Malaria Early Warning Systems

  • Kristie L. Ebi
Part of the Biometeorology book series (BIOMET, volume 1)

Malaria is the most important vectorborne disease in the world; it is also preventable. Climate patterns and weather events play a role in determining the incidence and geographic range of malaria, including through changes in human behavior, effects on the pathogen (Plasmodium), and effects on the malaria vector (Anopheles). Better understanding of the associations between malaria and environmental variables has lead to increased interest in developing early warning systems that alert public health and vector control personnel about developing conditions that are associated with epidemics, combined with the ability to implement appropriate and effective interventions to reduce the number of expected cases. A key challenge has been the inability to predict when and where outbreaks will occur far enough in advance that timely interventions can be implemented. Advances in several areas could increase the sensitivity and specificity of malaria early warning systems, including improving long-range forecasting, monitoring of environmental variables, and case surveillance. Better understanding is needed of how to incorporate uncertainties when setting thresholds for early warning systems. In most areas where malaria epidemics occur, additional capacity is needed to effectively respond to a warning that an epidemic is predicted to occur. Despite the uncertainties and constraints, there is significant promise in using climatic and environmental variables to help regions prepare for and effectively respond to malaria epidemics. Projected climate change suggests increased malaria risks, emphasizing the need for more effective warning systems.


