frequently asked questions

QUESTION: What is the relationship between HIV/AIDS and malaria?
ANSWER: There is a growing body of knowledge on the interactions between HIV/AIDS and malaria. The consequences of such interactions are particularly serious for reproductive health. Co-infected pregnant women are at very high risk of anemia and malarial infection of the placenta. As a result, a considerable proportion of children born to women with HIV and malaria infection have low birth weight and are more likely to die during infancy. It is unclear whether malaria during pregnancy increases the risk of mother-to-child transmission of HIV; studies examining this relationship have shown conflicting results.

Among adult men and women who are not pregnant, HIV/AIDS may augment the risk of malarial illness, especially in those with advanced immune-suppression. In areas of unstable malaria transmission, HIV-infected adults may be at increased risk of developing severe malaria. HIV-infected adults with low CD4 cell counts may also be more susceptible to treatment failure of anti-malarial drugs. Furthermore, acute malaria episodes temporarily increase viral replication and hence HIV viral load. As an important cause of anemia, malaria sometimes leads to blood transfusions, which is a potential risk factor for HIV infection if the blood is not tested for HIV.

WHO recommends that certain aspects of both malaria and HIV/AIDS control programs be integrated:

• People living with HIV/AIDS in areas of malaria transmission are particularly vulnerable to malaria; their protection by insecticide-treated nets has high priority.
• HIV-positive pregnant women at risk for malaria should always be protected by insecticide-treated nets, and in addition - according to the state of HIV infection - receive either intermittent preventive treatment with sulfadoxine-pyrimethamine (at least three doses) or daily cotrimoxazole prophylaxis.
• Programs for the control of the two diseases should collaborate to ensure integrated service delivery for the diagnosis and treatment of both diseases, and in particular within the framework of reproductive health services.

Source: WHO, Malaria and HIV/AIDS Interaction and Implications: Conclusions of a technical consultation convened by WHO, 23-25 June, 2004.

QUESTION: What is the most effective treatment for malaria?
ANSWER: There has been a shift recently in the recommended first-line treatment for malaria. Chloroquine (CQ) and Salphadoxine Pyramithamine (SP) were cheap and effective and could be used by village health workers and parents for home-based treatment. But misuse of these drugs led to resistance by the parasite and loss of effectiveness in many malaria-affected areas. Currently, Artemisinin Combination Therapy (ACT) is the most effective first-line treatment for malaria. Artemisinin is isolated from a medicinal herb (called Artemisia annua), which has been used for centuries in China as a traditional treatment for malaria.

ACT is comprised of two medicines that work in different ways, so it is believed to be unlikely that the malaria parasite ¾ which has rapidly developed resistance to other single treatments ¾ would develop resistance to these drug combinations.

ACT is present in two main forms: artemether-lumefantrine (Coartem) and artesunate-amodiaquine. The benefit of the artemether-lumefantrine combination is that the drugs are co-formulated (i.e., put together in one tablet), making use/administration easier. WHO has just added Coartem to its essential drug list.

Currently, many malaria-affected countries are contemplating changing their national malaria treatment guidelines from CQ or SP to ACT. This poses a programmatic and communication challenge. ACT is much more expensive than either CQ or SP, hence it needs to be used more selectively based on more accurate diagnosis. Communication strategies need to make sure that information dissemination and demand creation for ACT correspond with the availability of the new treatment.

Sources:
Reducing Malaria’s Burden: Evidence of Effectiveness for Decision Makers. Global Health Council, 2003. www.globalhealth.org
Roll Back Malaria www.rbm.who.int

QUESTION: What is Dengue fever and how can it be controlled?
(Question submitted by Monteron Yzable, Cotabato Province, Philippines)
ANSWER: Dengue fever is a disease caused by a virus transmitted to humans through the bite of an infected mosquito. In the last 25 years, the disease has become a major international public health concern. It is estimated that there are more than 100 million cases of dengue worldwide every year, in tropical areas, mainly urban and semi-urban areas. The disease is now endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, Southeast Asia and the Western Pacific. Southeast Asia, the Western Pacific, and the Americas are most seriously affected.

The principal symptoms of dengue include high fever, severe headache, backache, joint pains, nausea, and vomiting. In about 10 percent of cases, the disease presents in its more serious form called Dengue Hemorrhagic Fever (DHF), with bleeding from the nose or gums and possibly internal bleeding. DHF carries a high risk of circulatory system failure and shock, followed by death, if not treated.

