In 2015, the World Health Organization (WHO) published the Global Technical Strategy for Malaria 2016-2030. The aim of this global strategy, which follows on from the 2008 Global Malaria Action Plan (GMAP), is to make progress in the control and elimination of malaria. Both the global strategy and GMAP aim to reduce: • the case incidence (number of new cases each year) of malaria • the mortality rate (number of deaths each year) from malaria.

1. (a)(i)With reference to Fig. 3.1, describe the progress made in the control of malaria in the four countries between 2010 and 2015.[4]
2. (a)(ii)All the countries shown in Fig. 3.1 supplied households at risk of malaria with insecticide-treated nets (ITNs). This is one of the recommendations in the GMAP and the global strategy. Describe and explain the role of ITNs.[2]
3. (b)Another recommendation of the global strategy is to carry out rapid diagnostic testing (RDT) of individuals who may have malaria. This involves testing human blood samples for the presence of proteins specific to Plasmodium. Test sticks can be used. Table 3.1 contains information about two RDT test sticks. [Table 3.1] species of Plasmodium that produce the protein test stick Plasmodium protein tested for 1 PLDH (parasite lactate dehydrogenase) P. vivax P. falciparum P. ovale P. malariae 2 HRP-2 (histidine-rich protein 2) P. falciparum only Some details of the design of these RDT test sticks are shown in Fig. 3.2. [Figure 3.2] area with immobilised monoclonal antibodies area containing mobile monoclonal antibodies labelled with a coloured dye test window direction of movement of blood sample blood sample added to this area The immobilised monoclonal antibodies in the test window are not visible. If the blood sample contains a Plasmodium protein that can be detected by the RDT test stick: • the mobile monoclonal antibodies bind to one part of the protein • the immobilised monoclonal antibodies bind to another part of the protein • a coloured line in the test window indicates a positive result for the protein.
4. (b)(i)With reference to Table 3.1 and Fig. 3.2, explain why test stick 1 and test stick 2 will contain different mobile monoclonal antibodies.[2]
5. (b)(ii)Two blood samples were removed from a person. One sample was added to test stick 1 and the other sample was added to test stick 2. With reference to Table 3.1 and Fig. 3.2, explain what can be diagnosed for this person from a positive result for test stick 1 and a negative result for test stick 2.[2]

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