Running head: MALARIA 1

Health Impact Framework/Research Paper

Malaria

Delaware Technical Community College

NUR 310 Global Health

Makenzie D. Lee

April 21, 2019

.
MALARIA 2

Abstract

Malaria is a mosquito-borne disease that is most prevalent in developing regions, such as the

sub-Saharan African region. Malaria is transmitted through the bite of an infected female

Anopheles mosquito. This report will discuss the disease specifics surrounding malaria,

symptoms, mode of transmission, diagnostics, preventions, and treatments. Preventative

measures are vital to evading transmission. Factors surrounding health determinants and burden

of disease will be reviewed, as poverty and lack of education are key factors within this disease.

The topic of malaria will be incorporated into the five tiers of the Frieden health impact pyramid.

Each tier will be discussed in-depth and the relation to the disease will be determined.

Recommendation for future interventions towards malaria will be incorporated, as well as the

Diffusion of Innovation Model of behavior change theory. Further, global health professional

opportunities will be discussed.

Introduction

This global health impact report will discuss the burden of disease surrounding malaria.

Malaria will be defined, including symptoms, treatment, and prevention. Key factors of global

health and health determinants will be included. The use of the Frieden health impact pyramid

will be incorporated and utilized to further evaluate the presence of malaria, while understanding

the motive to improve overall health.

Malaria remains a prevalent disease affecting overall health of many around the world.

Malaria can be defined as “a mosquito-borne disease caused by a parasite” (Centers for Disease

Control and Prevention (CDC), 2019, para. 1). Malaria is rarely present in developed countries,

such as the United States of America; however, it continues to be present in much of the world,

specifically those areas in developing countries. “In 2014, 97 countries had ongoing

transmission of malaria and about half of all people in the world lived in places at risk of

malaria” (Skolnik, 2016, pp. 333). “In 2017, there were an estimated 219 million cases of

malaria in 87 countries” (World Health Organization (WHO), 2019, para. 1).

The parasite causing malaria infects mosquitos, which in turn feed on humans (CDC,

2019). The bite must come from a female Anopheles mosquito (Skolnik, 2016, pp. 333). After

the infected mosquito bites a human, transmission occurs. “Malaria is caused by parasites in the

genus Plasmodium, five species of which infect humans; P. falciparum, P. vivax, P. ovale, P.

malariae, and P. knowlesi” (Skolnik, 2016, pp. 333). Malaria is considered a dangerous disease

as it may result in death. With early detection and prompt treatment, malaria may be curable.

“Almost 550,000 people died of malaria in 2013” (Skolnik, 2016, pp. 333). “The estimated

number of malaria deaths stood at 435,000 in 2017” (WHO, 2019, para. 1). Although death rates

may be falling, prevalence remains high, particularly in low-income countries.

In Africa, predominantly in the sub-Saharan region, the malaria burden of disease

remains most prevalent. “Malaria occurs mostly in poor, tropical and subtropical areas of the

world” (CDC, 2019, “Geography”, para. 1). “About 80 percent of the cases occurred in Africa,

12 percent in Southeast Asia, and 5 percent in the Eastern Mediterranean region” (Skolnik, 2016,

pp. 333). The parasite P. falciparum is most prevalent in Africa (Skolnik, 2016, pp. 333). “For

the sub-Saharan Africa region, malaria is the leading cause of death for all age groups and for the

under 5 years of age” (Skolnik, 2016, pp. 334). “About 90 percent of the deaths were in Africa,

and almost 80 percent of those who died were children under 5 years of age, almost all of them

in Africa” (Skolnik, 2016, pp. 333-334). Africa is considered the most affected by malaria due

to an efficient mosquito responsible for high transmission, the predominant parasite species is

Plasmodium falciparum that is likely to cause severe malaria and death, weather allows

transmission to occur year-round, limited resources and socioeconomic instability (CDC, 2019).

