Subject: FCM III

Topic: MALARIA
Lecturer: DR. FLORES
Shifting /Date: 2nd Shifting/ Sept. 12, 2008
Trans group: we-love-brother’s-sandwich group

Impact Worldwide biological environment.

• Malaria causes about 350-500 million infections in • Usual transmission is through the infective bite of this
humans female
• Approximately 1.3-3 million deaths annually - this anopheles mosquito and rarely through blood
represents at least one death every 30 seconds. transfusion,
• Occur in children under the age of 5 years, in vast placenta and sharing of contaminated needles.
majority of cases and pregnant women are also • There are several types of mosquitoes but only certain
vulnerable. species that belong to the Genus Anopheles transmit
• Death rate is expected to double in the next twenty malarial parasites.
years. • Must be recognized promptly in order to treat the
• Precise statistics are unknown because many cases patient in
occur in rural areas where people do not have access time and to prevent further spread of infection in the
to hospitals andlor the means to afford health care. community
• Consequently, many cases are undocumented. • Should be considered a potential medical emergency
• Malaria is the most common and most persistent and
mosquito-borne infection in the Philippines although should be treated accordingly
cases and deaths have gone down. • Delay in diagnosis and treatment IS a leading cause of
• Endemic areas are usually rural, hilly or mountainous, death
and hard to reach. in malaria patients in the United States.
• Can be suspected based on the patient's symptoms
High-risk groups consist of upland subsistence and the
• farmers, forest-related workers, physical findings at examination.
• indigenous peoples and • However, for a definitive diagnosis to be made,
laboratory
• settlers in frontier areas, and
tests must demonstrate the malaria parasites or their
• Migrant agricultural workers.
components.
• Diagnosis of malaria can be difficult.
Disease transmission
• perennial • Where malaria is not endemic any more (such as the
• generally higher during the rainy season than the dry United
• season States), health care providers are not familiar with the
disease
Incidence rate of malaria • Clinicians seeing a malaria patient may forget to
Decreased from 101 cases per 100,000 population in 1996 to consider
67 per 100,000 in 2000, a 34 percent reduction within four malaria among the potential diagnoses .and not order
years the
needed diagnostic tests.
• Malaria is more common in rural areas than in cities;
• Laboratorians may lack experience with malaria and
• this is in contrast to dengue fever where urban areas fail to
present detect parasites when examining blood smears under
the greater risk. the
microscope.
• For example, the cities of the Philippines, Thailand and • Malaria transmission in some areas is so mtense that a
Sri large
Lanka are essentially malaria-free, but the disease is proportion of the population is infected but not made ill
present by the
in many rural regions. parasites.
• By contrast, in West Africa, Ghana and Nigeria have
malaria
• Such carriers have developed just enough immunity to
throughout the entire country, though the risk is lower protect them from malarial illness but not from
in the malarial
larger cities. infection.
• In that situation, finding malaria parasites in an ill
OVERVIEW OF MALARIA person
does not necessarily mean that the illness is caused by
• Malaria is a disease caused by one or more species of the
the parasites.
protozoan parasites called plasmodium.
• Mosquito: the malaria vector SIGNIFICANT BIOLOGICAL FEATURES OF MALARIA
VECTORS IN THE PHILIPPINES:
The natural vector is the female mosquito that is part
of the
TO CONTROL THE LARVAE

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC
PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU
RACHE ESTHER JOEL GLENN TONI

