Malaria Impact Report 2020

Where does malaria occur?

“In 2019, nearly half of the world’s population was at risk of malaria. Most cases and deaths occur in sub-Saharan Africa. However, the WHO regions of South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas also report significant numbers of cases and deaths.
The WHO African Region carries a disproportionately high share of the global malaria burden. In 2019, 94% of malaria cases and deaths occurred in the region.”

Source: WHO

•^{African Region |} • ^{South East Asian Region |} • ^{Eastern Mediterranean Region |} • ^{Western Pacific Region |} • ^{Region of the Americas}

Source: WHO

How many victims (fatalities) are caused by malaria?

Malaria is still one of the deadliest diseases in the world. In 2019, there were an estimated 229,000,000 malaria cases. The estimated number of malaria deaths in that same year was 409,000. The real figures are even higher, since not all infections are diagnosed and/or reported.

Unfortunately, COVID-19 is expected to have an unfortunate negative impact on the malaria death rate and malaria cases in 2020 and beyond. Estimates are that malaria deaths will match the numbers from the year 2000: 1 million. Children under the age of 5 are the most vulnerable group affected by malaria. In 2019, about two thirds of all malaria deaths worldwide were among this group of young children.

Are there any other consequences of malaria?

Malaria not only causes illness or death, but the consequences also reach further. For example, think of children not being able to go to school and families losing income or having no income at all, not being able to invest in their future. Malaria has a major impact on human lives, livelihoods, and the progress of countries.

What are the symptoms of malaria?

The most dangerous form of malaria, malaria tropica, can result in death without timely treatment (start within 48 hours with medication). In the case of other malaria types, the first symptoms usually start between 10 days and 6 weeks after the bite of an infected mosquito.
Two specific types of parasites (Plasmodium vivax and Plasmodium ovale) remain dormant in the liver. It can take months or years for the parasites to become active and symptoms to manifest. Malaria symptoms usually consist of bouts lasting four to eight hours, which recur every few days. Most common symptoms are:

• Headache
• Muscle and joint pain
• Nausea and vomiting
• Diarrhoea
• Jaundice
• Convulsions (in children)

Is the goal to strive for a malaria free world by 2030 a realistic one?

Malaria is an avoidable infectious disease. After all, if you are not bitten by a mosquito with the malaria parasite in her body, you will not get malaria.

What can be done to protect yourself against malaria?

Malaria prevention is strongly recommended for travellers to and from malaria-risk areas in (sub)tropical regions. The risk to contract malaria is reduced by taking prescribed malaria pills. In addition, wearing skin-covering clothing and using a mosquito net and Anti-Insect repellent are good measures to reduce the risk of infection. Bear in mind that the malaria mosquito bites between sunset and sunrise, so protection against mosquitoes is especially important during these times.

Nevertheless, the vast majority of malaria cases is among local populations in malaria-risk areas, so measures are needed to protect the people living in those areas until malaria is eliminated.

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World Malaria Day

World Malaria Day was established in May 2007 by the World Health Assembly, the decision-making body of World Health Organisation. The day was established to provide “education and understanding of malaria” and spread information on “year-long intensified implementation of national malaria-control strategies, including community-based activities for malaria prevention and treatment in endemic areas.

Besides providing education, World Malaria Day is also a good moment to look back on results obtained. Over the last 2 decades, a total of 7,6 million lives have been saved from malaria globally, of which 94% in Africa.

After Europe being officially declared malaria free by the World Health Organisation in 1975, other countries followed afterwards. Algeria, for example, has now been officially declared malaria free thanks to the efforts of professional teams and good and free healthcare in the country. This allowed good preventive action and rapid action to be taken on malaria outbreaks.Positive developments can also be found in Sub-Saharan Africa, with many more pregnant women and children sleeping under impregnated nets, from 3% in 2000 till 52% in 2019.

Until the world is free from malaria, drawing attention for the deadly disease is still needed. Preferably every day, but at least once a year on World Malaria Day. World Malaria Day is every year on 25 April.

