25 June 2005

Malaria in the Philippines

A reader from Sao Paolo, Brazil emailed me recently to ask what is the status of malaria in the Philippines. She asked what particular provinces are involved, how fatal the disease is, and if ever those who get the disease are reported to the proper health authorities.

Most of the time, a dreaded disease gets mentioned in the news only when an important personality gets sick or dies from it.

The truth is, malaria in the Philippines has been around or recognized as a public health problem since the early twentieth century. Malarial deaths during those times were already documented to be at 100,000 yearly.

Control has taken a roller coaster ride --- there were years when control was good and there were years when it was bad. At present, per Department of Health (DOH) data, morbidity cases has been observed to be decreasing: from 89,047 in the 1990 to 34,787 in 2001, a notable 60 percent decrease. This improvement can be due to the joint help efforts from loans extended by the World Bank in the mid-1990s, and the recent aid coming from the Japan International Cooperation Agency (JICA) which has supported the control of malaria in endemic areas like Palawan, Sulu, and Tawi-Tawi.

Phil_malariaHow would I describe the malaria situation in the Philippines today?

I would like to quote the new Health Secretary directly.

He says: "an average of 3 Filipinos die daily due to malaria despite government's intensified efforts to control the occurrence of the ailment."

While malaria is a preventable disease, a study in 1992 by Burton and colleagues revealed that 3 causes of malarial treatment failure in the Philippines were drug resistance, non-compliance of patients in the treatment regimen, and deficient drug absorption.

Other reasons cited for treatment failure were: self-medication, resorting to herbal remedies, and seeking help only when the disease is already severe (late diagnosis and treatment). Malaria is fatal only when it is seen in its later stages.

For purposes of classification, the DOH has grouped the country's provinces into several categories to describe the magnitude of malaria prevalence:

CATEGORY A - more than 1,000 cases per year; 25 provinces are included

CATEGORY B - 100 to 1,000 cases per year; 22 provinces are included

CATEGORY C - less than 100 cases per year; 18 provinces are included

CATEGORY D - malaria-free provinces; 13 provinces are included

[Infectious Disease Office, DOH, 2001]

The 25 provinces in CATEGORY A account for 90 percent of malaria cases nationwide. Most of these cases (60 percent) belong to the low income bracket of the society and involve the indigenous people of the Philippines. I believe that only those who seek help in clinics and hospitals get reported as statistical figures for morbidity and mortality data. There might be a significant number of malaria patients who do not seek help due to a variety of reasons, foremost of which are financial in nature.

Plasmodium falciparum is the cause of majority of malaria cases in the Philippines, followed closely by Plasmodium vivax. One hindrance to treatment are the reported cases of chloroquine and primaquine resistance among these 2 protozoan parasite species. The main insect vector of malaria in the Philippines is the female mosquito known as Anopheles minimus flavirostris. If you still do not know why only female mosquitoes bite, then, click here.

The best way not to get malaria is to avoid mosquitoes, and to avoid going to places known to be endemic for malaria. Prophylaxis against malaria is not 100 percent effective, so if the trip to a known and established endemic place can be avoided, that would be a wise decision.

Useful links for Malaria:
History of Malaria
FAQ on Malaria
Facts About Malaria

12 reactions:

Anonymous said...

Hi Dr. Emer, thank you very much, I've just read your post.

Jotakken said...

Very informative doc. Very helpful for us from outside of the country for our own awareness when travelling opportunities come around. I am sure you've gotten an email about "make povery history" dot org in regards of the exciting progress.


Aggravated DocSurg said...

Has there been any discussion regarding the reintroduction of DDT use in the Philippines? I know that would make the country ineligible for UN aid, but given the significant loss of life, it may be worth a look.

Dr. Emer said...

That's a good question, Aggravated Docsurg. Thanks for raising the DDT issue.

The Philippines has stopped using DDT since 1994. The founding director of Pesticide Action Network (PAN) Philippines, Dr Romy Quijano, a physician and former mentor, says the solution to the Malaria problem here goes beyond killing the mosquito. Hence, DDT becomes non-essential especially in the fight against malaria. It might sound a bit off-sync for you, but that is the case. Read more of his insights from the link below:

On DDT and Malaria in the Philippines

BabyPink said...

yes, this is truly informative. salamat, doc.:)

'di ba, reyster langit (son of rey langit) died of malaria two days after he came from a place where malaria was rampant. he and his crew (3 of them) all succumbed to the deadly disease. tsk, tsk, tsk.

Dr. Emer said...

Thanks for dropping by, BabyPink.

The Reyster case was partly mentioned in the post. Lamentably, too.

Anonymous said...

I have just been informed of a case of Malaria on the Island of Leyte, near or in the city of Maasin. Could you give any info on this?

Anonymous said...

good day! i would just like to as about the recent endemic areas of malaria in the Philippines and there corresponding prevalence rate.. Thank you! and God Bless!

Unknown said...

hi.I'll be in El Nido Palawan next week. I'm a bit botherd because of the malaria issue. can you give us some advise/tips on how we could avoid the disease. is prophylaxis still safe to take? does anyone know where are those areas that are extremely prone in getting the disease? thanks so much for the help. pls email me @ soshalera_sahra@yahoo.com

vea said...

gud eve dr. Emer..im vea from davao...i just want to ask something regarding po sa drug of choice for pregnant women na meron pong malaria? confused po kc ako... what po ba ang right med... CHLOROQUINE or QUININE?..ngrreview po kc ako 4 nurses board..mdjo ngkkaroon po ng comflict sa tinuturo smin at sa sister ko na mag wwork sa global fund malaria.. pls help me po..thank u..heres my email add: vea_marie@yahoo.com

Anonymous said...

I'm Coleen. I am very much interested in coming up with a research output to help solve malarial problem in our country.In fact we're going to have a seminar-workshop on research tomorrow at CLSU and my choice of topic is malaria. Can you suggest a specific topic for me to work on? I am from Mindanao but I'm presently a Nurse instructor in Pampanga. Thank you very much Doc. my email is coyeen@yahoo.com. 'Am glad to help.

Anonymous said...

Hi everybody, I just want to say hello! How is everyone??