• Changing the environmental condition can make it
unsuitable for larval development & can destroy the
aquatic
stages
• Predators such as fishes eat the mosquito larvae.
TO CONTROL THE ADULT MOSQUITOES
• Spraying insecticides on the walls and other surfaces
where the mosquitoes rest before and after biting can
control the adults
• Insecticide treated mosqUito nets are also used to
control
the adult population.
• Climactic conditions
- Prolonged dry season reduces the availability
of surface water for breeding other
mosquitoes leads to reduction of malarial
transmission.
- Even distribution of rainfall, temperature
between 20-30C and humidity >60 % on the
other hand are very favorable to malarial
transmission.
- In general, transmission is higher during rainy
season than during dry season.
Socioeconomicand behavioral factors that favor the
increase of malaria transmission:
• Population movement related to socioeconomic
activities
(logging, mining "kaingin" farming)
• sociopolitical factors (peace and order problems)
• Poor housing condition readily exposes the occupation
to
mosquito bites
• Poor compliance to control measures including
treatment
• Poor economy and inadequate political will to sustain
the
control program
• Lack of poor difficult roads in endemic areas.
Subject: FCM III
Topic: MALARIA
Page 2 of 8
• Malaria is the most common and most persistent
mosquitoborneinfection in the Philippines although
cases and deaths have gone down.
• Endemic areas are usually~ rural, hilly or mountainous,
and
hard to reach.
• MALARiA CONTROL in the Philippines in the 1990s had
Significantly reduced cases by 60% (from 89,047 in
1990 to
34,787 in 2001)
• Still malaria remains endemic in 65 of the 78
provinces, 760
of the 1,600 municipalities and 9, 345 of the 42, 979
barangays nationwide.
• At risk of malaria nationwide are 11 million Filipinos
mainly
living in the remote hard to reach areas.
• Endemicity is now generally moderate to low, With
pockets of high endemicity, persisting along the
provincial/regional borders in frontier areas, places
populated by indigenous cultural groups and areas
with socio-political conflicts.
• It constitutes to be a major impediment to human and
economic development in areas where it persists
• It still costs the economy over 100 million pesos to
sustain
control efforts
Geographical distribution of Malaria Philippines
Category A Provinces
- 25 Provinces
- No significant changes in the last 10 yrs
- More than 1000 cases/ year
- or situation worsened in the last 5 years
Category B Provinces
- 22 Provinces
- 100 to 1000 casesl year
- Situation has improved in the last 5 yrs

Prevalence and Incidence of Infection Category C Provinces

• The Prevalence of a condition is the percentage of - 18 Provinces
population which was affected at a single point in time. - less than 100 cases I year
- Significant reduction in the last 5 yrs
• The prevalence of malaria infection is generally used
to
Category D Provinces
characterize the level of transmission.
- Provinces that are already malaria-free (no more
• Prevalence of malaria infection is measured in 3 main indigenous cases for at least 3 years
ways: - Some are potentially malarious due to the presence of the
o Parasite rate: through microscopy of blood vector
films
o Spleen rate: spleen palpation
o Seroprevalence rate: serologic methods
• The methods mentioned previously can be used to
quantify Category A Provinces
the intensity of transmission e.g. force of infection (%) -Apayao -Mt. Provihce -Palawan
based on the parasite rate or seroprevalence. -Quezon -Bukidnon -Agusan del Sur
-Misamis Oriental -Compostela Occidental
Spleen Rate (%) Parasite Rate (%) -Kalinga -lsabela -Basilan
Hypoendemic 0-10 0-10 -Zamboanga del -Quirino Valley -Agusan del Norte
Mesoendemic 11-50 11-50 -Davao del sur -Cagayan -Sulu
Hyoerendemic >75 (low in adult) 51-75 -Ifugao Sur -Zambales -Tawi tawi
Holoendemic >75 (low in adult) >75 -Davao del Norte -Saranggani -Surigao del Sur
-Mindoro
Occidental
NATIONAL SITUATION

Category A
 Subject: FCM III
Topic: MALARIA
Page 3 of 8
- fn 25 provinces person remains asymptomatic and the parasites
- 90% of cases nationwide cannot be
- 348 of the 760 endemic municipalities seen yet in the blood.
- 4,407 of the 9, 345 barangays (distncts)
- Endemic population of 6,205,08 • After at least 6 days the parasites (merozoite stage)
- 50-60% of endemic areas categorized under the lowest are
• income group nationally released from the liver cells to the bloodstream and
- Indigenous peoples (IPs) constitutes 90% of the endemic invade the
• population blood cells. Further development and multiplication of
the
Category D parasites occurs in the RBC.
Provinces that are already malaria free (no more indigenous
cases for at least 3 yrs • Ultimately the infected RBCs are destroyed. the
parasites
Cateqorv D Provinces are released and invade other RBCs
Bohol Camiguin Aklan
Siquojor Catanduanes Cebu • This time there may be prodromal symptoms ( Low
Capiz Iloilo Sulu grade
Leyte Norte Guimaras Northern Samar fever, nausea, vomiting, headache.)
Biliran Leyte
• The development cycle in the RBCs is repeated every
36 to
Malaria Control Program 48 hrs for P. falcifarum, every 48 hrs for P vivax and P.
ovate;
Program Thrust and every 72 hours for P. malaria.
• Vision: Malaria Frep- Philippines by the year 2020
• Mission: To empower the health workers, the • The periodic destruction and subsequent invasion of
population at the
risk and all other concerned to eliminate malaria in the RBCs by the parasites cause periodic occurrence of
Philippines signs and
symptoms of malaria typically the paroxysms of chills,
• Goal: Malaria is eliminated as apublic health problem
fever,
in endemic provinces and sweating.

