THE FEDERAL UNIVERSITY OF TECHNOLOGY AKURE 2012/2013 ACADEMIC SESSION COURSE TILE: USE OF ENGLISH II COURSE CODE: GNS

102 A TERM PAPER ON: PREVENTION OF MALARIA AMONG TEENAGERS IN ILARA MOKIN

SUBMITTED TO: THE GENERAL STUDIES UNIT, FEDERAL UNIVERSITY OF TECHNOLOGY AKURE.

S/N 1 2 3 4 5

NAME OGUNBAMBI TAIWO RAHMON OKE YUSUF OLAWALE AYENIYO OLAYEMI OPEYEMI ADEBAYO TINUOLA OLUWASEYI ADEBAYO REGINA

GENDER MALE MALE MALE FEMALE FEMALE

MATRIC NO PMT/12/0558 PMT/12/ PMT/12/0536 PMT/12/ PMT/12

TABLE OF CONTENT
1.0 ABSTRACT 2.0 INTRODUCTION 3.0 SIGNS AND SYMPTOMS OF MALARIA 3.1 DANGER SIGNS OF SEVERE MALARIA 3.2 AWARENESS BE AWARE OF MALARIA RISK 3.3 BITES AVOID MOSQUITO BITE 4.0 TREATMENE OF MALARIA 4.1 SEVERE OR COMPLICATED MALARIA 4.2 MALARIA IN PREGNANCY 4.3 MALARIA IN CHILDREN 5.0 PREVENTION OF MALARIA 5.1 USE OF INSECTICIDE-TREATED MOSQUITO NETS 5.2 USE OF MOSQUITO COILS 5.3 PRECAUTIONS THAT SHOULD BE TAKEN TO MINIMISE INSECTICIDE PROBLEM 5.4 PERSONAL PROTECTION MEASURES TO PREVENT MOSQUITO BITES 6.0 REFERENCES

ABSTRACT
Malaria is a potentially fatal disease that can be prevented in the majority of cases by taking appropriate precautions. These guidelines, produced by the National Department of Health, provide detailed approaches to the options Available for preventing malaria transmission in Nigeria. The objective of these guidelines is to provide health care practitioners with information on the most appropriate Interventions for people who enter into malaria affected areas in Nigeria. These guidelines incorporate the World Health Organizations guidelines for the prevention of malaria. There is increasing resistance of malaria parasites to chloroquine, the cheapest and commonly used drug for malaria in Nigeria. However not much has been done to project antimalware properties of indigenous medicinal plants. This study thus, has the main objective of presenting the preventive measures of malaria in Ilara Mokin, Ondo State, South west Nigeria. Focus group discussions and interview were held about plants often found useful for malaria therapy in the community. Fifty species (local names) including for example: Morinda Lucida (Oruwo), Enantia chloranthy (Awopa), Alstonia boonei (Ahun), Azadirachta indica (Dongoyaro) and Khaya grandifoliola (Oganwo) plants were found to be in use for malaria therapy at Ilara Mokin, Southwest, Nigeria . The parts of plants used could either be the barks, roots, leaves or whole plants. The recipes also, could be a combination of various species of plants or plant parts. This study highlights potential sources for the development of new antimalarial drugs from indigenous medicinal plants found in Ilara Mokin, Nigeria.

INTRODUCTION
Malaria is a global disease that is predominant in the tropics and caused by blood parasites, Plasmodium falciparum, Plasmodium ovale, Plasmodium malariae and Plasmodium vivax. In Nigeria, malaria is mostly caused by P. falciparum and P. malariae. The female anopheles mosquito transmits these parasites to humans. Malaria has a great morbidity and mortality than any other infectious diseases of the world. High mortality rate is recorded in children and pregnant women (WHO, 2000), also the disease has negative impact on the economy of Indigenous medicinal plants in Nigeria used in combating malaria are yet to be projected in conferences as the foreign plants in spite of our rich flora diversity. Therefore, this present study has the main objective of presenting medicinal plants useful for malaria therapy in Ilara Mokin, Ondo State, Southwest of Nigeria. Malaria is a common and life-threatening disease in many tropical and subtropical countries.1 In some tropicaldistricts in Africa, over half of the residents may be infected with malaria. It is estimated that more than a million African children die of malaria each year. Malaria control operations have substantially reduced the risk of malaria in some countries. In South Africa, malaria was originally endemic in the low-lying northern and eastern districts. However, control measures introduced since 1930 have reduced malaria transmission significantly, and the risk ofmalaria is now comparatively low and seasonal.Malaria prevention includes measures taken both against mosquito vectors and against the malaria parasite. Theseinclude vector control programmes managed by government health authorities, personal protection measures to avoid mosquito bites. Due to the development of drug resistant parasites, drug side effects and contraindications, the control of vector mosquitoes and avoidance of their bites have become increasingly important This study was carried out in Ilara Mokin, Ondo State, Southwestern Nigeria. Ilara Mokin is a heterogeneous community, consisting of various groups of people from different parts of Southwest, Nigeria Ife, Ifewara, Egbas, Owu, Offa, Ilorin, Ibadan, Ijebu, Ondo, Ilesha to mention a few. This community has a single primary health care centre. The main occupations of the people are farming, teaching, hunting and petty trading. Some are also artisans, traditionalists and herbalists. Focus group discussions and interviews were held with members of this community. Members involved in this study were mainly the traditional herbal chief (Asosanyin) who sees to the management and control of traditional practices of the use of herbs, traditional practitioners, herb sellers, primary and secondary school teachers, elderly members of the community 60 years and above; middle age members between the ages of 35-59 years old and health workers in the local Primary health centre.

