Ottawa Charter For Health Promotion And Prevention Of Malaria In Pakistan

Malaria (also called biduoterian fever, blackwater fever, falciparum malaria, plasmodium, Quartan malaria, and tertian malaria) is one of the most infectious and most common diseases in the world. This serious, sometimes-fatal disease is caused by a parasite that is carried by a certain species of mosquito called the Anopheles. It claims more lives every year than any other transmissible disease except tuberculosis. Every year, five hundred million adults and children (around nine percent of the world’s population) contract the disease and of these, one hundred million people die. Children are more susceptible to the disease than adults, and in Africa, where ninety percent of the world’s cases occur and where eighty percent of the cases

Health promotion has emerged in the last decade as an important force to improve both quality and quantity of people’s lives. Sometimes termed ‘the new public health’ it seeks to support and encourage a participative social movement that enables individuals and communities to take control over their own health. (Bunton,R & Macdonald,G 1992)

In the past decade at an alarming rate Malaria has been escalating, especially in Africa. In Africa alone Malaria cases account for 90% of the known cases in the world. There are an estimated 400 million cases of this disease each year which is said to cause 1.5 – 2.7 million deaths.

Health promotion is a complicated activity and is challenging to define. It is defined in the Ottawa Charter (WHO 1986, as cited by Naidoo & Wills 2009, p 9) as "the process of enabling people to increase control over, and to improve, their health". Health promotion disagrees with the long-established model of health. Alternately, health promotion examines how cultural, psychological, socioeconomic and environmental circumstances also impact health. When both information and support is available, the patient is then able to make a knowledgeable decision, hence creating empowerment and an element of self control (Ryan et al.

Malaria is a parasite that has been impacting the world for the past couple of centuries. The illness associated with malaria gives intense fevers, chills, terrible headaches, muscle pains and can be deadly if not treated properly. Although overall malaria cases have decreased from 262 million in 2000 to 214 million in 2015, it is still an issue to be concerned about today.1 There have been developments of a vaccine against this parasite, but the parasite has adapted to the vaccine and developed a resistance to it, thus rendering it ineffective. The p. falciparum and p. vivax strains of malaria is what is causing problems as these resistant strains have popped up in much of Asia and Africa and a couple of countries in South America.1 This can potentially be a problem for the military and more specifically the Air Force as multiple countries where the Air Force deploys are infected with these resistant strains of malaria. It can be seen through the background and history of the fight against this parasite that the chemistry behind an antimalarial vaccine is important to the Air Force.

The pathway of malaria transmission from the mosquito to a person is detailed as after the mosquito has the parasite, the mosquito then bites the human, the parasite is released into the human, the parasite then goes to the liver and replicates itself, after replication the parasite enter the blood stream and attach to a red blood cell; the parasite is undetected by the immune system because it is attached to the red blood cells, the red blood cells is deformed from the parasite infection. The deformed red blood cell shape makes it stick to the cell membrane until it explodes and little particles from the red blood cell rushes through out the body; the cells goes through the body and enter other vitals

Malaria is a preventable disease transmitted by a female anopheles mosquito that has a global annual death impact of over one million mainly concentrated in sub-Saharan Africa (Patricia Schlagenhauf-Lawlor, & Funk-Baumann, M., 2005, pg. 6)(1). Although malaria is almost unheard of in developed countries like the United States, in the early 1900s malaria was just as prevalent as it is in sub-Saharan Africa today. The United States has eradicated local malaria due to increased finances and physician led public health missions in the 1940’s in the form of the DDT campaign(Humphries, 2001, pg. 2). However, in underdeveloped countries mainly located in tropical areas, the death toll to malaria continues to rise due to challenges and barriers between accumulating hefty finances, adequate resources and delivering affective outreach programs( Jennifer Kates, Michaud, J., Wexler, A., Valentine, A., 2013)(3).

Malaria is a disease of humans that is caused by the protozoa Plasmodium species and is transferred through the bite of infected female anopheles mosquito. The various species that cause infection in man include Plasmodium (P.) falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi. The symptoms of malaria include but not limited to cold, elevated temperature, tiredness, general body weakness, and muscle pains. Symptoms show within 28 days after a bite by the female anopheles mosquito, but in case of P. vivax, relapse could still occur up to five years after the initial infection (Walker and Colledge 2014). Various antimalarial medications are

According to the World Health Organization (WHO), 214 million cases of malaria reported in 2015, with mortality count has risen to more than 438,000 people dying from Malaria (parasite transmitted by mosquitos). Ninety-one percent of these deaths occurred in sub-Saharan Africa. Event though the mortality rates cause by malaria has fallen by thirty percent since 2000, but in Africa, a life of a child is taking away by malaria in every minute.

