Malaria is a parasitic disease transmitted through the bite of an infected mosquito. In the human body, the parasites multiply in the liver, and then infect the red blood cells.
Symptoms of malaria include fever, headache, chills and sweating and usually appear between 10 and 15 days after the mosquito bite. If left untreated, malaria can quickly become life threatening by disrupting the blood supply to vital organs.
Today, approximately 40% of the world's population is at risk of malaria. These people mainly live in the world's poorest countries. At least 1 million people, mostly children, die each year from malaria.
Key facts and figures
- Malaria is a life-threatening disease that is transmitted to people through the bite of an infected mosquito.
- In 2013, malaria caused an estimated 584 000 deaths (with an uncertainty range of 367 000 to 755 000), mostly among African children.
- Malaria in pregnancy leads to serious consequences for both the mother and her unborn child. It significantly contributes to maternal and child death.
- Malaria is both preventable and curable.
- Increased malaria prevention and control measures have dramatically reduced the malaria burden in many places.
- Non-immune travellers from malaria-free or -low areas are very vulnerable to the disease when they are infected.
Situation in the Lao People’s Democratic Republic
Malaria is endemic throughout most of the Lao People’s Democratic Republic, but the intensity of transmission varies greatly across different ecological zones. Rates of transmission are lower in the plains along the Mekong River.
Most of the transmission is associated with hilly, forested areas in the southern part of the country where many people are engaged in forest-related occupations.
The numbers of malaria cases and deaths have declined steadily since 2000. Confirmed malaria cases have decreased from approximately 40 000 in 2000 (77 cases per 1000 population) to less than 20 000 (17,52 ) in 2011. The reduction in the number of malaria-related deaths was even more substantial, from 350 deaths in 2000, to 17 in 2011.
Epidemiological transition resulted in marked changes in the patterns of malaria, culminating in an outbreak in Attapeu Province in 2011, which dramatically reversed the progress made in the country’s southern provinces in the last 10 years.
This outbreak in Attapeu Province spread rapidly to the neighboring provinces and the numbers of cases remained high, with the level of transmission not returning to the low transmission level seen in the dry season, prior to the outbreak.
In 2012, the number of confirmed cases increased to 46 202, and the number of deaths increased to 44. Current programme data for the first 6 months of 2014 suggest that the total number of confirmed cases is likely to be higher compared to the same period in 2012 and 2013.
The increase can be explained, in part, by an increase in the number of confirmed Plasmodium vivax cases, as well as improved case detection and reporting. About 95% of all reported cases came from 5 southern provinces, namely, Saravane, Champasack, Savannakhet, Attapeu and Sekong.
More importantly, the presence of Plasmodium falciparum populations resistant to antimalarial drugs as artemisinin derivatives was reported in Champassack Province. Resistance to antimalarial drugs will compromise the efficacy of artemisinin-based combination therapies (ACTs) in the future.
The Lao People’s Democratic Republic is working with WHO to put into action the Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010–2015), endorsed by the WHO Regional Committee in 2009, and the Malaria Elimination Strategy in the Greater Mekong Subregion. Key interventions to control malaria in the Lao People’s Democratic Republic include: prompt and effective diagnosis and treatment with ACTs; use of long-lasting insecticidal nets by people at risk; and indoor residual spraying with insecticide to control the vector mosquitoes.
In the Lao People’s Democratic Republic, the malaria control programme is implemented under the leadership of the Communicable Disease Control Department of the Ministry of Health, with strong technical support from the Center of Malariology, Parasitology and Entomology (CMPE). The programme focuses on strengthening the surveillance system for both humans and vectors, promoting the ban of counterfeit and substandard antimalarial drugs, and ensuring the engagement of people in the community and mobile/migrant populations.
WHO continues to provide technical support for the development and implementation of national policy, strategies, action plans, standards and guidelines for malaria control and elimination. The country demonstrated remarkable success in malaria control from 2000 to 2011, as evidenced by significant decreases in the numbers of confirmed malaria cases and deaths. Expanding access to ACTs was integral to this success in reducing the malaria burden.
WHO has prioritized its support on the southern provinces to focus on the containment of artemisinin-resistant malaria , while in the low-burden northern provinces, WHO is supporting the national malaria programme to work on universal coverage targeting at-risk population for the next decade, at which point they plan to enter the elimination phase.
More on artemisinin resistance
1. What is artemisinin?
Isolated from the plant Artemisia annua, or sweet wormwood, artemisinin and its derivatives are powerful medicines known for their ability to swiftly reduce the number of Plasmodium parasites in the blood of patients with malaria.
Artemisinin-based combination therapies (ACTs) are recommended by WHO as the first-line treatment for uncomplicated P. falciparum malaria. Expanding access to ACTs in malaria-endemic countries has been integral to the remarkable recent success in reducing the global malaria burden.
2. What is the state of artemisinin resistance in the Lao People’s Democratic Republic?
Parasite resistance to artemisinin has so far been detected in five South-East Asian countries: Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam (all in the Greater Mekong Subregion). In late 2013, research identified a molecular marker associated with delayed parasite clearance in patients given treatment containing artemisinin in Champasack Province, Lao People’s Democratic Republic. The national malaria programme is continuing to monitor the geographical distribution and spread of resistance in this country.
WHO is currently working with researchers, national malaria programmes and other partners—within and outside of the Greater Mekong Subregion—to map the presence of artemisinin resistance and to follow up the efficacy level of current antimalarial drugs for malaria treatment.
3. What is being done to contain artemisinin resistance?
Containment efforts are under way in areas with suspected or confirmed artemisinin resistance in affected countries, including the Lao People’s Democratic Republic .
In higher transmission areas, efforts focus on limiting the risk of spread by lowering the malaria burden through intensified malaria control, by increasing access to diagnosis and appropriate treatment, and by scaling up provision of health-care services to migrant and mobile populations.
Containment programmes in lower transmission areas seek to achieve an accelerated elimination of P. falciparum parasites. To date, the Lao People’s Democratic Republic does not have containment programmes in lower transmission areas.
4. How serious are the consequences of artemisinin resistance?
In the Greater Mekong Subregion, patients with resistant parasites still recover after treatment, provided that they are treated with an ACT containing an effective partner drug. However, there is a real risk of parasites developing resistance to all available medicines.
5. What more needs to be done to fight this threat?
Fighting the threat of artemisinin resistance requires an urgent and coordinated international response, as well as robust and predictable financing. The scale-up of containment efforts has major cost implications for the public health budgets of countries in the Greater Mekong Subregion, and affected countries cannot fight this challenge alone.
WHO is working with affected countries and partners to ensure a rapid and comprehensive scale-up of malaria interventions and containment efforts in the Greater Mekong Subregion.