Malaria is the world's most important tropical parasitic disease. There were a 165 million cases, and 854,000 deaths in 2013, making it the eighth leading cause of years of life lose, and the 10th leading cause of DALYs. Most of those deaths about 700,000 in 2013 were in children less than five years old, as I talked about earlier, it's the third leading cause of death in the world for children less than five years of age. Most cases and deaths occur in Sub-Saharan Africa. Those are children under five and also another high risk group, is women in their first pregnancy. So let's look at age-standardized incidence and mortality rates for malaria in 2013. So incidence mortality. The redder it is the higher the incidence. Again, you can see the concentration in Sub-Saharan Africa. This is Papua New Guinea here. So malaria is caused by four species of the protozoan parasite of the genus plasmodium. Falciparum is the most virulent. It's responsible for almost all malaria mortality, primarily of course in Africa, but there are the other three species as well. The vector is the Anopheles mosquito. This mosquito Anopheles is a genus, and it has about 500 species, 70 of which can transmit malaria to humans, but the primary vectors in Africa are two; gambiae and funestus. The mosquito feeds and rest indoors and outdoors, and it tends to be more of a rural mosquito than urban mosquito. You can see that by the breeding sites, prefers clean unpolluted water, could breed in fresh or saltwater marshes, and mangrove swamps, and rice fields, grassy ditches, edges of streams and rivers, or temporary rain pools. Again, like with other infectious diseases, there's a spectrum of disease, there's a large reservoir of asymptomatic infection. Malaria is a non-specific febrile illness, headache, muscle aches, fatigue, abdominal discomfort. Then we have severe malaria, which is what kills the children. That includes cerebral malaria where you have impaired consciousness and coma, could have shock, renal failure, pulmonary edema, metabolic acidosis, severe respiratory distress, and severe anemia. There's been a lot of work done on malaria control, and the different domains of malaria control or first anti mosquito measures, so that involves filling and draining mosquito breeding sites, reducing standing water, spraying larvicides on standing water, indoor spraying with persistent insecticides. Secondly, early diagnosis and treatment. So first, it's important to have confirmation of diagnosis with either microscopy or a rapid test. Artemisinin-based combination therapy has been a breakthrough. So why is early diagnosis and treatment a method for malaria control? Because it removes sources of infection for the feeding mosquitoes. So we have a cycle. So if a mosquito bites a non-infected person, and therefore the mosquito is not infected, then bites another non-infected person, there's no disease to transmit. If there are a lot of people who are infected, then mosquitoes are more likely to bite an infected person, then mosquito becomes infected itself, then when it bites another person, that person becomes infected. So in that sense, treatment is prevention. The third domain of malaria control is protection from mosquitoes. So that includes insecticide, treated bed nets which have proven to be quite effective, insect repellents, protective clothing, housing that keeps out mosquitoes having screens, for example, and separating housing from breeding areas. Finally, the fourth domain is chemo-prevention, which has also been proven to be pretty effective. That would be targeted to pregnant women and children less than five years of age, the two most vulnerable populations. So let's look at time trends and global malaria incidence and mortality. This is based on two different datasets for global burden of diseases and the World Malaria Report both 2013, and we're looking at time trends from 1990 to 2013. So the good news is that starting around the turn of the century, we see a decline in incidence, and we're also seeing a decline in mortality.