phase of implementation that
targets the pre-erythrocytic stage of the Plasmodium falciparum parasite in African infants (27).
The first endpoint during the trial resulted in efficacy for clinical and severe malaria in 55.8% of
the treated group. This study has the potential to greatly influence the understanding of the
relationship between exposure and immune response for malaria.
Research for understanding the complex interplay between climate and malaria
transmission is greatly dependent on predictive models. Modeling studies focus on malaria
estimates and transmission rates in regards to climate. One study created a model using the
Anopheles mosquito and the effect climate has on the vector capacity (11). They used historic
climate variation data from 2000-2010 and researched how malaria increased or decreased due to
fluctuations in climate. They used several mathematical equations looking at time, location,
rainfall, temperature, rate of larval development, and total degree-days of development through a
open source tool, the Spatiotemporal Epidemiological Modeller. When predictive results were
compared to reported malaria cases there was a positive correlation. By looking at specific
fluctuations, it gives scientist a tool to observe what locations displayed the most sensitivity to
climate variability.
An additional study using predictive modeling observed the malaria transmission cycle
and its dependence on temperature (12). Using mathematical equations they created a biological
model that used temperature dependence on the transmission cycle, with temperature data to
evaluate a time-series of ideal susceptibility for transmission (12). Three publically available
models were created that can help to identify populations at risk and enhance mapping of areas
that display increased Anopheles breeding. Combining these new technologies has the ability to
inform public health professionals of regions who will most likely need an intervention if and
15
when climate fluctuations occur (11). These analyses were done with limited surveillance data in
certain locations. With availability of monthly time sampling, there is the potential for 20 times
the improvement in accuracy (11). With increased surveillance and modeling techniques,
plausible prevention and predicative methods can be put into place during an ever-changing
global environment. Predictive models will impact public health decision-making in the future,
and is the key component in understanding the potential effects of climate variation and
transmission.
An additional research tool that will contribute to future prevention is through the use of
genetic sequencing. One study recently sequenced the entire Plasmodium falciparum genome
using an oligonucleotide array to express human profiles and stages of the malaria parasites life
cycle (4). An additional study found this parasite has a 23-megabase nuclear genome consists of
14 chromosomes, and encodes about 5,300 genes (28). Understanding the epidemiology of
Plasmodium falciparum is extremely useful for comparative purposes. This technology will
enable sampling of parasite, vector and host genomes in the field, providing information to
support the development and monitoring of malaria control methods (28). This technology
coupled with future sequencing data should be considered a starting point for identifying proteins
for new vaccine targets (4).
The combination of current prevention, potential vaccination, and predictive modeling
are the public health measures that contribute to the current and future prevention and control of
malaria not only Central and Western Africa, but globally as a whole.
16
2.4
WHAT GAPS IN RESEARCH AND POLICY ARE NEEDED FOR THE
FUTURE?
As malaria continues to impact central and western Africa, policies for prevention methods need
to be established and improved to help fill the gaps in research services. There is not currently a
licensed vaccine against malaria, which emphasizes how important research is in finding an
effective eradication strategy in endemic areas. A recent study used research to effectively
implement policy in moderate to high transmissibility endemic areas (29). A preventative study
was aimed at infants through administering a curative dose of sulphadoxine-pyrimethamine (SP)
during the time of DTP2, DTP3 and mumps vaccinations (29). The results from the trial reduced
the incidence of malaria by 30% and it is now mandatory for infants regardless of symptoms or
infection. In order for vaccine development to occur, understanding genetic epidemiology of
malaria at the molecular level is needed. Genome sequences alone provide minimal relief to
those suffering from malaria. There is currently only 35% of genes that code for Plasmodium
falciparum proteins with an identifiable function for malaria (4). The absence of routine genetic
tools suggests that this percentage is unlikely to change if conventional serial methods are
continued to be used to characterize encoded proteins (4). Molecular research needs to be
accompanied by additional efforts to develop new methods for control, including new drugs and
vaccines, through improved diagnostics and effective vector control techniques. The gap
between research and policy needs to be considered and become a driving force for policy
decision makers in the future.