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World Mosquito Day

World Mosquito Day was created to honour the discovery of the link between humans, malaria, and mosquitoes. On 20 August 1897, British doctor Ronald Ross discovered that malaria is transmitted to humans by infected mosquitoes. He won the 1902 Nobel Prize in Physiology and Medicine for this work. Since then, 20 August has been declared World Mosquito Day.

World Mosquito Day aims to raise awareness about the risks of a mosquito bite and how it can be prevented, as well as fundraising for research into a cure for malaria. It is also a salute to the groundbreaking work of Sir Ross and the scientists who have followed in his footsteps.

To mark World Mosquito Day, on 20 August, we published a podcast on this day, dedicated to mosquitoes. Care Plus Chief Mosquito Officer Arnoud Aalbersberg has an inspiring conversation with vector biologist Bart Knols. Bart Knols has over 30 years of research experience, specifically on mosquitoes, malaria and dengue. Therefore, he is our go-to expert when it comes to the deadliest animal in the world. They discuss subjects such as how to eradicate malaria and the “not-in-my-backyard” mentality, the (reasons for the) rising number of tiger mosquitos in Europe, the associated risks and what we can do to avoid being bitten.

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Buy One, Give One

Care Plus^® and Moustifluid^® relaunched the Buy One, Give One (BOGO) campaign in 2019. As stated in the introduction, the Travel Health Group brands did not start their fight against malaria in 2019. Care Plus^® started sponsoring malaria projects as early as 1999 with a net-for-a-net campaign, among others.

However, we did not want the aid in the fight against malaria to be based on donating a net when selling a net alone, but by donating when selling any of our products. Therefore, we relaunched the net-for-a-net campaign into the Buy One, Give One (BOGO) campaign in 2019, giving a face to the donation of mosquito nets in endemic areas when you purchase one of our products.

Our BOGO campaign, as we call it in our team, means that if you buy one of our products, you are contributing to our big goal: #malariafree2030. Buy One, Give One unfortunately does not mean that we can donate one net in Africa for every product sold. There are also costs involved with regard to importing, printing, and distributing nets. Nevertheless, we do our upmost to donate as many nets as possible. Actually, 1% of the turnover of Travel Health Group (Care Plus^®, Moustifluid^®, Primmed^®) is invested into this higher goal of making the world malaria-free by 2030.

Besides donating nets, we also use part of our funds to support applied science projects and inventions and to support the free global publication of the weekly MalariaWorld newsletter.

Why Uganda?

Our donated nets are mainly distributed in Uganda. We are often asked “why Uganda” when we talk about our outreach with mosquito nets to local communities and families that need them. An important reason for this is that Uganda ranks amongst the highest malaria burden countries in the world. But there are a few more reasons why we relaunched our Buy One, Give One campaign in Uganda.

Malaria is endemic in 95% of Uganda, the remaining 5% of the country, mainly the highland areas, being epidemic prone. It is estimated that 93% of the total population in the country is at risk of malaria. In Uganda, up to 50% of visits at health facilities are attributable to malaria. This is a significant burden on the healthcare system.

The impact of malaria has been categorised from three dimensions, being health, social and economic. The health dimension is usually described in terms of life years lost to premature death, as well as the morbidity caused by the disease. The social dimension focuses on the coping strategies for the disease and obstructions to usual social participation.

The economic dimension focuses on three main types of effects, namely: direct, indirect, and intangible effects. These effects are felt at both macro (national and community) and micro (household and individual) levels. Direct costs of malaria are the costs incurred by government, donors, communities, households and/or individuals in relation to providing or seeking treatment for malaria or preventative actions against malaria.

The indirect costs of malaria refer to the productivity losses due to illness or premature death. Malaria-related absenteeism, debility and mortality have a negative impact on the quantity and quality of work/production. Time lost to care for the sick increases the indirect costs of malaria. Intangible costs mainly refer to the anxiety, pain and suffering resulting from illness.

A worker in a malaria endemic zone loses up to 4 days per infection. Up to 4 infections per year are common for all workers. Meaning that on a yearly basis in a worst-case scenario every worker, next to suffering from a very dangerous infectious disease, loose up to 16 days of work per year. That leads to less income for the worker and less productivity for the employer.

