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Malaria PBH101

Malaria PBH101

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Published by: Monjur Sojib on Jul 28, 2011
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Introduction: It was not until 1880 that scientists discovered that malaria was a parasitic disease which is transmitted

by the ³Anopheles´ mosquito. Malaria is one of the most widespread infectious diseases of our time. The word malaria comes from 18th century Italian ³male´ meaning "bad" and ³aria´ meaning "air". The term was first coined by Dr. Francisco Torti, Italy, when people thought the disease was caused by foul air in marshy areas. There are more than 225 million cases of malaria each year, taking the lives of 781,000 people a year (World Malaria Report, 2010). Major proportion of death occurs in Sub-Saharan Africa and victims are under the age of 5. Children and pregnant women are among the most vulnerable. Many Sub-tropical countries of Latin America, Caribbean, Africa, Oceania and Asia are at risk. It is the fifth leading cause of death worldwide and almost 40% world¶s population is at risk.


Causes: Malaria parasites are members of the genus Plasmodium. P.falciparum, P.malariae, P.ovale, P.vivax and P.knowlesi are responsible for malaria in humans. P.falciparum is the most common type of infection and is responsible for 80% of all malaria cases and 90% deaths from malaria. ³Malaria parasites contain apicoplasts an organelle usually found in plants, complete with their own functioning genomes. These apicoplast are thought to have originated through the endosymbiosys of algae and play a crucial role in various aspects of parasite metabolism e.g. fatty acid bio-synthesis´, (Köhler et al, March 1997).

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malaria can also be transmitted by blood transfusions. It cannot pass directly from one person to another person. After one week or more. However. Malaria is not a contagious disease. The parasite may stay in the liver for a short period or longer. It can only be transmitted via a bite from an infected mosquito. the parasite leaves the liver and enters the red blood cells where it grows and multiplies in numbers. it is rare. the mosquito can spread the parasite to other people. 3|P ag e . This is the only type of mosquito that can spread malaria and only female Anopheles mosquitoes can spread it as the male mosquitoes feed on plant nectars. It is during this time that symptoms of malaria may begin to show. When an infected mosquito bites a person. the parasite enters the person's bloodstream and travels to the liver where it grows and multiplies. the mosquitoes ingest the malaria parasite and carry Plasmodium sporozoites in their salivary glands. At this time there are still no visible symptoms and the victim doesn't feel sick. It could be days or months. When an infected Anopheles mosquito bites a person infected with malaria. After some time the red blood cells open and free the parasites to attack other red blood cells. According to Marcucci C et al.How it infects: The primary hosts and transmission vectors of the malaria parasites are the female mosquitoes of the Anopheles genus. At some point.

delirium. Malaria has been found to cause cognitive impairments. falciparum. nausea and vomiting may also occur sometimes. Diarrhea. According to Idris R et al.wikipedia. falciparum can have recurrent fever every 36±48 hours or a less pronounced and almost continuous fever. P. muscle aches. anemia is caused by the destruction of infected red blood cells. headache. Extreme case of malaria can progress very rapidly and cause death within hours or 4|P ag e . especially in children. ovale infections.Symptoms: Malaria symptoms appear usually after 12 to 14 days of being infected. In addition. http://en.org/wiki/Malaria#External_links Effects: Extreme form of malaria is solely caused by P. This neurologic damage results from cerebral malaria to which children are more vulnerable. hemoglobinuria and according to Beare NA et al. P. children with malaria frequently behave abnormally. In people infected with P. while every three days for P. It causes widespread anemia during a period of rapid brain development and also direct brain damage. vivax and P. unconsciousness and convulsions. malariae. falciparum. a sign indicating severe brain damage.falciparum also causes extreme tiredness. there will be abdominal pain. Severe consequences include coma and death if not treated properly. retinal damage also occurs. The most common symptom associated with malaria is the cycle of sudden coldness followed by chills and then high fever and sweating lasting four to six hours occurring every two days in P. poor appetite and low blood pressure causing dizziness if moving from a lying or sitting position to a standing position.

