DR. IZUAGBA KELECHI U.
- Mode of transmission
- Types of malaria parasite
- Life cycle
- Clinical presentation
- Malaria is the most parasitic disease of humans.
- It is one of the 5 common causes of child mortality in Africa.
- It is mainly a disease of the tropical regions but can occur in temperate regions.
- First advances in malaria were made in 1880 by a French army doctor named Charles Laveran.
- He looked into infected red blood cells and discovered the parasite was a protest.
- Carlos Finlay discovered that mosquitoes transmitted this disease called malaria.
- 3 to 700 million people get malaria each year but only kill 1 to 2 million.
- Malaria fever can be uncomplicated (Acute) and severe malaria (i.e. life-threatening) or complicated malaria.
- Imagine a world free of malaria. It is not such a far-fetched idea. This lies in using existing information, prevention and treatment more effectively, together with cutting-edge approaches to tackling the disease.
- Malaria is a parasite that enters the blood.
- This parasite is a protozoan called plasmodium. Hence, malaria is transmitted by plasmodium species.
- The disease is transmitted by mainly mosquito which can be fatal.
- Once inside the blood stream, the malaria parasite infects the liver and RBCs (red blood cells), spreading to other parts of the body including the brain.
3. MODE OF TRANSMISSION
- Transmitted through a bite of a female anopheles mosquito.
- Transmitted transplacental (congenital malaria).
- Transmitted via blood transfusion (Transfusion malaria)
- Incidence = 270,000,000 per year worldwide.
- 80% in Africa.
- 1 – 2 million die annually.
- Plasmodium falciparum is responsible for 80% – 90% deaths.
5. TYPES OF MALARIA PARASITE
- Plasmodium falciparum
- Plasmodium vivax
- Plasmodium ovale
- Plasmodium malariae
6. LIFE CYCLE
– Inoculation of sporozoites – Blood stream – Multiply in the liver hepatocytes – Burst as merozoites into the blood stream and invade red blood cells (RBCs) ring-like trophozoites – Released as merozoites into bloodstream – Invade new erythrocytes – Causing lysis of RBCs – Gametocytes – Fusion of gametocytes – Zygotes – Ookinesis – Oocyte – Sporocytes deposited into man from mosquito bite.
7. CLINICAL PRESENTATION
a. Acute/uncomplicated malaria:
- Loss of appetite
- Body aches/weakness
b. Severe/Complicated malaria:
- Febrile convulsion
- Cerebral malaria
- Algid malaria
- Respiratory distress
- Impaired consciousness
- Severe jaundice
- Severe anaemia
- Electrolyte and acid-base imbalance
- Renal impairment
- Thick/thin blood film (Gold standard)
- Antigen detection (Parasite E optiMAL)
- Antibody detection (ELISA or Immunoflorescence)
- PCR (Polymerase chain reaction)
- QBC (Quantitative buffy coat)
- Supportive treatment (uncomplicated malaria)
- Fever (Antipyretics/tepid sponging)
- Vomitting (Correct fluid + electrolyte imbalance)
- Definitive treatment (uncomplicated malaria)
- Use of Anti-malariai e.g. ACTs
(Artemisinine combination therapy) – Drug of choice
Example: Artemether + Lumefantrin
Aartesunate + Amodiaquine
Artesunate + Mefloquine
Artesunate + Pyrimiethamine – Sulphadoxine
Ditydroartemisinine + Piperaquine phosphate
- Definitive treatment (Complicated/severe malaria)
- Quinine (Drug of choice)
- Other supportive care + close monitoring
- Blood transfusion sometimes.
- Vector Control:
- By use of insecticide treated nets (pyrethrin impregnated nets).
- Environmental sanitation e.g.clear bushes, avoid stagnant water.
- Some advocate planting of lemon grasses
- Use of mosquito repellants (DEET)
- IPT (Intermittent preventive treatment)
- People given chemoprophylaxis includes;
- Pregnant women
- Non-immune visitors
- Sickle cell diseases (haemoglobinopatry)
- Malaria remains a global burden contributing to morbidity and mortality especially in children under 5 years of age.
- Annually, 50% of Nigerians suffer from at least one episode of malaria. Under -5 children have an average of 2-4 attacks of malaria yearly.
- Reducing the burden of this illness requires a multi-pronged approach.
This entails addressing the high level of economic burden of malaria through concerted and sustained malaria preventive efforts.
- For health system and policy research, the best practices of risk pooling and risk protection mechanisms which are suited to the developing country context need to be investigated to get an optimal uptake with people.
- On paper, pregnant women and under – 5 children are entitled to free malaria treatment. But in reality, not all states offer these free services and even when they do, drug stock – outs at public hospitals will mean that they go to drug shops or itinerant drug sellers for their medication.
- Malaria treatment is divided into in-patient and out-patient services. In-patient services include treatment of severe cases of malaria. Example: Consultations, laboratory tests and medications. Out-patient services covers uncomplicated cases of malaria as well as preventive services e.g. provision of long-lasting insecticide- treated nets and preventive drugs (chemoprophylaxis).
- Despite the progress achieved towards malaria burden reduction, achieving elimination has remained a big challenge.
- Development of new vector control method is significant for malaria elimination; however, there are several gaps in most of these methods especially on reduction of disease burden requiring further research.
- Government should allocate resources to other pressing health needs like maternal and child health. Interventions e.g. controlling the diseases with ITNs would reduce the incidence but the overall effect would be to lower the cost of prevention and treatment. This would have an impact on government’s expenditure as well as the individual’s pocket.
- Malaria can often be prevented using the ABCD of prevention.
- Awareness of risk
- Bite prevention
- Check if you need chemoprophylaxis
- Drugs if you have malaria symptoms
- Efforts should focus on correcting misconceptions about malaria transmissions, prevention and getting prompt diagnosis and treatment once one suspects, signs and symptoms of the disease.
- Community mobilization and behavioural change mechanisms are significant for the success of malaria prevention activities. This could be in form of public health communication. That is, by use of information, education and communication materials, media and community based activities. Sometimes, using people with influence in the community and educating them on the benefits and correct use of malaria prevention tools helps communities to understand better about the disease.
We must commend a Nigerian statesman Prince Ned Nwoko who has set up a foundation known as Ned Nwoko foundation to research on possible vaccine against malaria fever.
- World Health Organization (WHO)
Malaria prevention works
- Oresanya OB, Hoshen M. Sofola OT. Utilization of insecticide –treated nets by under-five children in Nigeria: assessing progress towards targets.
- Global malaria programme.
Malaria elimination: a field manual for low and moderate endemic countries. Geneva: WHO; 2007
- WHO. Insecticide – treated mosquito net: a WHO position statement.
- Bernard J, Mtove G, Mandike R, Mtei F, Maxwell C, Reyburn H:
Equity and coverage of insecticide – treated bed nets in area of intense transmission of plasmodium flaciparum
- Equity trends in ownership of insecticide treated nets in 19 sub-saharan African countries. 2017.