ECONOMIC IMPACT: In addition to the loss of nearly half a million lives annually, malaria takes an enormous toll on healthcare systems and economies. In Nigeria, 60% of outpatient healthcare visits are due to malaria, and treatment of the disease depleted 7% of household income every month. Worldwide, direct costs are estimated to be at least $12 billion per year, with indirect costs much greater than that. The World Bank estimates that GDP growth in some African countries may be reduced as much as 1.3% annually due to malaria. The Global Fund and The President’s Malaria Initiative have helped reduce the economic impact of malaria (fig 1), providing sizeable returns on investment. Incredibly, the economic value of gains made in reducing malaria mortality from 2000-2015 are estimated at U.S. $2.04 trillion globally.

DISEASE: Malaria is caused by the Plasmodium parasite, a single-celled microorganism transmitted by a mosquito bite. Once the parasite enters human blood, it travels to the liver, then emerges into the bloodstream after more than a week in the body. At this point, the patient can develop fever, chills, headache, fatigue, and vomiting. Severe cases of malaria can cause shortness of breath, anemia, jaundice, involuntary muscle contractions, kidney failure, and low blood sugar. If untreated, severe malaria can progress to death within hours or days. An infected person becomes the source of new infections via mosquitoes which transfer blood parasites from the patient into uninfected individuals.

CEREBRAL MALARIA: The most serious complication of malaria is cerebral malaria, a condition characterized by seizures, coma, and death. If untreated, cerebral malaria is invariably fatal, and even with treatment, mortality remains around 20%. Those who survive cerebral malaria are at risk of long-term cognitive impairments including epilepsy, making cerebral malaria the number one cause of neurological disability in Africa. Over half a million African children develop cerebral malaria every year.

TREATMENT: Ideally, antimalarial drugs are administered to a patient to kill the parasite before it kills its host. Treatment options include quinine, chloroquinone, and an artemisinin (broadly, derivatives of the natural product artemisinin).  The most effective of these drugs are the artemisinins, which the WHO recommends be administered in combination with a second antimalarial drug to minimize the risk of relapse and drug resistance. This combination, known as antimalarial combination therapy (ACT), is the preferred standard of treatment throughout the world.