Succes stories

Message from Francis Kimera, Lead Farmer of Kapeeka (Kaki) Coffee Farmers Cooperative Society Limited located in Nakaseke District in Greater Luwero Sub-region. And a message from Denis Lule, Treasurer of Makulubita Cooperative Society Limited located in Luwero District in Greater Luwero Sub-region is also thankful for the nets.

The impact of COVID-19 on the fight against malaria in Uganda

At the start of December 2020, a digital interview between Arnoud Aalbersberg (Care Plus^®) and Ashaba Faridah (Bambino Life Foundation) took place to discuss the effects of COVID-19 on malaria in Uganda.

Uganda got ahead of COVID-19 before there were any cases. The president put the country under lockdown and closed the borders which resulted in a relatively low number of COVID-19 deaths in Uganda, but the strict lockdown measures affected outreach and malaria prevention as well. Moreover, the risk of malaria infection increased as people stayed more inside their houses during the COVID-19 pandemic.

COVID-19 gets way more attention than malaria, whereas malaria claims more fatalities than COVID-19. Outreach where information about malaria prevention and printed mosquito nets are distributed are therefore of vital importance.

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Twiga Ventures – printed mosquito nets

Twiga Ventures, founded in Kampala, Uganda by Willem van Prooijen (Meduprof-S) & Bart Knols (MalariaWorld) is contributing to a malaria-free world by printing a big and beautiful image on mosquito nets. Nets are being used for the wrong purposes: fishing, fences etc. By printing a large photo of a butterfly, a person or a quote, the bed net instantly creates value in the homes and will be used appropriately. Twiga is supplying the printed mosquito nets to Travel Health Group to distribute in Uganda.

The importance of printing bednets

Lullabies are sung by Ugandan mothers to pray their children have pleasant dreams and wake up healthy each morning. This is not a given with the risk of malaria always being present. This video, created by HP in cooperation with Bart Knols and Twiga Ventures, visualises the importance of printed bednets. The bednet, when used correctly, has proven to be an effective tool to protect people against malaria, a disease that kills some 400.000 people annually. Malaria affects mainly young children and pregnant women in Africa. In many countries bednets are being distributed free of charge to vulnerable people. However, bednets are increasingly being misused for other purposes such as fishing, crop protection, and even to make bridal veils. This misuse has resulted in an increase in malaria mortality in recent years. But how can we avoid this and stimulate that people use the bednet correctly? That can be done by personalising the net with a beautiful printed image. Something people really like. And when people like something, they will use it better and take better care of it. That’s how printed bednets contribute to the fight against malaria.

The efforts of Twiga Ventures to get mosquito nets to be used for the purpose they are intended by printing images on the nets

In Uganda, 60 million mosquito nets are distributed each year, while there are only 30 million inhabitants. This means an average of 2 nets per person per year, which should be enough to protect against mosquitoes as the life span of a mosquito net is around three years if used correctly. However, many of the mosquito nets distributed for free are misused, for example bridal veils, fishing nets and chicken coops.

In this interview between Arnoud Aalbersberg, Chief Mosquito Officer at Travel Health Group, and Willem van Prooijen, Managing Director of Twiga Ventures in Uganda, you will hear what a reduced awareness of risk and life survival have to do with this misusage. It also talks about how Twiga Ventures achieved a raise in mosquito net usage around the bed as intended from 20% to 80% (research by Twiga Ventures and the Malaria Consortium) by printing mosquito nets. Moreover, you will hear how rotary clubs and Care Plus^® support the distribution of the printed nets to rural areas.

Bambino Life Foundation – education and distribution of nets

Bambino Life Foundation, founded in Kampala, Uganda by Ashaba Faridah, enables the long-term success of young women and children throughout Uganda by providing them access to basic human needs, education, and knowledge. It is amazing that Ashaba offers her help by distributing printed nets and providing communities with (malaria) education as part of her foundation’s outreach.