National Health Objectives for 2004

Health Status Objectives
-To reduce malaria mortality to 20% annually
-To reduce mortality by 10% annually
-To prevent the recurrence of transmission in malaria free
provinces
Risk Reduction Objectives
-Increase household utilization of mosquito nets
-Increase compliance rate on malaria treatment
-Increase coverage of streams that serve as' breeding sites
seeded with larvivorous fish
-Increase coverage of streams that serve as breeding site
cleared
Strategies
-Provision of early diagnosis and prompt treatment
-Planning and implementation of selective or prevention of
malaria epidemics
-Strengthening local capabilities in basic and applied research
to promote assessment of the country's malaria situation
LIFE CYCLE
• The cycle begins with the introduction of the parasites
(sporozoite stage) in the bloodstream of man through
the bite
of infective female Anopheles mosquito.
• W/in 30 mins the sporozoites will invade the liver cells.
• There will undergo development in the liver, the
infected
• After 2 to 3 cycles in the red blood cells, some
merozoites .
give rise to sexual forms (gametocytes).
• During the blood feeding of the mosquito, the different
stages of the parasites are ingested All except the
gametocytes are destroyed.
• A series of development occurs until the sporozoites
are
developed and congregate in the salivary glands ready
for
transmission during biting.
• Usually the developmental cycle in the mosquito takes
about 14 days. In other words the parasites can only
be
transmitted to another person after 14 days from the
day the
parasite (gametocyte) were ingested by the mosquito.
• ln cases of P.vivax and P.ovale, some sporozoites
develop
into the dormant stage called hypn020ites in the liver.
• The activation of this dormant stage and its
subsequent
development in the liver and in the RBC causes
relapse.
• In some areas, malaria transmission is so intense that
a
large proportion of the population is infected but not
made ill
by the parasites.