A recent document was published on the importance of modeling research on shaping the
financial situation in endemic countries (30). In January 2002, the Global Funds application was
implemented as a protocol to follow to apply for funding. Since then there has been an increased
17
demand of epidemiological risk information in endemic areas before allocating funds. Through
the use of modeling, epidemiological risks can be assessed and ranked in endemic areas, thus
helping policy makers make evidence based decisions. Without research being the driving force,
“the successes of recent investment in malaria control will be lost unless until a more rational
basis for financing is established” (30). Advanced research is the next step for future prevention
for malaria and policy in central and western Africa and globally. With the predicted climate
change and increased vector transmissibility, malaria needs to take a front seat for prevention
policy.
There are challenges with malaria policy when dealing with upstream and downstream
factors. An upstream factor is the policy and regulatory challenges that affect the development of
interventions based on international regulations and international policy (31). International
regulations are an issue because not all prevention products undergo a full review by authorities.
This procedure has been criticized for long delays in implementation when malaria prevention is
a high priority (31). Additionally, the international policy processes are important in prevention,
but have also been accused of using time-consuming procedures. The downstream factors
include quality control, and the adoption and enforcement of policies (31). There are challenges
after upstream factors have created recommendations and policies. The lack of resources and
capacity in malaria endemic countries cause problems in adoption of these policies due to
funding problems. There is an issue with resources, needs, and implemented policy for malaria
prevention due to gaps in upstream and downstream factors.
18
3.0
IMPLICATIONS FOR PUBLIC HEALTH
3.1
RESEARCH
Future research has positive public health implications regarding malaria endemic countries. As
technology advances at the molecular and computational levels, the host, environment, and agent
triad has the potential to be disrupted. Future climate anomalies have the ability to severely
increase the incidence and prevalence of malaria. Through understanding the life cycles of the
Plasmodium falciparum parasite, prevention methods can begin to lessen these effects and
eventually eradicate malaria. This review will help researchers to consider the gaps of knowledge
between necessary molecular components as well as climate change and its impact on malaria.
3.2
POLICY
Policy could have positive or negative implications on public health regarding malaria
preventative strategies. With more of an emphasis of using epidemiological research for
allocating funds prevention polices could be improved. Additional funding will help countries to
implement policy and target need based areas. This review will help policy makers understand
the importance of the timing of policy and recommendation on countries. The future climate
impacts on malaria have serious public health implications on malaria endmic countries and
additional policy procedures need to be put in place.
19
3.3
PUBLIC EDUCATION
The public health implication of public education is critical for public health prevention for
malaria on a global scale. Understanding the impact of malaria on an individual’s health,
finances, and the environment is an essential tool for prevention. This review will educate the
public on current and future implications of malaria and climate change. By understanding how
human anthropogenic activity impacts climate, the public can begin to slowly work towards
improving malaria prevention strategies.
3.4
HEALTH PROFESSIONAL EDUCATION
The implications of health professional education on the issue of malaria and climate change are
of high importance. With motivated, educated individuals, malaria prevention can be attacked
from all aspects of research, funding, and policy. Understanding the public health significance of
this review is valuable in understanding what questions still need answered and what aspects
need to be improved.
20
4.0 DISCUSSION / CONCLUSION
Malaria is a current public health burden for central and western Africa and has the potential to
become an increased problem with future climate change. This infectious disease affects all
individuals in these areas regardless of age, sex, or socio-economic status. Quantitative analysis
of research is needed to have a better understanding of prevention methods, impacts of predictive
modeling and genetic sequencing for climate on vector transmission, and how policy has
contributed to the fight against malaria. These components have the potential to provide insight
on new control and reduction methods with a strong emphasis on future climate changes. The
public health importance of this review is to help professionals from all fields to avoid becoming
complacent regarding malaria prevention. It is a valuable educational tool that highlights the
need for additional research in the areas of climate change and vector response, environmental
influences, prevention, policy, and contributes to the public health issue of malaria in the fight
for Central and Western African health and potential global health in the future.
In addition to specific research in central and western Africa, global education methods
need to become a priority to decrease the impact of climate on disease. Humans need to have a
better understanding of how their actions impact the earth’s climate and individual health. With
increased awareness, the goal of global of malaria eradication can be achieved. Policy makers
and researchers need to work together to better understand the future of this disease. Climate
change should not be taken lightly and has the potential to have a huge impact on the health of
21
the public. Malaria is one infectious disease that will be affected by increased temperature and
precipitation. There will be additional public health problems that re-emerge in the future that
have currently been contained. Public health prevention is essentially in lessening the severity of
the impact of climate on disease. With increased collaboration and understanding of gaps in
research, policy and educational methods, malaria eradication can be possible.
22
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