Malaria Transmission Early Warning System Malaria Incidence Climate Suitability Plasmodium Falciparum Malaria 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abeku TA (2007) Response to malaria epidemics in Africa. Emerging Infectious Diseases 13:681–686.Google Scholar
  2. Abeku TA, Hay SI, Ochola S, Langi P, Beard B, deVlas SJ, et al. (2004) Malaria epidemic early warning and detection in African highlands. Trends in Parasitology 20:400–405.CrossRefGoogle Scholar
  3. Bhattacharya S, Sharma C, Dhiman RC, Mitra AP (2006) Climate change and malaria in India. Current Science 90:369–375.Google Scholar
  4. Blench R (1999) Seasonal climatic forecasting: who can use it and how should it be disseminated? Nat Resource Persp 47:1–4 ( Scholar
  5. Breman J (2001) The ears of a hippopotamus: anifestation, determinants and estimates of the burden. American Journal of Tropical Medicine and Hygiene 64:1–11.Google Scholar
  6. Breman JG, Alilio MS, Mills A (2004) Conquering the intolerable burden of malaria: what's new, what's needed: a summary. American Journal of Tropical Medicine and Hygiene 71(Suppl 2):1–15.Google Scholar
  7. Breman JG, Alilio MS, White NJ (2007) Defining and defeating the intolerable burden of malaria. III. Progress and perspectives. American Journal of Tropical Medicine and Hygiene 77(Suppl 6):vi–xi.Google Scholar
  8. Campbell-Lendrum DH, Corvalan CF, Pruss-Ustun A (2003) How much disease could climate change cause? In: Climate Change and Human Health: Risks and Responses. A.J. McMichael, D. Campbell-Lendrum, C.F. Corvalan, K.L. Ebi, A. Githeko, J.D. Scheraga, A. Woodward (eds.), Geneva: WHO/WMO/UNEP.Google Scholar
  9. Casimiro E, Calheiros J (2002) Human health. In: Climate Change in Portugal: Scenarios, Impacts and Adaptation Measures — SIAM Project. F. Santos, K. Forbes, R. Moita (eds.), Gradiva, Lisbon, pp. 241–300.Google Scholar
  10. Caulfield L, Richard SA, Black R (2004) Undernutrition as an underlying cause of malaria morbidity and mortality. American Journal of Tropical Medicine and Hygiene 71(Suppl 2):55–63.Google Scholar
  11. Ceccato P, Ghebremeskel T, Jaiteh M, Graves PM, Levy M, Ghebreselassie S, Ogbamariam A, Barnston AG, Bell M, del Corral J, Connor SJ, Fesseha I, Brantly EP, Thomson MC (2007) Malaria stratification, climate, and epidemic early warning in Eritrea. American Journal of Tropical Medicine and Hygiene 77(Suppl 6):61–68.Google Scholar
  12. Chan NY, Smith F, Wilson TF, Ebi KL, Smith AE (1999) An integrated assessment framework for climate change and infectious diseases. Environmental Health Perspectives 107:329–337.CrossRefGoogle Scholar
  13. Cox J, Abeku TA (2007) Early warning systems for malaria in Africa: from blueprint to practice. Trends in Parasitology 23:243–246.CrossRefGoogle Scholar
  14. Craig MH, Snow RW, le Sueur D (1999) A climate-based distribution model of malaria transmission in sub-Saharan Africa. Parasitology Today 15:105–111.CrossRefGoogle Scholar
  15. Craig MH, Kleinschmidt I, Nawn JB, Le Sueur D, Sharp B (2004) Exploring 30 years of malaria case data in KwaZulu-Natal, South Africa. Part I. The impact of climatic factors. Tropical Medicine and International Health 9:1247.CrossRefGoogle Scholar
  16. D'Alessandro U, Buttiens H (2001) History and importance of antimalaria drug resistance. Tropical Medicine and International Health 6:845–848.CrossRefGoogle Scholar
  17. DaSilva J, Connor SJ, Mason SJ, Thomson MC (2007) Response to Cox and Abeku: early warning systems for malaria in Africa: from blueprint to practice. Trends in Parasitology 23:246–247.CrossRefGoogle Scholar
  18. Ebi KL, Schmier JK (2005) A stitch in time: improving public health early warning systems for extreme weather events. Epidemiologic Reviews 27:115–121.CrossRefGoogle Scholar
  19. Ebi KL, Hartman J, McConnell JK, Chan N, Weyant J (2005) Climate suitability for stable malaria transmission in Zimbabwe under different climate change scenarios. Climatic Change 73:375–393.CrossRefGoogle Scholar
  20. Githeko AK, Ndegwa W (2001) Predicting malaria epidemics using climate data in Kenyan highlands: a tool for decision makers. Global Change and Human Health 2:54–63.CrossRefGoogle Scholar
  21. Githeko AK, Shiff C (2005) The history of malaria control in Africa: lessons learned and future perspectives. In: Integration of Public Health with Adaptation to Climate Change: Lessons Learned and New Directions. K.L. Ebi, J. Smith, I. Burton (eds.), Taylor & Francis, London. pp. 114–135.Google Scholar
  22. Greenwood B, Mutabingwa T (2002) Malaria in 2002. Nature 415:67–672.CrossRefGoogle Scholar
  23. Grover-Kopec EK, Benno Blumenthal M, Ceccato P, Dinku T, Omumbo JA, Connor SJ (2006) Web-based climate information resources for malaria control in Africa. Malaria Journal 5:38, doi:10.1186/1475–2875–5–38.CrossRefGoogle Scholar
  24. Hay SI, Were EC, Renshaw M, Noor AM, Ochola SA, Olusanmi I, Alipui N, Snow RW (2003) Forecasting, warning, and detection of malaria epidemics: a case study. Lancet 361:1705–1706.CrossRefGoogle Scholar
  25. Hoshen MB, Morse AP (2004) A weather-driven model of malaria transmission. Malaria Journal 3:32.CrossRefGoogle Scholar
  26. Janssen M, Martens P (1997) Modelling malaria as a complex adaptive system. Artificial Life 3:213–236.CrossRefGoogle Scholar
  27. Jones AE, Uddenfeldt Wort U, Morse AP, Hastings IM, Gagnon AS (2007) Climate predictions of El Nino malaria epidemics in north-west Tanzania. Malaria Journal 6:162, doi:10.1186/1475–2875–6–162.CrossRefGoogle Scholar
  28. Kiszewski AE, Teklehaimanot A (2004) A review of the clinical and epidemiologic burdens of epidemic malaria. American Journal of Tropical Medicine and Hygiene 71(Suppl 2):128–135.Google Scholar
  29. Kiszewski A, Mellinger A, Spielman A, Malaney P, Ehrlich Sachs S, Sachs J (2004) A global index representing the stability of malaria transmission. American Journal of Tropical Medicine and Hygiene 70:486–498.Google Scholar