When reviewing disease progression and symptoms, malaria can be considered

complicated and uncomplicated. Following a bite from an infected mosquito, an incubation

period occurs prior to the onset of the first symptoms, typically seven to 30 days (CDC, 2019).

In reference to uncomplicated malaria, symptoms occur in stages. Symptoms include “a cold

stage (sensation of cold, shivering), a hot stage (fever, headaches, vomiting; seizures in young

children), and finally a sweating stage (sweats, return to normal temperature, tiredness)” (CDC,

2019, “Uncomplicated Malaria”, para. 1). Symptoms may also present in any combination,

including fever, headaches, nausea, chills, sweats, aches, etc. (CDC, 2019). Complicated malaria

can also be referenced as severe malaria. “Severe malaria occurs when infections are

complicated by serious organ failures or abnormalities in the patient’s blood or metabolism”

(CDC, 2019, “Severe Malaria”, para. 1). Complicated malaria can include, but is not limited to,
MALARIA 5

anemia, respiratory distress, cerebral malaria, kidney injury, metabolic acidosis, etc. (CDC,

2019).

Malaria is often referenced as a burden of disease, in relation to global health. Burden of

disease can be broken down between communicable and non-communicable diseases.

Communicable diseases, such as malaria, are considered infectious diseases. These are

“illnesses that are caused by a particular infectious agent and that spread directly from people to

people, animals to people, or people to animals” (Skolnik, 2016, pp. 25). Additionally, when

understanding burden of disease, it is important to understand DALYs. DALYs can be defined

as “the sum of years loss due to premature deaths (YLLs) and years lived with disability

(YLDs)” (Skolnik, 2016, pp. 26). In sub-Saharan Africa, malaria is ranked number one in

leading causes of DALYs (Skolnik, 2016, pp. 34). Malaria is ranked number three in leading

causes of death in children under five (Skolnik, 2016, pp. 35). “In terms of DALY’s, malaria is

the sixth leading cause among all age groups and the fourth leading cause among those under 5

years of age” (Skolnik, 2016, pp. 334). In understanding the vast differences when considering

the burden of disease of malaria, it is important to compare developed and developing countries.

For example, the United States of America (a developed country) had zero DALYs per 100,000

in 2017 in regards to malaria, whereas Niger (a developing country within Africa) had 10,767.04

DALYs per 100,000 (Institute for Health Metrics and Evaluation (IHME), 2017).
MALARIA 6

Application of the Health Impact Pyramid

While discovering the burden of disease of which malaria is, it is beneficial to understand

the effects of this disease. For that reason, the application of the health impact pyramid will be

used to address the issue of malaria, with a primary focus on the sub-Saharan African region

where malaria is predominantly present. The “5-tier pyramid best describes the impact of

different types of public health interventions and provides a framework to improve health”

(Frieden, 2010, pp. 590). From the base of the pyramid, and in an ascending order, the five tiers

include, socioeconomic factors, changing the context to make individuals’ default decisions

healthy, long-lasting protective interventions, clinical interventions, and lastly counseling and

education (Frieden, 2010). The base of the pyramid indicates the biggest influence. “In general,

public action and interventions represented by the base of the pyramid require less individual

effort and have the greatest population impact” (Frieden, 2010, pp. 591). Each level of the health

impact pyramid will be discussed below.

Socioeconomic Factors

The first tier of the health impact pyramid (the base) is socioeconomic factors. These are

often referred to as “social determinants of health, that help form the basic foundation of a

society” (Frieden, 2010, pp. 591). Health determinant factors can include sex, age, education,

socioeconomic status, employment, government, culture, access to resources, and many more

(Skolnik, 2016, pp. 21).