Uncomplicated malaria is treated with oral drugs. In the most severe cases of the disease. Treatment: When properly treated. In these 13 endemic districts there are 70 endemic Upazilas covering 620 unions with the total population of 10. The treatment of malaria depends on the severity of the disease. vivax. 2008).B in its research found 5|P ag e . whether patients who can take oral drugs have to be admitted depends on the assessment and the experience of the clinician.org/wiki/Malaria#External_links Current situation in Bangladesh According to National Malaria Control Program (NMCP). which can lead to severe breathing problems). in order to avoid the development of drug resistance against artemisinin-based therapies. as it is possible that the patient has dengue. falciparum infection recommended by WHO is the use of artemisinins in combination with other antimalarials artemisinin-combination therapy. a patient with malaria can expect a complete recovery. ACT. Over 98% of the total cases in the country are reported from these areas. The most effective strategy for P. ³This area belongs to the forested and hilly zone and more than 96% of total positive cases and 99% of total P.9 million. malariae is usually treated on an outpatient basis. Until recently the most used treatment for severe malaria was quinine but artesunate has been shown to be superior to quinine in both children and adults. It can also cause pulmonary edema (a serious condition where fluid builds up in the lungs.days. Severe malaria requires the parenteral administration of antimalarial drugs. fatality rates can exceed 20%. Out of the total 64 districts 13 districts are in the high endemic areas of malaria transmissions. http://en.falciparum cases are detected from these areas´. not malaria. even with intensive care and treatment. Malaria is one of the major public health problems in Bangladesh. ovale or P. Infection with P. (Bangladesh Malaria Country Profile. Treatment of severe malaria also involves supportive measures. vivax requires both treatment of blood stages (with chloroquine or ACT) as well as clearance of liver forms with primaquine. P. ICDDR. It is advised to be cautious diagnosing and treating without the presence of a headache. Treatment of P.wikipedia.

the high cost of replacement insecticides have serious implications for disease vector control. and the response to control the epidemic is inadequate.5% and between 5 and14 years. 6. largely because of malaria prevention policies such as the distribution of LLINS and ITNs. Majority of malaria cases are reported from 13 out of the total 64 districts in the country. Malaria cases are grossly under-reported due to shortcomings in surveillance and information.599 laboratory confirmed cases. The prevalence of Falciparum malaria in children up to 4years was as high as 8. 6|P ag e .that the overall malaria prevalence in these 13 districts was 3. with a population of 24 million of which 10 million are considered to be at the higher risk. According to World Health Organization. In Khagrachari district however. The Country did not report any probable malaria case in 2009. in its Review of Roll-Back Malaria Strategies in the South-East Asia Region. In 2000. and 469 deaths. Bangladesh Government¶s ban on DDT (which in the past was produced locally and was affordable). Focal outbreaks occur every year.1% and it was significantly higher in children. 55. there were 265. These 13 districts. About 4 million people living in 34 upazillas of eight of the thirteen districts live in the epidemic-prone border areas.794 clinical cases. in Bangladesh approximately 88% of the 128 million populations are at risk from malaria. the average prevalence was over 15%.6%. The malaria situation in Bangladesh was worsening in the recent years.

Figure: The 13 districts vulnerable to Malaria 7|P ag e .

The following table shows the recent trend in malaria in Bangladesh from 2002 to 2008: Year Population in malarious areas Positives P.9% 77.9% 78.5% 73.5% 83% 598 574 505 501 508 228 154 Source: (WHO SEAR review: Bangladesh Malaria Profile) 8|P ag e .falciparum percentage Deaths 2002 2003 2004 2005 2006 2007 2008 117251000 106551000 106551000 108051000 106500000 106191000 50615030 63516 56879 59853 48096 48248 59587 84690 73% 73.6% 78.