  30. Koram KA, Molyneux ME (2007) When is “malaria” malaria? The different burdens of malaria infection, malaria disease, and malaria-like illnesses. American Journal of Tropical Medicine and Hygiene 77(Suppl 6):1–5.Google Scholar
  31. Kovats RS, Bouma MJ, Hajat S, Worrall E, Haines A (2003) El Nino and health. Lancet 263:1481–1489.CrossRefGoogle Scholar
  32. Lindsay SW, Martens P (1998) Malaria in the African highlands: past, present and future. Bulletin of the WHO 76:33–45.Google Scholar
  33. Mabaso MH, Craig M, Ross A, Smith T (2007) Environmental predictors of the seasonality of malaria transmission in Africa: the challenge. American Journal of Tropical Medicine and Hygiene 76:33–38.Google Scholar
  34. Mabaso MLH, Vounatsou P, Midzi S, DaSilva J, Smith T (2006) Spatio-temporal analysis of the role of climate in inter-annual variation of malaria incidence in Zimbabwe. International Journal of Health Geographics 5:20, doi:10/1186/1476–072X-5–20.CrossRefGoogle Scholar
  35. McMichael AJ, Woodruff R, Whetton P, Hennessy K, Nicholls N, Hales S, Woodward A, Kjellstrom T (2003) Human Health and Climate Change in Oceania: Risk Assessment 2002. Department of Health and Ageing, Canberra, 128 pp.Google Scholar
  36. McMichael AJ, Campbell-Lendrum D, Kovats S, Edwards S, Wilkinson P, Wilson T, Nicholls R, Hales S, Tanser F, LeSueur D, Schlesinger M, Andronova N (2004) Global climate change. In: Comparative Quantification of Health Risks: Global and Regional Burden of Disease due to Selected Major Risk Factors. M. Ezzati, A. Lopez, A. Rodgers and C. Murray (eds.), World Health Organization, Geneva, pp. 1543–1649.Google Scholar
  37. Murray CJ, Lopez AD (1996) The Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries and risks factors in 1990 and projected to 2020. Cambridge, MA, Harvard School of Public Health (Global Burden of Disease and Injury Series, Vol. 1).Google Scholar
  38. Pascual M, Ahumada JA, Chabes LF, Rodo X, Bouma M (2006) Malaria resurgence in the East African highlands: temperature trends revisited. Proceeding of the National Academy of Sciences 103(15):5829–5834CrossRefGoogle Scholar
  39. Poveda G, Rojas W, Quiñones ML, Vélez ID, Mantilla RI, Ruiz D, Zuluaga JS, Rua GL (2001) Coupling between Annual and ENSO Timescales in the Malaria-Climate Association in Colombia. Environmental Health Perspectives 109(5):489–493.CrossRefGoogle Scholar
  40. Rogers DJ, Randolph SE (2000) The global spread of malaria in a future, warmer world. Science 289:1763–1769.CrossRefGoogle Scholar
  41. Tanser FC, Sharp B, le Sueur D (2003) Potential effect of climate change on malaria transmission in Africa. Lancet 362:1792–1798.CrossRefGoogle Scholar
  42. Teklehaimanot HD, Lipsitch M, Teklehaimanot A, Schwartz J (2004a) Weather-based prediction of Plasmodium falciparum malaria in epidemic-prone regions of Ethiopia. I. Patterns of lagged weather effects reflect biological mechanisms. Malaria Journal 3:41, doi:10.1186/ 1475-2875-3-41.CrossRefGoogle Scholar
  43. Teklehaimanot HD, Schwartz J, Teklehaimanot A, Litpsitch M (2004b) Alert threshold algorithms and malaria epidemic detection. Emerging Infectious Diseases 10:1220–1226.Google Scholar
  44. Teklehaimanot HD, Schwartz J, Teklehaimanot A, Lipsitch M (2004c) Weather-based prediction of Plasmodium falciparum malaria in epidemic-prone regions of Ethiopia. II. Weather-based prediction systems perform comparably to early detection systems in identifying times for interventions. Malaria Journal 3:44, doi:10.1186/1475-2875-3-44.CrossRefGoogle Scholar
  45. Thomas CJ, Davies G, Dunn CE (2004) Mixed picture for changes in stable malaria distribution with future climate in Africa. Trends in Parasitology 20:216–220CrossRefGoogle Scholar
  46. Thomson MC, Mason SJ, Phindela T, Connor SJ (2005) Use of rainfall and sea surface temperature monitoring for malaria early warning in Botswana. American Journal of Tropical Medicine and Hygiene 73:214–221.Google Scholar
  47. Thomson MC, Doblas-Reyes FJ, Mason SJ, Hagedorn R, Connor SJ, Phindela T, Morse AP, Palmer TN (2006) Malaria early warnings based on seasonal climate forecasts from multi-model ensembles. Nature 439:576–579.CrossRefGoogle Scholar
  48. Van Lieshout M, Kovats RS, Livermore MTJ, Martens P (2004) Climate change and malaria:analysis of the SRES climate and socio-economic scenarios. Global Environmental Change 14:87–99.CrossRefGoogle Scholar
  49. WHO (2004) Malaria Epidemics: Forecasting, Prevention, Early Warning and Control — From Policy to Practice. World Health Organization, Geneva.Google Scholar
  50. WHO-UNICEF (2005) World Malaria Report 2005 (WHO/HTM/MAL/2005.1102). World Health Organization — United Nations Children's Fund.Google Scholar
  51. Worrall E, Rietveld A, Delacollette C (2004) The burden of malaria epidemics and cost-effectiveness of interventions in epidemic situations in Africa. American Journal of Tropical Medicine and Hygiene 71(Suppl 2):136–140.Google Scholar
  52. Worrall E, Connor SJ, Thomson MC (2007) A model to simulate the impact of timing, coverage and transmission intensity on the effectiveness of indoor residual spraying (IRS) for malaria control. Tropical Medicine and International Health 12:75–88.Google Scholar
  53. Woodruff RE (2005) Early warning systems: Ross River virus disease in Australia. In: Integration of Public Health with Adaptation to Climate Change: Lessons Learned and New Directions. K.L. Ebi, J. Smith, I. Burton (eds.), Taylor & Francis, London, pp. 91–113.Google Scholar
  54. Zhou G, Minakawa N, Githeko AK, Yan G (2004) Association between climate variability and malaria epidemics in the East African highlands. Proceeding of the National Academy of Sciences 101(8):2375–2380.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2009

Authors and Affiliations

  • Kristie L. Ebi
    • 1
  1. 1.ESSLLCAlexandriaUSA

Personalised recommendations