An important determinant of health surrounding malaria is sex and age. Some groups

with the highest risk include “infants, children under 5 years of age, pregnant women and

patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travelers”
MALARIA 7

(WHO, 2019, “Who is at risk?”, para. 1). The most vulnerable include young children and

pregnant women (CDC, 2019). Young children have not yet developed immunity and pregnant

women have decreased immunity, thus making this group of individuals in the greatest danger of

contracting malaria (CDC, 2019). “Partial immunity is developed over years of exposure, and

while it never provides complete protection, it does reduce the risk that malaria infection will

cause severe disease” (WHO, 2019, “Transmission”, para. 5).

As previously stated, malaria is most often prevalent in developing countries, such as

Africa. When considering developing countries, socioeconomic status is important.

Socioeconomic status is another aspect, likely one of the most important, of the health

determinants surrounding malaria. The sub-Saharan African region is stricken with poverty and,

therefore, a lack of basic resources. Socioeconomic status can be defined as, “a person’s

economic, social, and work status” (Skolnik, 2016, pp. 20). The burden of malaria causes

considerable cost to the individuals, total population, and government. Costs to individuals

include purchasing medications for treatment, cost of appointments and possible hospitalization,

preventative costs, etc. (CDC, 2019). Government costs include resources, purchasing of

medications and supplies, staffing of healthcare workers, preventative measures, etc. (CDC,

2019). Considering direct costs of malaria aids in understanding of how poverty acts as a risk

factor for this disease. It is estimated that costs related to malaria equate to at least 12 billion US

dollars per year (Skolnik, 2016, pp. 20). The low socioeconomic status of this region allows for

lack of resources and instability. Lack of resources hinders preventative measures and/or

treatment to be implemented in these high-risk areas, such as sub-Saharan Africa. “The more

likely you are to access services of appropriate quality, the more likely you are to stay healthy”

(Skolnik, 2016, pp. 21).

Another specific health determinant is environment. As mentioned prior, malaria occurs

mostly in poor tropic and subtropical areas (CDC, 2019). The environment within sub-Sahara

Africa allows for transmission of this disease throughout the year. “The long lifespan and strong

human-biting habit of the African vector species is the main reason why approximately 90% of

the world's malaria cases are in Africa” (WHO, 2019, “Transmission”, para. 3).

Cultural factors and education also coincide with malaria health determinants. “Culture

helps to determine how one feels about health and illness, how one uses health services, and the

health practices in which one engages” (Skolnik, 2016, pp. 20). Lack of education promotes lack

of understanding the importance of the disease and its transmission. “People with higher

educational attainment have higher socioeconomic status and more control over their lives than

people of lower status” (Skolnik, 2016, pp. 20). In a culture where poverty is vastly present, and

therefore lack of education, much of the population may not even be aware of the basic facts

surrounding the disease devastating their people.

Another important aspect in reference to global health is the Sustainable Development

Goals (SDGs). The 17 SDGs are considered “an urgent call for action by all countries—

developed and developing—in a global partnership” (Sustainable Development Goals (SDGs),

n.d., para. 1). The main goal behind the SDGs is to “recognize that ending poverty and other

deprivations must go hand-in-hand with strategies that improve health and education, reduce

inequality, and spur economic growth—all while tackling climate change and working to

preserve our oceans and forests” (SDGs, n.d., para. 1). Many of the SDG’s relate to malaria,

however, goal number one, no poverty, and goal number three, good health and well-being, are

most related (SDGs, n.d.). As mentioned, poverty plays a large role in malaria transmission in
MALARIA 9

developing countries resulting in access to resources, including preventative measures and

treatments.

Changing the Context to Make Individuals’ Default Decisions Healthy

The next tier of the health impact pyramid is changing the context to make individuals’

default decisions healthy. “The second tier of the pyramid represents interventions that change

the environmental context to make healthy options the default choice, regardless of education,

income, service provision, or other societal factors” (Frieden, 2010, pp. 591). Important

interventions to be encouraged include public awareness and education. Promoting access to

resources as well will in turn promote health decisions as the individuals will have the ability to

use preventative measures. “The defining characteristic of this tier of intervention is that

individuals would have to expend significant effort not to benefit from them” (Frieden, 2010, pp.