The Coffee Quest – distribution of nets

The Coffee Quest is a green coffee beans importer/ exporter co-founded by Michiel Lampers. They import Robusta & Arabica coffee beans from 10.000 farmers in Uganda. The trucks collecting the coffee intended for transport to Kampala were empty, so it makes sense to use them for shipping mosquito nets to the rural malaria areas. The Uganda Coffee Farmers’ Alliance (UCFA) supplying The Coffee Quest is helping to hand out the nets with the help of their farmer coaches. These coaches also share knowledge on how to use the mosquito nets properly.

Malaria-free World Campaign by The Coffee Quest

Since the start of the collaboration between The Coffee Quest and Care Plus^® in the fight against malaria in March 2020, The Coffee Quest has successfully distributed 900 mosquito nets among members of four coffee cooperatives in Uganda. The latest net distribution was in December 2020 with the help of UCFA and four partner roasters: Felixkaffee, Zwarte koffie, Beans Coffee Roasters and Spot on Coffee Roasters.

Rotary Club Midden Betuwe-Valburg in the Netherlands and Rotary Club Muyenga and Kiwatule in Kampala, Uganda

The Rotary STOP MALARIA project is initiated by Rotary Club Midden Betuwe-Valburg the Netherlands, Rotary club Muyenga and Rotary club Kiwatule in Kampala, Uganda. Their joint goal is to distribute 1 million mosquito nets to children age 8-14 years in Uganda. For that reason, they work together with Malaria Consortium, Ministry of Health, Uganda and Rotary clubs worldwide. The challenge has started! At the end of November 2020, the first 2000 mosquito nets were distributed in Ssesse Islands, an archipelago with a very high malaria density. The printed mosquito nets were provided by Care Plus^® and distributed by local Rotary clubs.

Drive Against Malaria (DAM)

The Dutch-English NGO & Medical Aid Organisation Drive Against Malaria treats children and pregnant women in Cameroon and distributes hundreds of protective mosquito nets for each family. “To prevent people from having to travel unnecessarily, we drive our Land Rover from village to village. Along the way, people stop to thank us and wherever we are recognised, wherever we are” explains David Robertson, founder of DAM. DAM has been committed to the prevention and treatment of malaria for years.

“Every consultation day is a special and moving event for the residents, when we give everyone a warm welcome and reassure all children and their mothers. We give them the utmost confidence that all sick children will receive the best quality medication and will be cured quickly. In addition, each family receives an impregnated net, which will protect them for the next three years.”

Gratitude

Julia Samuël, who supervises the project for DAM: “As soon as the people in the crisis area of South-West Cameroon realise that we are persistent and we visit their villages, they are filled with joy! The gratitude of the residents is overwhelming. Families put welcome banners, flags, and balloons along the roads. In one of the villages, we were even welcomed by the village men performing traditional dances. This is how the villagers show how much the aid means to them. It is very touching. They trust us. For the families, we are the only lifeline for their children. The villagers see us as one of them, as their brothers and sisters. Their village is our village, their house is our house. When we are in the villages, the fear of violence disappears. It is an uncertain time for everyone.”

Rebellions

While banners and flags for DAM fly along the long roads from village to village, a fierce battle rages “just around the corner”. The rebels are seeking refuge in the mountain forests but have kept a low profile so far. Insurgents wanted to set fire to one of the villages, but when they saw the Drive Against Malaria flag flying high on the mast, they retreated. David Robertson: “We were welcomed as heroes everywhere. A crowd of over 200 people welcomed us at the entrance of the village this morning.”

Julia: “We will continue with our mission as long as the families and their children need us. And it is precisely in this crisis that we must not abandon them. We are here to help the residents. And particularly children under 10 years of age. Many have lost all their possessions and are affected by the violence. We must prevent them from being hit by a devastating malaria outbreak as well.”

The Dutch Malaria Foundation

Arnoud was co-founder of the Dutch Malaria Foundation. The Dutch Malaria Foundation is a charitable organization that supports innovative ways to fight malaria and makes existing knowledge and information about fighting malaria available to stakeholders all over the world. In 2020 The Dutch Malaria Foundation facilitated donations for distribution of our nets in Uganda. If you want to make a donation to support the distribution of more nets, please visit the Dutch Malaria Foundation.