There is no specific medication for treatment of dengue infection. Pain relievers and drinking plenty of fluids are recommended. It is important to quickly recognize DHF and seek immediate medical care. Hospitalization is frequently required for DHF for effective fluid replacement therapy to prevent circulatory failure.

No vaccine is available yet for preventing dengue. The best preventive measure is to work with affected communities and their governments to eliminate or control places where dengue mosquitoes lay eggs, primarily artificial containers that hold water and are commonly stored outdoors as well as in kitchens and bathrooms. Items that collect rainwater or are used to store piped water (for example, clay or cement jars, metal drums, cement tanks and cisterns as well as smaller plastic containers, such as buckets) should be covered with a thin filter cloth to prevent mosquitoes. Pet and animal watering containers should be completely emptied and scrubbed at least once a week before refilling to eliminate eggs and larvae.

Vases with fresh flowers should be completely emptied of both water and flowers after a week. This is particularly important in cemeteries. Used tires are most responsible for spreading dengue mosquitoes from country to country. Tires - which are used for a variety of purposes such as securing a cheaply constructed roof, functioning as animal drinking dishes, chairs, swings or being stored for future use - should be filled with dirt, punctured in strategic places to allow draining without destroying the tire's function, or covered with plastic on all sides to prevent mosquito entry and egg laying.

For more information visit the Centers for Disease Control and Prevention at www.cdc.gov and WHO site at www.who.int

QUESTION: What are the symptoms of malaria and how dangerous is it?
ANSWER: Malaria symptoms appear about 9 to 14 days after an infectious mosquito bite. Typically, malaria causes fever, headache, vomiting, and other flu-like symptoms. If drugs are not available for treatment or the parasites are resistant to them, the infection can progress rapidly to become life-threatening. Malaria can kill by infecting and destroying red blood cells (causing anemia, which manifests itself by weakness, pallor, and yellow discoloration of eyes); or, in the case of cerebral malaria, by clogging the capillaries that carry blood to the brain causing convulsions and coma; or by clogging the capillaries of other vital organs, such as the kidney or the liver, which leads to kidney or liver failure. The illness is usually less severe in adults, thanks to their acquired immunity. Infections in young children are serious and can be fatal if not treated promptly.

Source: Roll Back Malaria, 2001-2010 United Nations Decade to Roll Back Malaria. For more information visit: www.rbm.who.int

QUESTION: What are the effective strategies for malaria control?
ANSWER: Science still has no magic bullet for malaria. Nevertheless, effective low-cost strategies are available for its treatment, prevention, and control:

• Mosquito nets treated with a safe insecticide reduce malaria transmission and child death. Vulnerable groups, such as pregnant women and children, should sleep under insecticide-treated nets. Although most nets developed to date need to be retreated every six months, new long-lasting nets are becoming available that can withstand dozens of washings before needing retreatment.
• Indoor Residual Spraying - including spraying the inside walls and ceilings of houses and buildings with safe and effective insecticides - kills anopheles mosquitoes that tend to rest and feed indoors.
• Pregnant women are more vulnerable to malaria, especially during their first pregnancy. Through measures such as preventive treatment (often referred to as Intermittent Preventive Treatment) and the use of insecticide treated nets, preventing malaria in pregnant women results in improved maternal and infant health as well as survival. Intermittent Preventive Treatment (IPT) should be available as part of antenatal care. IPT with an approved antimalarial drug should be given at least twice during monthly antenatal care visits after quickening.
• Prompt access to treatment with effective, up-to-date medicines, such as artemisinin-based combination therapies (ACT), saves lives. National malaria treatment policies in affected countries are being or have been revised to feature ACT. Since ACT is more expensive than chloroquine and sulfadoxine-pyramethamine (the former 'first line' drugs), more accurate diagnosis is needed to prevent wastage of the drug.

If countries apply these and other measures on a wide scale and monitor them, then the burden of malaria will be significantly reduced.

Source: Roll Back Malaria. www.rbm.who.int. See also: A Strategic Framework for Malaria Prevention and Control during Pregnancy in the Africa Region. Brazzaville: WHO Regional office for Africa, 2004, AFR/MAL/04/01. The Use of Malaria Rapid Diagnostic Tests. www.wpro.who.int/rdt