591).

An additional aspect to this tier in relation to malaria is Larval Source Management

(LSM). LSM is the “management of aquatic habitats that are the potential breeding sites for

mosquitoes, to prevent the completion of immature development” (Tizifa et al., 2018, pp. 44).

LSM “provides the dual benefits of reducing numbers of house-entering mosquitoes and those

that bite outdoors” (Tizifa et al., 2018, pp. 44). LSM, if initiated, would allow for manipulation

of the environment therefore making these changes unavoidable. Changes made would affect the

population, not based on individual decision. Classifications of LSM include habitat

modification, habitat manipulation, biological control, and larviciding (Tizifa et al., 2018).

Habitat modification includes “permanent change of land and water including landscaping,

drainage of surface water, land reclamation, and filling” (Tizifa et al., 2018, pp. 44). Habitat

manipulation contains “water level manipulation, includes measures such as flushing, drain
MALARIA 10

clearance, shading, or exposing habitats to the sun” (Tizifa et al., 2018, pp. 44). Biological

control includes “introduction of natural enemies into aquatic habitats (e.g., predatory fish,

invertebrates, para-sites, or disease organisms)” (Tizifa et al., 2018, pp. 44). Larviciding

includes “regular application of biological or chemical insecticides to water bodies to control

mosquitoes” (Tizifa et al., 2018, pp. 44). Possible implementation of LSM would result in

positive outcomes in prevention of malaria.

Long-Lasting Protective Interventions

The third tier of the health impact pyramid is long-lasting protective interventions. This

is considered “protective interventions that do not require ongoing clinical care” (Frieden, 2010,

pp. 592). In relation to the burden of malaria, protective interventions include vector control and

preventative treatment.

Two major forms of vector control include insecticide-treated nets (ITNs) and indoor

residual spraying (IRS). The goal of vector control is to prevent transmission of the disease by

reducing the vector population. ITNs are either conventional nets or long-lasting nets. Long-

lasting insecticidal nets (LLINs) last up to three years compared to conventional nets which last

up to 12 months (Tizifa et al., 2018, pp. 42). The insecticides used aim to kill mosquitos, thus

controlling the vector causing disease. “The insecticides also repel mosquitoes, reducing the

number that enter the house and attempt to feed on people inside” (CDC, 2019, “How do ITNs

work?”, para. 2). “In 2017, about half of all people at risk of malaria in Africa were protected by

an insecticide-treated net, compared to 29% in 2010” (WHO, 2019, “Insecticide-treated

mosquito nets”, para. 2). The use of ITNs does come with constraints. These include cost,

socioeconomic status, distribution, etc. (Tizifa et al., 2018, pp. 43). This again relates to the

health determinant of poverty in relation to disease. “ITNs were shown to reduce the death of
MALARIA 11

children under 5 years from all causes by about 20%” (CDC, 2019, “Insecticide-treated Bed

Nets”, para. 1). Additionally, to ITNs is IRS. The goal of IRS is similar to ITNs; vector control.

“Many malaria vectors are considered “endophilic”; that is, the mosquito vectors rest inside

houses after taking a blood meal” (CDC, 2019, “Indoor Residual Spraying”, para. 1). Through

IRS, these mosquitos can be controlled. IRS involves coating surfaces of a house with a residual

insecticide which will kill mosquitoes once in contact with these surfaces (CDC, 2019).

Constraints to IRS use include cost in high transmission areas and health risks and environmental

hazards related to the insecticides used” (Tizifa et al., 2018, pp. 44).

