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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.

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

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

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

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

Figure: The 13 districts vulnerable to Malaria 7|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% 73.9% 78.9% 77.6% 78.5% 83% 598 574 505 501 508 228 154 Source: (WHO SEAR review: Bangladesh Malaria Profile) 8|P ag e .5% 73.The following table shows the recent trend in malaria in Bangladesh from 2002 to 2008: Year Population in malarious areas Positives P.

and promote partnership with NGOs and the private sector. The general objectives of the program are: y y y y To reduce malaria morbidity by 60% of the level in 2005 by 2015. BRAC led NGO association (composed of 21 NGOs) is implementing the community based activities in partnership with Government of Bangladesh. To prevent and contain malaria epidemics. a Country Working Group Meeting to prepare the policy and technical guidelines for the country implementation was held in December 1994. 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´. These guidelines form the policy basis for the gradual implementation of the Revised Malaria Control Strategy (RMCS) in Bangladesh. 9|P ag e . The specific objectives of the program are: y To provide early diagnosis and prompt treatment (EDPT) with effective drugs to 90% of malaria patients. Bangladesh approved the World Declaration on the Control of Malaria and the Revised Malaria Control Strategy (RMCS) derived from the Amsterdam Meeting in 1992. Bangladesh received R-6 GFATM grant and is currently implementing the proposal focused on early diagnosis of uncomplicated P.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. According to National Malaria Control Program. To empower community for malaria control. As continuation of RMCS. To reduce malaria mortality 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. falciparum malaria by introducing RDT with improved microscopy and introducing treatment with ACT and prevention by promoting use of Insecticide Treated Mosquito Nets.

y To provide pre-referral treatment and timely referral of 90% severe malaria cases to the hospital. the Global Fund (US$ 7. y To promote community participation. Cox¶s Bazar and Chittagong) and 80% of population at risk in the remaining 8 districts.7 million).5 million.y To provide effective malaria prevention to 100% of population at risk in 5 districts (Bandarban. Rangamati. and strengthen partnership with research and academic institutions. 10 | P a g e . Khagrachari. private sector and NGOs for malaria control. y To strengthen program management capacity As reported by WHO. y y To strengthen malaria epidemiological surveillance system. the World Bank (US$ 890 000) and WHO (US$ 230 000). the main sources for this was the Bangladesh Government (US$ 555 000). there had been no reports of probable malaria case in 2009. A total of 2. As seen earlier. To establish Rapid Response Team (RRT) at national. total financing for malaria in 2009 was approximately US$ 9.42 million people are covered by it.57 million bednets (LLINS + ITNs) were distributed and 6. district and upazila levels and increase preparedness and response capacity for containment of outbreaks.

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

y Long Lasting Insecticidal Nets (LLIN) and Insecticide Treated Mosquito Nets (ITMN) should be distributed to the people through the NGOs. if vaccine like FMP2.1/AS02A passes the experimental stage. y Awareness should be created to keep the environment clean. who can reach people faster. 12 | P a g e . y y Government should provide anti-malarial treatment free of cost. y Constantly monitoring the outbreak of malaria and taking actions rapidly. This can be done through NGOs and also by conducting campaigns. so that mosquitoes are unable to breed near people¶s homes. so that it can be treated at an early stage. y People should be made aware of the early symptoms of malaria. 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. y The Government should be proactive in distributing vaccines.

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