• Such carriers have developed just enough immunity to


protect them from malarial illness but not from
malarial
infection.
• In that situation. finding malaria parasites in an ill
person
does not necessarily mean that the illness is caused by
the
parasites.
• In many malaria-endemic countiies lack of resources is
a suspicion index
major barrier to reliable and timely diagnosis.
• Health personnel are undertrained, underequipped and
underpaid.
• They often face excessive patient loads, and must
divide
their attention between malaria and other equally
severe
infectious diseases such as pneumonia, diarrhea,
tuberculosis and HIV/AIDS.
Social and economic effects
• The disease has been associated with major negative
• economic effects on regions where it is widespread.
• There has been demonstration of developmental
impairments
• in children who have suffered episodes of severe
malaria.
o A comparison of average per capita GOP in
1995, (adjusted
• to give parity of purchasing power) between malarious
and
• non-malarious countries demonstrate a five-fold
difference
• (US$1 ,526 versus US$8,268).
o Moreover, in countries where malaria is
common, average
• per capita GOP has risen (between 1965 and 1990)
only 0.4%
• per year, compared to 2.4% per year in other
countries.
• In its entirely, the economic impact of malaria has
been
estimated to cost Africa US$12 billion every year
Clinical Diagnosis
• Clinical diagnosis is based on the patient's symptoms
and on
physical findings at examination.
• The first symptoms of malaria (most often fever, chills,
sweats, headaches, muscle pains, arthralgia, nausea
and
vomiting, severe anemia caused by hemolysis,
hemoglobinuria) are often not specific and are also
found in
other diseases (such as the "flu" and common viral
infections).
• Likewise, the physical findings are often not specific
(elevated
temperature, perspiration, tiredness).
• There may be the feeling of tingling in the skin,
particularly
with malaria caused by P. falciparum.
• In severe malaria (caused by Plasmodium falciparum) ,
clinical
Subject: FCM III
Topic: MALARIA
Page 4 of 8
findings (confusion, coma, neurologic focal signs,
severe
anemia, respiratory difficulties, death if untreated-
young
children and pregnant women are especially vulnerable
• Splenomegaly (enlarged spleen)
• severe headache
• cerebral ischemia and hemoglobinuria with renal
failure may
occur.
• These are more striking and may increase the
for malaria.
• Thus, in most cases the early clinical findings in
malaria are
not typical and need to be confirmed by a laboratory
test.
Transmission and symptoms
• Malaria is caused by protozoan parasites of the genus
Plasmodium (phylum Apicomplexa):
o P falciparum
o P. malariae
o P.ovale
o P. vivax.
• P. falciparum is responsible for about eighty percent of
infections and ninety percent of deaths.
• Infections with P. knowlesi and P. simiovale are also
known to
cause malaria but are of limited public health
importance.
• The parasite's primary hosts and transmission vectors
are
female mosquitos of genus Anopheles;
• Humans act as intermediate hosts.
Methods of Mosquito Control
• -Controlling mosquitoes, and exposure to diseases they
may
carry, can be done by chemical and non-chemical
methods
Your first line of defense begins at home.
What you can do to control mosquitoes around the home
o Remove their habitat (where they live and breed)
• Eliminate standing water in rain gutters, old tires,
buckets,
plastic covers, toys, or any other container where
mosquitoes can breed
• Empty and change the water in bird baths, fountains,
wading pools, rain barrels, and potted plant trays at
least
once a week to destroy potential mosquito habitats
• Drain or fill temporary pools of water with dirt
• Keep swimming pool water treated and circulating.
o Prevent your exposure to mosquitoes
• Use EPA-registered mosquito repellents when
necessary
and follow label directions and precautions closely.
• Use head nets, long sleeves and long pants if you
venture
into areas with high mosquito populations, such as salt
marshes.
• If there is a mosquito-borne disease warning in effect,
stay
 Subject: FCM III
Topic: MALARIA
Page 5 of 8
inside during the evening when mosquitoes are active. • Oils and films disperse as a thin layer on the surface of
• Make sure window and door screens are "bug tight." the
• Replace your outdoor lights with yellow "bug" lights water which cause larvae and pupae to drown.
which
tend to attract less mosquitoes than ordinary lights.
• Liquid larvicide products are applied directly to water
using backpack sprayers and truck or aircraft-mounted
The
sprayers.
yellow lights are NOT repellents, however.
o Neighborhoods are occasionally sprayed to prevent disease • Tablet, pellet, granular, and briquet formulations of
and nuisance caused by large mosquito numbers (If you larvicides are also applied by mosquito controllers to
have breeding areas.
any questions about mosquitoes and their control, contact
your Controlling Adult Mosquitoes
local mosquito control district or health department.)
• Adult mosquito control may be undertaken to combat
o Methods used by federal, state and local agencies in an
mosquito control: outbreak of mosquito-borne disease or a very heavy
• Surveillance as First Step in Mosquito Control nuisance
infestation of mosquitoes in a community.
o The first step in mosquito control is
• Pesticides registered for this use are known as
surveillance. State or local mosquito adulticides
specialists conduct surveillance for diseases and are applied either by aircraft or on the ground
harbored by domestic and nonnative birds, employing
including sentinel chickens (used as virus truck-mounted sprayers.
transmission indicators), and mosquitoes.
• State and local agencies commonly use the
o State and local mosquito control authorities organophosphate insecticides malathion and naled and
also conduct surveillance for larval habitats the
by using maps and aerial photographs, and by synthetic pyrethroid insecticides permethrin,
evaluating larval populations. resmethrin, and
o ( Other tecnniques include various light traps, sumithrin for adult mosquito control.
biting counts, and analysis of reports from the • Mosquito adulticides are applied as ultra-low volume
public. (ULVj
• Mosquito control programs also put high priority on sprays ULV sprayers dispense very fine aerosol
trying to droplets that
prevent a large population of adult mosquitoes from stay aloft and kill flying mosquitoes on contact.
developing so that additional controls may not be • lILV applications involve small quantities of pesticide
necessary active
• Since mosquitoes must have water to breed, methods ingredient in relation to the ~ize of the area treated,
of typically
prevention may include: less than 3 ounces per acre, which minimizes exposure
and
o controlling water ievels in lakes, marshes, risks to people and the environment.
ditches, or other mosquito breeding sites; • Adulticides can be used for public health mosquito
o eliminating small breeding sites if possible; control
o stocking bodies of water with fish species that programs without posing unreasonable risks to the
feed on larvae. general
• Both chemical and biological measures may be population or to the environment when applied
employed to according to
kill immature mosquitoes during larval stages. the pesticide label.
• (For more Information on pesticides commonly-used in
Chemical or Biological Measures to Control Mosquitoes public
health mosquito control programs, see the specific fact
• Controlling mosquitoes at the larval stage sheets
mentioned below.)
o Malathion for Mosquito Control
• Larvicides target larvae in the breeding habitat before
o Larvicides for Mosquito Control
they can mature into adult mosquitoes and disperse.
Larvicides include: o Naled for Mosquito Control
Bacterial Insect Growth Organophosphate o Permethrin, Resmethrin, Sumithrin (Synthetic
lnsecticides Inhibitor Insecticide Pyrethroids)
o for Mosquito Control
• Bacillus Methoprene • Temephos
thuringiensis
Presumptive Treatment
israelensis
• Bacillus
• ln highly endemic areas (particularly in Africa), the
sphaericus
great
prevalence of asymptomatic infections and lack of
resources
• Other Materials (such as microscopes and trained microscopists) have
− Mineral oils led
− Monomolecular films peripheral health facilities to use "presumptive
treatment"