In addition to vector control, preventative treatment to pregnant women and children is

included in protective interventions. As stated prior, women whose immunity is diminished

during pregnancy and children who have yet acquired immunity are populations most at risk of

contracting malaria. Intermittent preventative treatment of malaria in pregnant women (IPTp)

“entails administration of a curative dose of an effective antimalarial drug (currently sulfadoxine-

pyrimethamine) to all pregnant women without testing whether or not they are infected with the

malaria parasite” (CDC, 2019, “IPTp”, para. 1). It has been shows that IPTp may be

administered at each routine visit, starting in the second trimester (CDC, 2019). Malaria

infection during pregnancy can have adverse effects on both mother and fetus, including

“maternal anemia, fetal loss, premature delivery, intrauterine growth retardation, and delivery of

low birth-weight infants (<2500 g or <5.5 pounds), a risk factor for death” (CDC, 2019,

“Intermittent Preventative Treatment of Malaria in Pregnant Women (IPTp)”, para. 2). As well

as IPTp, preventative treatment for children includes intermittent preventative treatment during

infancy (IPTi). This includes “administration of a full therapeutic course of sulfadoxine-

pyrimethamine (SP) delivered through the Expanded Program on Immunization (EPI) at

intervals corresponding to routine vaccination schedules” (CDC, 2019, “What is IPTi”, para. 1).

Treatment is to be given regardless of malaria infection status of the child (CDC, 2019).

Limitations to IPTp and IPTi include cost and access. Again, in relation to poverty and access to

resources, if families are unable to receive healthcare treatments or even have the ability to go

get the treatment, these resources become useless.

Clinical Interventions

Next on the health impact pyramid is clinical interventions. This represents any current

ongoing interventions (Frieden, 2010). Interventions to malaria can include diagnostics and

treatment. When considering diagnostics, two main tests are known. These include a rapid

diagnostic test and microscopy. “Diagnostic testing improves the overall management of

patients with febrile illnesses and may also help to reduce the emergence and spread of drug

resistance by reserving antimalarials for those who actually have the disease” (WHO, 2019,

“Diagnostic Testing”, para. 1). A Rapid Diagnostic Test is an “alternate way of quickly

establishing the diagnosis of malaria infection by detecting specific malaria antigens in a

person’s blood” (CDC, 2019, “Malaria Diagnostic Test”, para. 1). This may be beneficial in

developing countries that lack resources to perform microscopy testing. The rapid diagnostic test

was developed to “make it easier to test for malaria in low-resource settings” (Skolnik, 2016, pp.

335). “Blood for the test is commonly obtained from a finger-prick and results are available

within 15–30 minutes” (WHO, 2019, “Various Types of RDT’s on the Market”, para. 1).

Additionally, microscopy diagnostics may be performed. These include a blood sample that is

stained and reviewed under a microscope in a lab. Often considered the gold standard for

diagnostics, again it may not be the most available for developing countries.
MALARIA 13

Treatment of malaria has been most beneficial with prompt initiation. Treatment is

recommended within 24 hours of the first symptoms (CDC, 2019). “Appropriate treatment of

malaria is essential to reduce malaria morbidity and mortality” (Skolnik, 2016, pp. 335). “Drugs

such as chloroquine, Fansidar (sulfadoxine and pyrimethamine), and mefloquine were used

earlier as standard treatments for malaria” (Skolnik, 2016, pp. 335). Currently, antimalarial

treatment has changed. “The best available treatment, particularly for P. falciparum malaria, is

artemisinin-based combination therapy (ACT)” (WHO, 2019, “Diagnosis and Treatment”, para.

1). Treatment aims to cure the disease and prevent further transmission. The main objective of

treatment is to guarantee a “complete cure, that is the rapid and full elimination of the

Plasmodium parasite from the patient’s blood, in order to prevent progression of uncomplicated

malaria to severe disease or death, and to chronic infection that leads to malaria-related anaemia”

(WHO, 2019, “Treatment”, para. 1). Additionally, mass drug administration (MDA) may be

considered. MDA includes “administration of antimalarial treatment to every member of a

defined population or every person living in a defined geographical area (except those for whom

the medicine in contraindicated) at approximately the same time and often at repeated intervals”

(CDC, 2019, “Use of Antimalarials to Reduce Malaria Transmission”, para. 2). Complications

of malaria treatment arise with antimalarial drug resistance. Currently there is no vaccine to

prevent malaria. When drug resistance occurs, treatment becomes more difficult. With ensuring

diagnostics prior to treatment, it is with hope that resistance can be lessened.

