Malaria is a life threatening disease that is caused by Plasmodium parasite and is transmitted through the bite of an infected Anopheles mosquito. Malaria is mostly found in tropical and subtropical countries where the parasite can multiply and survive. According to WHO in 2016, half of the population of the world were at a risk of developing malaria. Typically, malaria develops in people who live in these tropical and subtropical climates and also in people who travel to these countries where malaria is most common.
Which Countries Have Malaria?
So which countries are endemic for malaria? According to CDC (Center for Disease Control and Prevention) 2018 malaria can occur in 100+ countries. The territories most affected by malaria are large parts of Africa and South Asia, areas of Central and South America, the Caribbean, the Middle East and some Pacific islands.
The countries that are at high risk for malaria are Angola, Burkina Faso, Cameroon, Central African Republic, Chad, Cote D’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Gabon, The Gambia, Ghana, Guinea, Guyana, Liberia, Mali, Mauritania, Niger, Nigeria, Papua New Guinea, Senegal, Sierra Leone, Solomon Islands, Somalia, Republic of South Sudan, Sudan, Tanzania, Togo and Uganda. Chloroquine resistance has been found in all of the above countries.
The countries that are at moderate risk for malaria are Afghanistan, Benin, Burma (also known as Myanmar that is resistant to chloroquine and mefloquine), Burundi, Ethiopia, Guinea-Bissau, Haiti (no drug resistance), Honduras (no drug resistance), India, Madagascar, Malawi, Mozambique, Pakistan, Peru, Rwanda, Timor-Leste (also known as East Timor), Vanuatu, Zambia and Zimbabwe. The rest of the above countries are resistant to chloroquine.
The countries that are at low risk of malaria are Bangladesh, Bolivia, Botswana, Brazil, Cambodia (resistance to chloroquine and mefloquine), Colombia, Dominican Republic (no drug resistance), French Guiana, Guatemala, Indonesia, Kenya, Malaysia, Namibia, Nepal, Nicaragua (no drug resistance), Panama, Philippines, South Africa, South Korea (no drug resistance), Suriname, Thailand (resistance to chloroquine and mefloquine), Venezuela, Vietnam (resistance to chloroquine and mefloquine) and Yemen. The remaining above countries is resistant to chloroquine.
The countries that are at very low risk of malaria are Belize, Bhutan, Cape Verde, China (resistance to chloroquine and mefloquine), Costa Rica (no drug resistance), Ecuador including the Galapagos Islands, El Salvador (no drug resistance), Iran, Laos (resistance to chloroquine and mefloquine), Mexico (no drug resistance), Oman, Sao Tome and Principe, Saudi Arabia, Swaziland and Tajikistan. The rest of the above countries are resistant to chloroquine.
There is currently no data provided for Comoros, Djibouti, Mayotte in France, North Korea (no drug resistance) and Western Sahara. The rest of the above countries are resistant to chloroquine.
Factors such as local weather conditions, mosquito vector density and infection prevalence, which affect the local malaria transmission patterns can change very rapidly and can differ from year to year. The above estimated risk is based on the number of malaria cases reported by American travelers and also the estimated people that travel to these places.
Prophylaxis and Treatment Of Malaria
The causative parasite for malaria is Plasmodium and the species that most commonly infect humans are Plasmodium falciparum, Plasmodium vivax and Plasmodium ovale. Anopheles mosquitoes act as vector for transmission of the disease, so it is best to prevent these vectors to avoid transmission of the disease. Malaria vector control is done in two forms, either by long lasting insecticide treated mosquito nets and indoor residual spraying.
Chemoprophylaxis is also used to prevent malaria transmission in travelers who travel to the areas where malaria is prevalent. The commonly used antimalarials are chloroquine, quinine, quinidine, artemether-lumefantrine, doxycycline (used in combination with quinine), clindamycin (used in combination with quinine), artesunate, hydroxychloroquine, mefloquine, primaquine, combination of atovaquone and proguanil. There have been a lot of cases of drug resistance all around the world, especially P. falciparum species to chloroquine. The most effective chemoprophylaxis is Malarone (combination of atovaquone and proguanil). Primaquine has been known to cause hemolytic anemia in people with G6PD (glucose 6 phosphate dehydrogenase) deficiency. Therefore, prior to starting of Primaquine, patients must be screened for deficiency of G6PD. The above drugs are also used to treat malaria.
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