• Patients who suffer from a fever that does not have
any
obvious cause are presumed to have malaria and are
treated
for that disease. based only on clinical suspicion, and
without
the benefit of laboratory confirmation
• This practice is dictated by practical considerations
and
allows the treatment of a potentially fatal disease.
• But it also leads frequently to incorrect diagnoses and
unnecessary use of antimalarial drugs.
-This results in additional expenses and increases the
risk
of selecting for drug-resistant parasites.
Microscopic diagnosis
• Malaria parasites can be identified by examining under
the
microscope a drop of the patient's blood, spread out as
a
"blood smear" on a microscope slide.
• Prior to examination, the specimen is stained (most
often with
the Giemsa stain) showing a white blood cell (on left
side)
and several red blood cells, two of which are infected
with
Plasmodium falciparum (on right side).
• The Giemsa stain gives to the parasites a distinctive
appearance.
• This technique remains the gold standard for
laboratory
confirmation of malaria
• However, it depends on the quality of the reagents, of
the
microscope, and on the experience of the laboratorian
Alternate methods for laboratory diagnosis include:
Antigen Detection
• Various test kits are available to detect antigens derived from
malaria parasites.
• Such immunologic ("immunochromatographic") tests most
often use a dipstick or cassette format, and provide results in
2-10 minutes.
• These "Rapid Diagnostic Tests" (ROTs) currently used in
some clinical settings and programs, offer a useful alternative
to microscopy in situations where reliable microscopic
diagnosis is not available
• These Malaria ROTs however, befc~e they car. be widely
adopted, should address several Issues such as Improving
their accuracy; lowering their cost; and ensuring their
adequate performance under adverse field conditions
• Malaria ROTs are currently not approved by the U. S. Food
and Drug Administration (FDA) for use in the United States
• The World Health Organization's Regional Office for the
Western Pacific (WHOM'PRO) provides technical
information, including a list of commercially available malaria
ROTs
Molecular Diagnosis
• Parasite nucleic acids are detected using polymerase
chain reaction (PCR).
• This technique is more accurate than microscopy.
• However, it is expensive, and requires a specialized
laboratory (even though technical advances will likely
result in field-operated PCR machines).
Other techniques related to malaria diagnosis are:
Subject: FCM III
Topic: MALARIA
Page 6 of 8
Serology
• Serology detects antibodies against malaria parasites,
• using either indirect immunofluorescence (IFA) or
enzyme-linked immunosorbent assay (ELISA).
• Serology does not detect current infection but rather
measures past experience.
Drug Resistance Tests
• Drug resistance tests are performed in specialized
laboratories to assess the susceptibility to antimalarial
compounds of parasites collected from a specific
patient.
Two main laboratory methods are available:
1. In vitro tests: The parasites are grown in culture in the
presence of increasing concentrations of drugs; the
drug concentration that inhibits parasite growth is
used as endpoint:
2. Molecular characterization: molecular markers
assessed by PCR or gene sequencing allow also the
prediction, to some degree, of resistance to some
drugs; however, the predictive values of these
molecular tests are still being evaluated
Information for The General Public
• Malaria can be a sel/ere, potentially fatal disease
(especially
when caused by Plasmodium falciparum) and
treatment should
be initiated as soon as possible.
• In endemic areas, the World Health Organization
recommends that treatment be started within 24 hours
after the first symptoms appear.
• Treatment of patients with uncomplicated malaria can
be
conducted on an ambulatory basis (without
hospitalization) but
patients with severe malaria should be hospitalized if
possible.
• In areas where malaria is not endemic, all patients with
malaria (uncomplicated or severe) should be kept
under
clinical observation if possible.
• Patients who have severe P. falciparum malaria or who
cannot take oral medications should be given the
treatment by
continuous intravenous infusion.
• In some countries (but not the United States) sdme
antimalarial drugs are found in suppository form
• Several antimalarial drugs are available for treatment
by
• continuous intravenous infusion.
• Most drugs used in treatment are active against the
parasite
forms in the blood (the form that causes disease) and
include:
o chloroquinesulfadoxine-pyrimethamine
(Fansidar®)
o mefloquine (Lariam®)
o atovaquone-proguanil (Malarone®)
o quinine
o doxycycline
o artemisin derivatives (not licensed for use in
the United
o States, but often found overseas)
• In addition, primaquine is active against the dormant
 Subject: FCM III
Topic: MALARIA