Malaria is a major public health problem in most of the tropical regions of the world including Papua New Guinea (PNG). As stated by Allen et al., 1996 “In many tropical and sub-tropical regions, malaria remains a major cause of mortality” (Allen et al., 1996: pg1). In Papua New Guinea, being at the risk of getting infection is very high because studies reported that 90% of the total population are at the risk of being infected (Pulford, 2012: pg1). As a result, the highest out patients complains reported in PNG is malaria and is one of the leading cause of deaths, even it’s a preventable and curable disease (Pulford, Mueller et al., 2012: pg1). It will take a long time to eliminate malaria in PNG because of the geography of the country. There are a lot of swampy areas creating an environment conducive for the anopheles mosquito to breed. Therefore, malaria can only be controlled. Control measure such as vector control and personal protection have been carried out in the last eight years by the PNG National Department of Health (NDoH) under the Global Fund to fight AIDs, tuberculosis and Malaria (GFATM) program (Hetzel, Gideon et al., 2012: pg2) however, there seem to still be a need for increased net usage across the country. Therefore, is the intervention in encouraging Insecticide Treated mosquito nets usage among febrile patients in PNG effective?

Malaria is a disease whose effects can be felt worldwide. Not only does the disease touch adults, unfortunately the major population affected by the disease is children under the age of 5yrs old and pregnant women. Malaria is the third largest killer of children worldwide. The number of malaria related deaths per years has decreased through the years form 300 million cases worldwide in 1999 to 198 million cases in 2013, also malaria related deaths have decreased by a sum of 60% from the year of 2000 to 2015, however the number of deaths (438,000 in 2014) is extremely high and can be drastically lowered or even diminished completely with the right resources. These resources have proven to be available and successful in some particularly wealthy areas of the world including Brazil, Eritrea, and Vietnam, yet malaria is still very prevalent and fatal in others namely Kenya, Nigeria and Rwanda. The question is why? What roles does government play in this international issue? What steps can be taken to rid the world of malaria completely?

The deterioration of health and development of several serious symptoms, including fever, headaches, fatigue, and the loss of life are the most prominent effects of malaria. Malaria causes thousands of preventable deaths each year around the world, including children and pregnant women despite the prevention and treatment methods. Malaria is prevalent in many regions despite adequate preventive measures, especially developing countries, including South Asia, South America, and Africa. Although developed countries also experience outbreaks of malaria, the death rate relevant to the disease is considerably lower than developing nations due to effective policies and strategies. Although governments and healthcare professionals can curb or alleviate the prevalence of the illness in many regions, thousands of people die due to malaria regardless of the measures. The loss of life stemming from the sickness is a serious issue mainly because the government, community, and healthcare sector can save lives through prevention, treatment, and awareness.

Malaria is one of the ten most common, yet deadly diseases in the world. It is a parasitic disease spread by the bite of Anopheles mosquito, which is active between dusk and dawn. Malaria occurs in over 100 countries and territories.

The objectives of RBM also reflect the 1986 Ottawa Charter’s theme of enabling individuals and communities to take responsibility for and gain control over their health.(WHO 1986)

One of the most densely populated developing countries in the world is the South-Asian country of Pakistan. According to data collected by the World Health Organization in 2015, Pakistan has an estimated population of over 189 million, with a steady rate of growth of around 2% per year (1). Females in Pakistan are expected to live till 67.5 years, while males trail shortly behind at 65.5 years. The literacy rate, which is amongst the lower end of the worldwide literacy scale sits at 58% for both, women and men who are in the age range of 15-24 years. In the realm of health, Pakistan is affected by various outbreaks including, but not limited to hepatitis A and B, HIV, measles, polio and typhoid. However, one of the leading epidemics in the country is malaria; a reported number of annual cases of over 3.7 million and incidence of 1.1 per 1,000 people. The climate in the country changes throughout the year from tropical to temperate along with dry conditions along the southern coast. (2) Malaria is typically unstable and the major transmission period is usually from the months of August to November, which is the post-monsoon season (3). Figure 1, shows that only 3.8% of the population in Pakistan is not considered at risk for malaria. In 2009, the Pakistani government announced that malaria control will be one of the top priorities in the National Health Policy.