Counseling and Education

The final tier of the health impact pyramid is counseling and education. This is

considered “education provided during clinical encounters as well as education in other settings”

(Frieden, 2010, pp. 592). Included within their tier is the role of a nurse. Nursing advocacy
MALARIA 14

remains a significant aspect of disease prevention and treatment. According to the American

Nurses Association (ANA), advocacy is a “pillar of nursing” (ANA, n.d., para. 1). Nurses must

be able to perform diagnostic testing and have skills in treatment. Malaria is predominantly

present in developing countries, where poverty is often significant. Poverty increases the

likelihood that a population has lack of education. In relation to malaria, many educational

opportunities exist. It is important to educate all, even more so those who are the highest risk.

Education should include symptoms and prevention. Particularly with IPTp and IPTi, education

should encourage maintaining appointments as medication is given many times throughout

follow-up appointments. It is also important to encourage and advocate for the use of

preventative measures such as ITNs and IRS. Although resources may be present, benefits are

not received if the population is not educated in its use. Through promotion of education and

awareness, it is with hopes that knowledge is gained.

A health behavior change theory with an application to malaria is the Diffusion of

Innovation Model. Diffusion is defined as “the process by which innovations are communicated

over time among members of different groups and societies” (Skolnik, 2016, pp. 152). An

innovation is defined as “an idea, practice, service, or other object that is perceived as new by the

individual or group” (Skolnik, 2016, pp. 152). The main idea of this model is that

“communication is needed to promote social change” (Skolnik, 2016, pp. 152). Additionally, it

suggests that people can be encouraged to adopt the innovations (Skolnik, 2016, pp.152). This

can be incorporated when discussing malaria as preventative measures and treatments can be

viewed as innovations. This includes adopting the technologies, accepting it into the current

culture, and maintaining its existence. Communication encourages recognition and therefore

concepts may be developed and utilized.

Recommended Future Intervention

Considering malaria has remained a burden of disease for a substantial period of time,

future interventions and improvements must be considered. The global plan for addressing malaria

includes “long-term eradication of malaria, through progressive elimination in different countries”

(Skolnik, 2016, pp. 335). A large aspect of future malaria endeavors includes the need for

additional funding. “Funding for nets, and other malaria prevention and control interventions, is

likely to plateau or even decline in the next few years due to the current economic situation” (CDC,

2019, “Long-lasting Insecticide-treated Nets (LLINs)”, para. 3). Funding for malaria includes

preventative treatments such as IPTp, IPTi, ITN, and IRS. “In 2015, malaria funding totaled US$

2.9 billion, representing only 45% of the funding milestone for 2020 (US$ 6.4 billion)” (WHO,

2019, “Urgent Need for more Funding”, para. 1). Due to malaria being most prevalent in

developing countries with poverty, funding must be raised to promote disease eradication.

Another future improvement may be house improvements. The goal of house

improvements is to prevent mosquitos in living environments, thus reducing the mosquito to

human contact occurring. “House improvement refers to the full-screening or closing of

openings such as windows, doors, and eaves or installation of ceilings” (Tizifa et al., 2018, pp.

44). “Historically, improved housing was thought to have contributed to the elimination of

malaria in the USA and to its decline in Europe” (Tizifa et al., 2018, pp. 44). In regions such as

those of sub-Saharan Africa, housing is often very under-developed, often lacking basic

protection from the elements. “Modern houses tend to be more protective against malaria than

traditional houses made of natural materials that leave multiple gaps through which mosquitoes

can enter, and in some settings, they offer protection equivalent to ITNs” (Tizifa et al., 2018, pp.

44).
MALARIA 16

As previously mentioned, antimalarial drugs are important in the treatment of malaria.