Elements

“For more than 10 years now, we have been working very closely with Travel Health Group. The Care Plus^® range stands for quality, innovation, and protection. Just like our company, Elements BV, Travel Health Group is a company with a mission and a vision – this is why our partnership is so far-reaching. It is very encouraging for us to know that for every Care Plus^® product sold, a contribution is made to a greater goal; a malaria-free world by 2030” – Elements, distributor Care Plus^®.

Results Buy One, Give One

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What is the solution to eradicate malaria?

There is not one solution to eradicate malaria. If we keep on doing what we did we will get the results we got, which means no total eradication of malaria. It is of vital importance that we combine solutions and efforts to reach our big goal. It is not only about various ways of curing malaria. It is much more about avoiding being bitten by a malaria mosquito. We need innovation and out-of-the-box ideas to get additional results. So, effectively a cocktail of solutions that focuses on mosquitoes. The cocktail basically consists of 3 pillars, prevention, reducing the number of mosquitoes/parasites and treatment.

Prevention

Personal protection
Long lasting impregnated (& preferably printed) mosquito nets. These nets, if used correctly by motivated locals, has proven to be an effective way of reducing the number of mosquitoes in the room by 70% and reduce the number of bites for people sleeping under the net.

Environment
Eliminate puddles and water surfaces around the home. Small, stagnant waterbodies provide perfect breeding areas for malaria mosquitoes. Keep a rigid regime to organise this. Fewer new generations of mosquitoes lead to fewer mosquito bites.

Additional prevention is available for travellers
Malaria prophylaxis. Malaria tablets may be advised. Administered according to advice pre-, during and post travel.

Vaccine (future development)
This is a hard nut to crack. Decades and vast amounts of money have been spent on vaccine development. Resulting in three vaccines, the Sanaria vaccine, the R21 vaccine and RTS,S.

Reducing the numbers of mosquitoes/parasites

Larvae
Larvae treatment (preferably biological) of surface water. If the waterbody is too small for fish or other larval predators, treatment of stagnant water with larvicide is effective in preventing larvae from developing into mosquitoes.

Parasites
Ultimately, malaria is caused by a parasite. Therefore, it may be of interest to combat the parasite instead of its host, the mosquito.

Beat the disease itself

Rapid diagnosis
Malaria parasites in the body need to be confirmed as soon as first symptoms arise. Rapid diagnostics can play a vital role here in addition to traditional blood sample test.

Treatment
As soon as a fever is detected in a malaria risk area, it is treated as malaria, until proven otherwise. Commencing treatment with malaria medication is essential. Therefore, the availability of malaria medicines is of vital importance.

An interview between Teun Bosma (professor in epidemiology) and Arnoud Aalbersberg

Malaria is a complicated disease that can only be tackled if you invest in targeting the mosquito, though vaccines can help, according to Teun Bousema. Teun is a professor in epidemiology of tropical infectious diseases at Radboud UMC, Nijmegen the Netherlands, and honorary Professor at the London School of Hygiene and Tropical Medicine (LSHTM, UK). He is interested in interplay between mosquitoes, humans, and parasites. Together with Chief Mosquito Officer at Travel Health Group, Arnoud Aalbersberg, he discusses the reversed developments in malaria control since 2015. Apart from a reduction in malaria funding in recent years, there are some challenges to deal with, like an increased resistance of mosquitoes to insecticides, emergence of a new mosquito species in Africa able to survive in urban areas, and resistance of malaria parasites to most commonly used antimalarials. However, there are also some positive developments to report. For example, a good range of antimalarials that are being tested, the development of new antimalarials and the registration of the first malaria vaccine 5 years ago for a pilot programme, that is a good starting point for better vaccines. Moreover, they discuss a promising and elegant new approach to poison mosquitoes by making your blood toxic for them. And finally, the ideal cocktail of tools against malaria (mosquitoes) is discussed.

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Will you join us in the fight against malaria?

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