In 2008 the Global Sustainable Tourism Council Criteria was launched at the IUCN World Conservation Congress. The Criteria, managed by the Global Sustainable Tourism Council, created a global standard for sustainable travel and tourism and includes criteria and performance indicators for destinations, tour operators and hotels. The GSTC provides accreditation through a third-party to Certification Bodies to legitimize claims of sustainability.Environmental impact assessments could also be used as a form of accreditation. Feasibility is evaluated from a scientific basis, and recommendations could be made to optimally plan infrastructure, set tourist capacity, and manage the ecology. This form of accreditation is more sensitive to site-specific conditions. Some countries have their own certification programs for ecotourism. Costa Rica, for example, runs the GSTC-Recognized Certification of Sustainable Tourism (CST) program, which is intended to balance the effect that business has on the local environment. The CST program focuses on a companys interaction with natural and cultural resources, the improvement of quality of life within local communities, and the economic contribution to other programs of national development. CST uses a rating system that categorizes a company based upon how sustainable its operations are. CST evaluates the interaction between the company and the surrounding habitat; the management policies and operation systems within the company; how the company encourages its clients to become an active contributor towards sustainable policies; and the interaction between the company and local communities/the overall population. Based upon these criteria, the company is evaluated for the strength of its sustainability.
However, if supported by training of healthcare providers and patient information, there is improvement in compliance of those receiving treatment. Prognosis
When properly treated, people with malaria can usually expect a complete recovery. However, severe malaria can progress extremely rapidly and cause death within hours or days. In the most severe cases of the disease, fatality rates can reach 20%, even with intensive care and treatment. Over the longer term, developmental impairments have been documented in children who have had episodes of severe malaria. Chronic infection without severe disease can occur in an immune-deficiency syndrome associated with a decreased responsiveness to Salmonella bacteria and the Epstein–Barr virus.During childhood, malaria causes anaemia during a period of rapid brain development, and also direct brain damage resulting from cerebral malaria. Some survivors of cerebral malaria have an increased risk of neurological and cognitive deficits, behavioural disorders, and epilepsy. Malaria prophylaxis was shown to improve cognitive function and school performance in clinical trials when compared to placebo groups. Epidemiology
The WHO estimates that in 2019 there were 229 million new cases of malaria resulting in 409,000 deaths. Children under 5 years old are the most affected, accounting for 67% of malaria deaths worldwide in 2019. About 125 million pregnant women are at risk of infection each year; in Sub-Saharan Africa, maternal malaria is associated with up to 200,000 estimated infant deaths yearly. There are about 10,000 malaria cases per year in Western Europe, and 1300–1500 in the United States.