The long term goal of the program is ³To reduce malaria morbidity and mortality until the disease is no longer a public health problem in the country´. The general objectives of the program are: y y y y To reduce malaria morbidity by 60% of the level in 2005 by 2015. This Meeting formulated the country Guidelines and Recommendations in order to implement the Revised Strategy for Malaria Control (RMCS) in Bangladesh. As continuation of RMCS. According to National Malaria Control Program.Existing policies to combat the situation The malaria control activities are currently conducted through the Directorate of Disease Control under the Directorate General of Health Services. Bangladesh received R-6 GFATM grant and is currently implementing the proposal focused on early diagnosis of uncomplicated P. 9|P ag e . To reduce malaria mortality by 60% of the level in 2005 by 2015. a Country Working Group Meeting to prepare the policy and technical guidelines for the country implementation was held in December 1994. The specific objectives of the program are: y To provide early diagnosis and prompt treatment (EDPT) with effective drugs to 90% of malaria patients. BRAC led NGO association (composed of 21 NGOs) is implementing the community based activities in partnership with Government of Bangladesh. Bangladesh approved the World Declaration on the Control of Malaria and the Revised Malaria Control Strategy (RMCS) derived from the Amsterdam Meeting in 1992. To empower community for malaria control. falciparum malaria by introducing RDT with improved microscopy and introducing treatment with ACT and prevention by promoting use of Insecticide Treated Mosquito Nets. To prevent and contain malaria epidemics. and promote partnership with NGOs and the private sector. These guidelines form the policy basis for the gradual implementation of the Revised Malaria Control Strategy (RMCS) in Bangladesh.

To establish Rapid Response Team (RRT) at national.5 million. y To promote community participation. Cox¶s Bazar and Chittagong) and 80% of population at risk in the remaining 8 districts.y To provide effective malaria prevention to 100% of population at risk in 5 districts (Bandarban. the main sources for this was the Bangladesh Government (US$ 555 000). private sector and NGOs for malaria control. there had been no reports of probable malaria case in 2009. district and upazila levels and increase preparedness and response capacity for containment of outbreaks. Khagrachari.42 million people are covered by it. As seen earlier. Rangamati. y To provide pre-referral treatment and timely referral of 90% severe malaria cases to the hospital.7 million). 10 | P a g e . the World Bank (US$ 890 000) and WHO (US$ 230 000). total financing for malaria in 2009 was approximately US$ 9. A total of 2. and strengthen partnership with research and academic institutions. y y To strengthen malaria epidemiological surveillance system.57 million bednets (LLINS + ITNs) were distributed and 6. the Global Fund (US$ 7. y To strengthen program management capacity As reported by WHO.

com/wp-content/uploads/pl/2010/04/places-affected-by-malaria1. The government should take the following actions: y Government should train the Medical Lab Technologist.http://youth4world. We have come to a point where we can deduce that malaria can be eradicated. Community health workers and Doctors in malaria prevention. treatment and program management y Introducing the Rapid Diagnostic Tests (RDT) to the health care facilities. we have seen that the mortality rate has fallen down. so that malaria can be detected early. 11 | P a g e . We have some suggestions of our own to get rid of malaria in Bangladesh. Nurses. diagnosis.gif&imgrefurl Affected areas of the world Recommendations Although the clinical cases have increased.

1/AS02A passes the experimental stage. y Awareness should be created to keep the environment clean. y y Government should provide anti-malarial treatment free of cost.y Long Lasting Insecticidal Nets (LLIN) and Insecticide Treated Mosquito Nets (ITMN) should be distributed to the people through the NGOs. y The Government should be proactive in distributing vaccines. so that mosquitoes are unable to breed near people¶s homes. 12 | P a g e . y Constantly monitoring the outbreak of malaria and taking actions rapidly. so that it can be treated at an early stage. who can reach people faster. The Government should ensure that the health facilities do not run out of stock of anti malarial drugs and are not past their expiration date. if vaccine like FMP2. This can be done through NGOs and also by conducting campaigns. y People should be made aware of the early symptoms of malaria.

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