Page 7 of 8
parasite liver forms (hypnozoites) and prevents for the few cases requiring second-line drugs
relapses. (artemisinines).
• Primaquine should not be taken by pregnant women or • It is probable that the second-line drugs distributed by
by the
people who are deficient in G6PD (glucose-6- national government are routinely used in place of the
phosphate unavailable first-line drugs (chloroquine pius
dehydrogenase). sulfadoxine-pyrimethamine).
• Patients should not take primaqUine until a screening
test • The risk is that the prar.tice may hasten the
has excluded G6PD deficiency development of
resistance to second-line drugs.
How to treat a patient with malaria depends on: • There are signs that the level of drug-resistant cases
 The type (species) of the infecting parasite of
malaria is increasing in some areas. Further
 The area where the infection was acquired and its investigation by
drug
resistance status • DOHand medical institutions is necessary to confirm
 The clinical status of the patient and
address this problem.
 Any accompanying illness or condition
 Pregnancy Goal: Malaria burden is significantly reduced in endemic
areas and the malaria-free status for 13 provinces is
 Drug allergies. or other medications taken by the
maintained.
patient
(A province is considered malaria-free when there is no
reported indigenous case for three consecutive years)
• The incidence rate of malaria decreased from 101
cases Comparison of Etiologic Agents
per 100,000 population in 1996 to 67 per 100,000 in P. • The most common in the Philippines, around
2000, falciparum 70 % of cases.
a 34 percent reduction within four years
• Causes severe malaria and death if not
• Mortality rate from malaria 'has remained below one treated promptly
death appropriately
per 100,000 populations since 1995 (PHS 2000) • Resistance to antimalarial drugs in the
• The case detection rate for malaria has also continued country is widespread
to P. vivax Comprise about 30% of cases
decrease from 1996 to 2000. Very rarely causes severe disease
• Provinces have been categorized according to the Sensitive to antimalarial drugs
number relapse is common if not treated adequately with
and trend of cases. anti-relapse drug
o Category A refers to highly endemic provinces P. malariae Very rare in the Philippines less than 1% of cases
in the country
o Category B are those classified moderately Infection is usually not severe but many last up
endemic. to 50 yrs if not treated
o Category C are low endemic provinces Drug resistance has not yet been documented
o Category D are those declared as malaria-free P. ovale Rarely found in the Philippines present in some
African countries
Relapse may occur If not treated adequately with
• There are 26 Category A provinces which continue to carry
anti-relapse drug
the burden of at least 90 percent of all malaria cases in the
drug resistance is not yet been documented
country despite the reported sustained treatment of ail
confirmed cases of malaria, and the 100 percent coverage of
Characteristics P. falciparum P. vivax P.
blood smear examination for the clinically diagnosed malaria
malariae
patients. The 13 malaria-free provinces composed of Aklan,
Biliran, Sohol, Camiguin, Capiz, Catanduanes, Cebu, Incubation (days) 12 (9-14) 13 ( 12 to 28 (18-40)
Guimaras, Iloilo, Leyte, Southern Leyte, Northern Samar and 17)
Siquijor continue to be malaria free as of 2003 Exoerythrocytic 5.5 – 7 6-8 12 – 16
cycles (days)
• Several international health and bUSiness organizations No. 40,000 10,000 2,000
support maiana control initiatives in different parts of the merozoites/liver
country such that quality assurance measures are done for cell
various program components: clinical and laboratory diagnosis, Erythrocytic cycle 48 42 - 48 72
drug supply management and case treatment. RBC preference Younger Reticulocyte Older cells
cells (but s
• Population groups in malaria-endemic areas are often invades cells
geographicaiiy and socioeconomically marginalized and rely on of all ages)
the local government for medical assistance. Relapses No Yes No
• However, the procurement of first-line anti-malaria Fever periodicity 36 to 48 48 72
(hours)
drugs by
local governments is not assured. On the other hand, Febrile paroxysm 16-36 or 8 to 12 8 to 10
the drugs bought by the national government are only length longer
Severity of attacks Severe in Mild to Mild
 Subject: FCM III
Topic: MALARIA
Page 8 of 8
non-immune severe • case detection and case management in 26 Category A
Drug resistance ++ provinces
Species dist. in the
Phil
70% 30% <1%
• In collaboration with LGUs which provides direct
service delivery to the populace in households located
in all endemic barangays suchas indigenous people,
night shift and forest workers, especially in Category A
endemic localities using standard DOH treatment
protocols in areas where malaria has been eliminated.
National Objectives for 2005-2010

