What Is Malaria and the Global Picture of Malaria?

WHAT IS MALARIA?

Malaria is a life threatening blood parasitic disease caused by the bite of female anopheles mosquito which transmits the parasite (plasmodium of 5 types) to human beings.

Pathogenesis and Cycle of Malaria 

After the bite from the infected mosquito, the injected parasite go to the liver to multiply, some of the new parasite stay dormant in the liver and cause recrudescent from time to time while some invade the blood red cells, continue to multiply these in and destroy them resulting into signs and symptoms of malaria in the individual.

The cycle is repacted over and over again through the mosquito biting an uninfected person; after the parasite multiply in the blood and liver another mosquito bites this newly infected person swallow the blood and bite another infected person and transmit again and the cycle continuous.

The disease can also be transmitted form an infected mother to her unborn child, through transfusion of infected blood to an uninfected person and also through sharing of infected needles while doing drug abuse.

Global Picture of Malaria.

Each year approximately 210million peoples get infected with malaria, and about 440,000 deaths occur as a result of malaria. (CDC) 2017.

Most of the people dying 91% are young children under the age of 5years in sub Saharan Africa.

African region carries a disproportionate burden of malaria 92% of world malaria and 93% of malaria deaths.

The most burdened countries with malaria are Nigeria 25% DR Congo 11%, Mozambique 5%, India 4% and Uganda 30% deaths with 4%. 90% of Nigeria’s population in at risk and at least 50% of the Nigerian population have at least one episode of malaria/yr. In nigera the six geopolitical zones are variably affected by malaria. North West 37%, North central 32%, North East 26%, South South 19%, South West 17% and south east 14%.

The World Health Organization (WHO) recognizes malaria as a disease of public health importance. In that about 300milion an about half a million deaths occur annually as a result of infestation with malaria. Suffice it to say that 25^th April every year in set aside as world malaria day with a them every year to recognize the global effects on malaria so far in the said efforts and to enunciate the remaining challenges.

The World Health Organization (WHO) Director General Mr. Tadros has pronounced the them for World Malaria day 2019 as READY TO BEAT MALARIA. Through an approach “high burden high impact”.

Sign and Symptoms Include:

Fever, Headache, Vomiting, Nausea, Muscle Pains, Chills and Rigors Fatigue, Sweating, Chest Pain, Abdominal Pain, Diarchies and Convulsions most especially among young children < system.

Attacks of malaria comes in a stage live  manner.

Cold state:       It start with a feeling of cold and chills patient may have shivering and cover up with blanket     

Hot Stage:       Gradually the temperature of the body rises and the body feels hot, there is Nausea and vomiting, seizures may occur in small children

Sweating Stage: Follows hot stage, patient throws off the blanket sweats profusely, the temperature drops to normal and there is feeling of immense fatigue.

Complication from malaria infection

Most cases of malaria deaths are as a result of one or more of the following:

1. Cerebral malaria where the small parasites invade and block the small blood vesels that supply the brain. This leads to swelling of the brain seizures (convulsion) lost of limb action = paralysis and canal/death.
2. Respiratory failure: Accumulation of fluids in the lungs up to inability to breath-suffocation and death.
3. Anaemia: as a result of the parasite invation of the red blood cells, proliferation and bursting of the cells leads to destruction and anaemia.
4. Organ failure: The kidney, liver, spleen may fail leading to death.

Types of Malaria

Malaria can occur in two forms:

1. Uncomplicated malaria: where you have signs and symptom that do not show severe infection or destination of the vital organs.
2. The clinical manifestation include sensation of cold (chills) there is shivering, fever, headache and vomiting, some children may convulse, sweating following with creating of fever and fatigue.
3. Complicated malaria: This is when an attack of malaria shows signs and symptoms indicating involvement and dysfunction of vital organs: like liver, kidney, heart and central nervous system (brain).
4. Complicated malaria shows by fever and chills, impaired consciousness, prostration or adoption of prone posture multiple, recurrent convulsion, respiratory district abnormal bleeding or anaemia, jam dice and vital organs without adequate treatment complicated. Malaria is usually fatal.
5. Low blood sugar by severe from of malaria, and also when quinine (a drug for malaria treatment) is used can lead to coma and death.
6. Abortion/Still birth/primitive birth/ Neonatal malaria can all be consequent to severe malaria infection

What is the effect of malaria on women and children (reproductive age group) and overall health care system)

Malaria is a disease of public health importance. It affects high care system).

Malaria is a disease of public health importance: it affects high number of people cause high number of deaths and burden the individual, the family, the community and the country at large.