“Continuous development of new drugs to fight malaria is also critical, given the speed with

which malaria has developed resistance to other drugs and the limited number of drugs that now

work effectively against malaria” (Skolnik, 2016, pp. 336). Due to the large burden of disease in

some areas, drug resistance is occurring. “Five countries have now shown resistance to ACT and

there is no new proven drugs available to combat malaria” (Skolnik, 2016, pp. 336).

Many new projects through WHO are underway with hopes of malaria eradication. The

Malaria Policy Advisory Committee (MPAC) was established to “provide independent strategic

advice to WHO on developing policy recommendations on malaria control and elimination”

(WHO, 2019, “Malaria Policy Advisory Committee”, para. 1). The Rapid Access Expansion

Programme (RAcE) is a grant to support “diagnosis and treatment services of malaria,

pneumonia, and diarrhea for children under 5 in sub-Saharan Africa” (WHO, 2019, “Rapid

Access Expansion Programme (RAcE)”, para. 1). Mekong Malaria Elimination (MME) program

supports “malarial elimination in the GMS by facilitating coordination and dialogue among

partners, communication with external stakeholders and coordination cross-border initiatives”

(WHO, 2019, “Mekong Malaria Elimination (MME) Programme”, para. 1).

Professional Opportunities Available in the Global Health Field

Global Health can be defined as “health problems, issues, and concerns that transcend

national boundaries and may best be addressed by cooperative actions” (Skolnik, 2016, pp. 7).

Within the field of global health, many professional opportunities and career paths are available.

Global health often surrounds burden of disease in under-developed regions. Work with the

CDC and WHO may allow abroad travel to such locations to provide education, treatment,

healthcare assistance, and allocation of resources. Additionally, in regards to education, it is a

possibility to become an educator specifically for global health. It is important to educate others

about the importance of global health, burdens of disease, and health determinants affecting the

world. Through nursing, another career path includes public health nursing. This focuses on the

importance of the health and well-being of others. Becoming an advocate in the field of global

health is extremely important when advocating for those who are less fortunate. Poverty stricken

regions with lack of resources and education need someone to promote change and provide

education.
MALARIA 18

Conclusion

In conclusion, awareness regarding health disparities around the world is essential in

promoting change. Many health determinants and factors are prevalent within the topic of

malaria and need to be considered. Through the integration of the health impact pyramid, it is

clear that many factors surrounding malaria exist. It has been shown that burden of disease can

be vastly different depending on location and the socioeconomic factors present. Nurses must

continue to advocate and educate for disease prevention and health maintenance.
MALARIA 19

References

American Nurses Association (ANA). (n.d.). Advocacy. Retrieved from

https://www.nursingworld.org/practice-policy/advocacy/

Centers for Disease Control and Prevention (CDC). (2019). Parasites—Malaria. Retrieved from

https://www.cdc.gov/parasites/malaria/index.html

Frieden, T. (2010). A framework for public health action: The health impact pyramid. American

Journal of Public Health, 100(4), 590-595. doi: 10.2105/AJPH.2009.185652)

Institute for Health Metrics and Evaluation (IHME). (2017). GBD Compare. Retrieved from

https://vizhub.healthdata.org/gbd-compare/

Skolnik, R. (2016). The principles and goals of global health. In Riegelman, R (Ed.), Global

health 101(3rd ed.). Burlington, MA: Jones & Bartlett Learning

Sustainable Development Goals (SGDs). (n.d.). Retrieved from

https://sustainabledevelopment.un.org/?menu=1300

Tizifa, T., Kabaghe, A., McCann, R., Van den Berg, H., Van Vugt, M., & Phiri, K. (2018).

Prevention efforts for malaria. Current tropical medicine reports, 5(1), pp. 41-50. doi:

10.1007/s40475-018-0133-y

World Health Organization (WHO). (2019). Malaria. Retrieved from https://www.who.int/news-

room/fact-sheets/detail/malaria