MALARIA-THE DISEASE
Malaria is transmitted to humans by the bite of an infected female Anopheles mosquito. Human malaria is a parasitic infection/disease caused by four species of the Plasmodium parasite: Plasmodium falciparum (P. falciparum) Plasmodium malariae (P. malariae) Plasmodium ovale (P. ovale) Plasmodium vivax (P. vivax) In Sub-Saharan Africa over 90% of human malaria infections are due to P. falciparum. Plasmodium falciparum is the only species associated with severe morbidity and mortality6,8. The other three species cause milder illness, however infections with P. ovale and P. vivax may relapse months later if appropriate treatment is not provided. Mixed infections involving more than one species may also occur. The life cycle of the malaria parasite involves two hosts (Figure 1). During a blood meal, a malariainfected female Anopheles mosquito inoculates sporozoites into the human host. Sporozoites infect liver cells and mature into schizonts, which rupture and release merozoites into the blood stream where they infect red cells.

Figure 1: Life cycle of malaria parasites in human and mosquito http://www.malaria.org.za/Malaria_Risk/General_Information/general_ information.html In P. vivax and P. ovale malaria infections, a dormant stage [hypnozoites] can persist in the liver and cause relapses by invading the bloodstream months, or even years later. After this initial replication in the liver (exoerythrocytic

schizogony), the parasites undergo asexual multiplication in the erythrocytes (erythrocytic schizogony). The ring stage trophozoites mature into schizonts, which rupture, releasing merozoites. Some parasites differentiate into sexual erythrocytic stages (gametocytes). Erythrocytic schizogony is responsible for the clinical manifestations of the disease. Some parasites differentiate into sexual erythrocytic stages (gametocytes). The gametocytes in the blood do not cause symptoms and may persist for several weeks after successful treatment of the acute illness8. This is the stage of the parasites lifecycle responsible for continued malaria transmission and spread of drug resistance. The Anopheles mosquito ingests the male (microgametocytes) and female (macrogametocytes) gametocytes during a blood meal. The parasites multiplication in the mosquito is known as sporogony. The resulting sporozoites make their way to the mosquitos salivary glands from where inoculation into a new human host perpetuates the malaria life cycle. Following infection during a mosquito blood meal, there is an asymptomatic incubation period of approximately 7 to 30 days during which the parasites develop in the liver and multiply in the blood. This period can be prolonged in patients taking chemoprophylaxis (or some antibiotics). Reproduction in the blood is extremely rapid and destruction of red blood cells soon induces disease symptoms. Without treatment, the illness may progress rapidly, especially in high-risk groups (non immunes, pregnant women, young children, splenectomised and immunocompromised patients). Following appropriate treatment, P. falciparum and P. malariae infections are normally completely cured. However, hypnozoites (the dormant stage) in the liver may be responsible for relapses of P. ovale and P. vivax infection, presenting 2 3 months or more after treatment of the asexual stages of the original infection8. A twoweek course of primaquine is needed to ensure a radical cure (eradication of this latent liver stage). Mosquitoes are scientifically classified by their appearance into groups (families). One of these, the Anopheline family, includes all of the species responsible for transmitting malaria. At least three species have been shown to transmit malaria in Southern Africa. Mosquitoes have four distinct stages in their life cycle: egg, larva, pupa and adult. The duration of the larval stage and lifespan of the adult mosquito is strongly influenced by temperature.