The most highly affected are the children under the age of five and women of child bearing age especially pregnant mothers. It leads to attribute deaths including abortion and premature or still birth

30% of all hospitalization, 11% of malaria deaths, 10% of LB weight, 25% of infect deaths and 20% of <5 deaths are recorded annually in Nigeria.

Cont Economic Effect

1. In 2017, the total funding for the elimination and control of malaria amounted to USD 3.1 billion. The endemic countries contributed about 28% (about 900million USD).
2. In 2015 the World Health Assembly (WHA) adopted a global technical strategy for malaria control 2016-2030 where it aimed.
3. Reduction of malaria cases by 90%
4. Reduction of malaria deaths by 90%

iii.        Eliminate malaria in at least 35 countries by 2030

1. Prevent resurgence in all malaria free countries
2. The united states president malaria initiate in 2010-2017 amounted to 492m USD.

What is the Effect of Malaria on the Economy

Of the global population 6 billion about 3.3billion are at risk of malaria. An individual has at least one attack of malaria per year. Leading to loss of school days and man hours at work. The associated cost of treatment and death of family members consequently oveates a vicious circle of poverty it has been estimated that malaria course annual depression of the economy by 1.3 annually.

Socio cultural background of the affected population has been observed to contribute to the propagation of the viscion circle poverty-lack of education, lack of good housing, bad roads to health centers, no hospital and the associated belief that malaria is a normal problem of life and do not care i.e they have poor risk perception further aggravates the menace and control efforts futile.

Risk Factors of Malaria Infection include:

1. Living in or visiting malaria endemic area: sub Saharan Africa, (including Nigeria, Asian Subcontinent, New Guinea, The Dominican republic).
2. Young children and infants and very elderly adults.

iii.        Travelers from non endemic countries who have no immunity to malaria and also when people move out of malaria zone they loose their immunity

1. Pregnant mothers and their unborn children
2. People with low or immunity (HIV/AIDs pts, those on corticosteroid therapy).
3. Additional risk include: The developmental stages of the plasmodium parasite making it possible for it to replace hide in tissue like liver and come up from time to time.

vii.       Also the vector: Anopheles mosquito is very hideous; it can live in a small but conducive environment and proliferate.

viii.     People who are poor, ignorant and has little or no access to prevention and treatment are more at risk.

What effect does malaria have on the health care system in Sokoto

How do we protect, prevent and treat malaria

Protection and Prevention

Mosquitoes needs humidity and ambient temperature to survive and most active at dusk and down.

1. Clear bushes and water collections and dark places.
2. Stay indoors after dusk, cover your skin with long sleeves, apply repellent to skin and doth. To avoid situation here mosquito bits.
3. Fogging or spraying the environment unit insecticide reduces the mosquito population.
4. Sleep under the Insecticide Treated nets (LLINs) especially pregnant mother and under five children.
5. Take prophylactic treatment long before travel to malaria endemic countries, based on competent advice from doctors.
6. All pregnant women to take two episodes of malaria prophylaxis after the first trimester (3months) and before the end of 8^th Month). With subphadoxine-phyrimethanion (fansidar) = IPT.
7. Treat Malaria Promptly if signs and symptoms occur and RDT indicate malaria.

Treatment of Malaria

1. Seek early diagnosis and treatment once malaria in suspected
2. RDT (Rapid Diagnostic Test) can detect malaria but parasitological test is needed fro confirmation of which parasite it is
3. Many of the known ant malarial drugs have become in effection or poorly effective when used especially along, e.g. chloroquine artemisinin based combination therapy (ACT) is recommended for the treatment of uncomplicated malaria. They reduce the concentration of plasmodium parasites in the blood. WHO recommends ACT.

The combination aims to reduce the parasites within 3days by the Artemisia base, while the combination drug finishes the rest in the remaining days.

ACT must be prescribed by trained health workers not self treatment.  

Vaccines:

In sub Saharan Africa due to multiple infections and severity some individuals may develop some form of immunity to malaria and fall sick less frequently.

Overall – No vaccines yet for the prevention of malaria but effects are ongoing with huge success.

WHO in collaboration with governments and developmental partners have been supporting efforts to develop a malaria vaccine.

-      RTS, S/ASO1 is so far the only vaccine tried, that show some efficacy and it is now under trial in 3 Sub Sahara African countries Ghana, Malawi and Kenya. Possibly to be extended to Nigeria in 2020. This vaccine is against the most deadly malaria parasite plasmodium falcifarum.

Dr Larai Aliyu Tambuwal