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Malaria is a major infectious disease that burdens countries across the globe. The disease is parasitic and transmitted by mosquitos, this makes it more prevalent in areas with a high concentration of this insect. Most people who fall victim to the disease are considered to be of low socio-economic status because they lack the ability to access resources (cost of medical treatment, preventative measures, accessible care, etc). The following presentation will discuss the disease background, prevalence in Costa-Rica's population, and the quality improvement intervention of mass drug administration to minimize this global health issue (World Health Organziation, n.d.)

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According to the WHO, 3.2 billion in 97 countries people are at risk for contracting malaria

In 2015, approximately 214 million cases were recorded resulting in approximately 438,000 deaths

This disease disproportionately affects the poor who cannot afford preventative measures and treatment

Between 2001 and 2013 Malaria intervention programs resulted in a 47% decline in Malaria mortalities but remains endemic across the world

Costa Rica is on track to eliminate Malaria transmission with a 33-month period without transmission prior to 2020

(Chaves et al., 2020)

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Epidemiology:

Malaria is a disease most often caused by 5 species of the Plasmodium protozoa parasites which infect female Anopheles mosquitoes and inoculate into a human host

The parasite enters the human liver where it replicates, releases into the blood stream, and infects red blood cells

Symptoms:

Body aches, cough, chest pain, weakness, nausea, vomiting and diarrhea

Severe symptoms include coma, severe anemia, acidosis, hypoglycemia and bleeding

Genomics:

The typical Plasmodium genome is composed of 14 chromosomes with greater than 5000 protein coding genes

The Plasmodium parasite continues to evolve and survive despite human driven evolutionary pressures as a result of its broad genetic diversity

There are more than 3488 samples of the parasite from 43 locations in 23 countries showing over 900,000 single nucleotide polymorphisms or changes in a nucleotide at a specific base pair location

(Su, et. al, 2019)

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Programmatic costs are hard to define given the time periods, costing methods and geographic locations different interventions involved; however, they can range from several hundred dollars USD to millions

Median Annual Cost for Malaria Control (all studies): $2.21 per capita (range $0.11 - $234.17)

Median Annual Cost for Malaria Elimination: $3.00 per capita (range $.10 - $20.95)

Economic Benefit: A 10% decrease in Malaria burden is associated with a .3% increase in GDP growth (Gallup et al, 2001 as cited in Shretta, et al., 2016)

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Community-Oriented Primary Health Care (PHC):

Health model built on 5 main pillars:

1. Integration of public health with primary health care (Icon of health providers)

2. Multidisciplinary teams integrated within the community

3. Geographic empanelment

4. Measurement and quality improvement at all levels

5. Integration of digital technologies at all levels

(VanderZanden et al., 2021)

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High Quality Primary Health Care in Action: The Story of Costa Rica (Spanish Subtitles)

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Malaria has been a major infectious disease that has affected the people of Costa Rica throughout its history

Presence of Malaria is noted from 1976 to 2009 in Huetar Norte Region (HNR) and Huetar Caribe Region (HCR), where it mostly noted today

Major earthquake experienced in 1991 which caused severe damage to the health services and infrastructure.

147 malaria cases have occurred since 2016, mostly due to international worker and illegal open-pit gold mining

(Chaves et al., 2020)

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Quality Improvement Intervention in Advanced Practice

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Quality Improvement Intervention in Advanced Practice

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Focal mass drug administration (MDA):

MDA involves different time frames of treatment and a combination of drugs used to battle malaria and reduce resistance

This intervention was used to eradicate malaria in Costa Rica from 2013-2015

The most recent type of MDA uses a seven-day treatment of chloroquine and primaquine (7DCPT) and produces a significant impact lasting 3-5 months

Role of APN:

MDA requires monitoring and follow up visits to evaluate treatment efficacy and potential side effects

This is a major role of the APN considering their ability to treat and diagnose patients with a variety of conditions

Practicality of QI Intervention:
MDA is an interprofessional intervention that requires various members of the healthcare team:

1. Trained community health workers

2. Volunteers

3. APN

This healthcare team allows for effective dispersion of the antimalarial treatments to underserved locations, bridging the gap in care

The APN must be involved to evaluate the patients for positive or negative effects of the treatment

Given the past knowledge and outcomes of MDA, we know that it has been a successful intervention that has potential to eradicate the disease again

Considering this, it is doable and can be easily implemented within one year

(Chaves et al., 2020)