Malaria Intelligence
We define malaria intelligence as the information that is needed to make malaria policies. The goals of malaria programs are to reduce the burden of malaria and set the stage for malaria elimination. Disease can be understood as the outcome of repeated exposure and infection, development of immunity, and treatment with anti-malarial drugs. Malaria control reduces disease in three ways:
Treating malaria with anti-malarial drugs: treatment can cure infections; prompt treatment can prevent development of severe disease; treatment of severe disease can reduce suffering and the risk of death; and post-discharge chemoprophylaxis can prevent death and other severe disease.
Reducing exposure to malaria through various modes of vector control; bednets can reduce exposure, and most modes of vector control can suppress transmission.
Reducing infection given exposure through vaccines, monoclonal antibodies, and the use of antimalarial drugs for chemoprophylaxis.
Notably, these are not mutually exclusive: treatment that cures infections and mass vaccination can reduce transmission, for example. To this, we can add a few special cases:
Attention to malaria during prenatal care can be an effective way of reducing disease. Primigravid women are at a high risk of severe malaria, and malaria has been shown to increase the chances of abortion or low birth weight infants.
Malaria outbreaks are often associated with severe outcomes, so outbreak response is an important part of malaria programs.
In weighing the effects of malaria, we should recognize the indirect effects of malaria.
We can understand the net impact of malaria control by developing mathematical models for malaria infection, immunity and disease and various forms of care seeking, and we can weigh the likely benefits of various modes of malaria control in context. Important information needed for scenario planning are:
The intensity of malaria transmission and its seasonality and propensity for outbreaks
Care seeking behaviors – access to health care and the propensity to test and treat, and adherance to antimalarial drugs
Human travel patterns, the age distribution and birth rate of the current population, and other measures of health
The mix of vector species in an area
The levels of resistance to various public health pesticides
The levels of resistance to anti-malarial drugs