Malaria In Afghanistan: Understanding The Risks And Realities

Afghanistan has the world's third-highest burden of malaria, with the disease being endemic in large areas of the country. The acute and potentially life-threatening disease is spread by the female Anopheles mosquito, which transmits the parasitic protozoon, Plasmodium, into the human body. The most vulnerable regions in Afghanistan are low-altitude areas where rice is cultivated and cattle farming occurs, due to the better environment for the zoophilic nature of the disease vectors. The most prevalent malaria vector species in Afghanistan are Anopheles stephensi, Anopheles culicifacies, Anopheles pulcherrimus, and Anopheles superpictus. These species breed in river pools, river edges, and irrigated rice fields.

The CDC recommends that travellers going to certain areas of Afghanistan take prescription medicine to prevent malaria.

Afghanistan has the world's third-highest malaria burden

The nation has a deteriorating healthcare system, with mass relocations and civil conflict causing a five-to-tenfold increase in malaria cases in recent years. The COVID-19 pandemic has also played a role in the surge of cases, with symptoms of the two diseases often overlapping, leading to misdiagnosis and mistreatment.

Malaria transmission in Afghanistan occurs seasonally, from June to November, with regional variations influenced by human population density, behaviours, climate, agriculture, and access to health services. The disease is most prevalent in low-altitude regions where rice is cultivated and cattle farming occurs, due to the environment being more suitable for the vectors.

The most effective prevention method for malaria is vector control via insecticide-treated nets (ITNs). However, a 2015 study revealed that only 26% of people in Afghanistan owned at least one ITN, and only 3% owned enough to cover all household members. This highlights the need for more sustainable and economical preventative measures, as well as improved control and surveillance measures, to reduce the burden of malaria in the country.

The country accounts for 11% of malaria cases in the WHO Eastern Mediterranean region

Afghanistan has the world's third-highest burden of malaria cases, accounting for 11% of cases in the WHO Eastern Mediterranean region. The WHO Regional Office for the Eastern Mediterranean serves 21 or 22 member states and territories in West Asia, North Africa, the Horn of Africa, and Central Asia, with a population of nearly 583 million people. The region typically includes the countries around the Levantine Sea, such as Turkey, Cyprus, Egypt, Israel, Jordan, Palestine, Syria, and Lebanon.

Afghanistan's high malaria burden is due to several factors, including civil conflict, a lack of healthcare services, and the COVID-19 pandemic, which resulted in a five- to tenfold increase in malaria cases in recent years. Additionally, refugee movements and fluctuating environmental conditions have contributed to the proliferation of malaria vectors, and limited access to treatment has impeded elimination efforts.

The WHO has been actively working to address the issue by providing technical support, distributing insecticide-treated nets, and improving surveillance and public awareness. Despite these efforts, insecurity, limited skilled staff, insufficient financial support, and weaknesses in the monitoring system continue to pose challenges in the fight against malaria in Afghanistan.

The civil conflict, lack of healthcare services, and the COVID-19 pandemic resulted in a five-to tenfold increase in malaria cases

The civil conflict, lack of healthcare services, and the COVID-19 pandemic have resulted in a five-to tenfold increase in malaria cases in Afghanistan. The country's healthcare system has been in disarray for many years, with a minimal number of facilities and staff. The Taliban takeover in 2021 led to a sharp reduction in financial and technical development support for the public health system, severely harming the country's healthcare system.

The loss of donor funding for Afghanistan's public health system, coupled with the collapse of the economy and the loss of hundreds of thousands of jobs, has left millions of Afghans unable to pay medical expenses, worsening their social determinants of health, and threatening rights essential for maintaining an adequate standard of living, including the right to food.

The Taliban's restrictions on women's freedom of movement and employment have gravely impeded women and girls' access to health services, while bans on education for women and girls have blocked almost all training of future female healthcare workers in the country.

Insecticide-treated nets (ITNs) are the most effective prevention method for malaria

Insecticide-treated nets (ITNs) are a core intervention for malaria control. A previous version of this Cochrane Review showed they are very effective at reducing malaria-related death and illness. Since the review was published, many areas affected by malaria have reported mosquito populations that are resistant to the insecticides used in ITNs. The aim of this review update was to evaluate the available evidence and find out whether ITNs continue to be effective at controlling the disease. Cochrane researchers collected and analysed relevant studies and assessed the overall certainty of the evidence.

The CDC recommends that travellers going to certain areas of Afghanistan take prescription medicine to prevent malaria

Malaria is a life-threatening disease spread through the bite of an infected female Anopheles mosquito, which transmits the parasitic protozoon, Plasmodium, into the human body. The four species of Plasmodium that infect humans are P. falciparum, P. vivax, P. ovale, and P. malariae. In Afghanistan, P. falciparum and P. vivax are the major causes of malarial incidence, with P. falciparum being less common and less severe. Symptoms of malaria include cyclic fevers, headaches, gastrointestinal and respiratory distress, anaemia, body pain, and, in the worst cases, coma or death.

The CDC recommends that travellers going to certain areas of Afghanistan consult their doctor about which malaria medication to take and start taking this medication multiple days before their trip, as well as during and after their trip. This is because different medications have different active ingredients and protection times. For example, products with active ingredients like picaridin or oil of lemon eucalyptus can help prevent mosquito bites, while higher percentages of active ingredients provide longer protection.

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