Objective Indicator Target Baseline Data &

Source
Malaria Morbidity 15 cases per 50.3 case per
cases are rate of 100,000 26 100,000
reduced malaria per Category A population
least 70 100,000 provinces Field Health
percent in 26 population Service
Category A in 26 InformationSyste
provinces provinces m, 2002
Transmission Proportion TBD TBD
of malaria in of
the population
general malaria-risk
population is areas using
reduced insecticide
treated bed
nets
Proportion TBD TBD
of children
under five
years old
sleeping
under
insecticide
treated bed
nets
Morbidity Morbidity Morbidity Morbidity
and rate and 2.6 cases or 5.1 cases per
mortality are mortality less per 100,000
reduced by rate of 100,000 population
at least 50 malaria per Mortality Mortality:
percent in 100,000 and 0.04 007 death per
Category B Population death or less 100,000 pop’n
and in Category per 100,000
Category C B & C pop’n National Center
provinces provinces for Disease
Prevention and
Control, DOH
Malaria-free Number of 13 provinces 13 provinces are
status is provinces maintained malaria-free
achieved declared as as malaria- (DOH Administrative
Reports)
malaria-free free
5 more
provinces
declared as
malaria-free

Strategic Thrusts for 2005-2010

• Ensure the availability of anti-malaria drugs to endemic
areas through centralized procurement and distribution
• Promote effective and regUlar use of insecticide-
treated bed nets
• Plan and implement malaria control measures with
specific target population groups
• Promote early diagnosis, management and referral of
malaria cases
• Mobilize local government and community resources
for malaria case surveillance