SIGNS AND SYMPTOMS OF MALARIA

Symptoms of malaria infections commonly develop 10 14 days after an infective mosquito bite, as they only develop once the parasites infect the red blood cells. It is difficult to tell whether a sickness is caused by malaria or some other disease, because the features may be similar. Ask the patient, or the adult accompanying a young patient, whether there has been any fever at any time during the past 2-3 days. The patient has a fever when the forehead feels hot, or more precisely when his or her temperature is more than 37.5 degrees centigrade on a thermometer. Very young children with malaria may present with low body temperatures or hypothermia. Patients who have had fever during the last 2-3 days may have malaria. In this case, ask and then look for danger signs.

DANGER SIGNS OF SEVERE MALARIA

Look for the following signs of malaria, and ask the following questions to each patient, or parent or caregiver Accompanying a child: If he/she is able to drink If he/she has had fever at home If he/she has had convulsions (fits) Does he/she vomit repeatedly or have diarrhea or a cough How much urine he/she has passed very little, none at all? Is it dark or blood coloured? . The symptoms of malaria may initially resemble a non-specific flu-like illness with one or more of the following: Fever (although common, fever may be absent in some cases) Rigors Headache Sweating Fatigue Myalgia (back and limbs) Abdominal pain Diarrhoea Loss of appetite Nausea and vomiting Cough In young children, malaria may present with fever, lethargy, poor feeding and vomiting. The presentation of P. falciparum malaria is very variable and may mimic many other diseases including influenza, hepatitis, meningitis, septicaemia, viral haemorrhagic fever, trypanosomiasis, HIV seroconversion illness and urinary tract infection. Non-immune patients with uncomplicated malaria are prone to the development of severe P. falciparum malaria.

AWARENESS BE AWARE OF MALARIA RISK

Life threatening complications can develop rapidly in these patients. Pregnant women, young children, and persons who have undergone a splenectomy or who are immune compromised and debilitated individuals are high-risk groups for the development of severe and complicated malaria. 21 Location Cities less risk Camping near river high risk Accommodation Air conditioned hotels low risk Huts or tents higher risk Time of the year Transmission is less during dry cold months Time of the day Malaria carrying mosquitoes bite at night Length of stay The longer the stay, the higher the risk

BITES AVOID MOSQUITO BITES.

Measures taken should include:
Remain indoors between dusk and dawn Wear long - sleeved clothing, long trousers (preferably light - coloured) and socks Apply an insect repellent containing DEET to exposed skin, repeat as recommended on the container label. Avoid eyelids, lips, sun burnt or damaged skin, do not spray on the face and do not overdose young children. Protect doors and windows with screens, but if not available, windows and doors should be closed at night. Use overhead fans or air conditioners, which are effective in hindering mosquitoes from landing. Sleep in an insecticide sprayed house. Sleep under a mosquito net (preferably impregnated with an insecticide registered for this purpose, e.g. a pyrethroid), with the edges tucked in. Ensure that the net is not torn and that there are no mosquitoes inside. Spray inside the house with an aerosol insecticide (for flying insects) at dusk, especially the bedrooms, after closing the windows. Use mosquito mats, impregnated with an insecticide (heated electrically or by a non-electric lamp), or burn mosquito coils in living and sleeping areas during the night. Treat clothes with an insecticide registered for this purpose, e.g. a pyrethroid.

TREATMENT OF MALARIA
In Ilara Mokin where chloroquine resistance is still low, chloroquine is used to treat uncomplicated malaria cases. In many regions of the world, chloroquine is no longer effective in treating malaria, hence second line antimalarial drugs are often used. Most cases of mild malaria can be cared for at home but the or caregiver should be aware of the following dosage and frequency of the medication: symptoms will return if treatment is not completed (even if symptoms disappear immediately after first medication) vomiting soon after medication may require more treatment fever which persists during treatment or which returns after a few days of completed anti-malaria treatment may indicate treatment failure. If treatment fails, it may either be because the patient received incomplete treatment (e.g. vomited or forgot to take the medication) or because the malaria might be resistant to the drug. Discuss the possibilities of incomplete compliance with the patient or guardian and check national guidelines for alternative antimalaria drug therapy.

SEVERE OR COMPLICATED MALARIA

The recommended treatment of severe complicated malaria is intravenous quinine or artemisinin derivatives. Intravenous infusion of quinine should be given slowly over 8 hours to avoid cardiac complications. This should be followed by oral quinine tablets for a total of 7 days once the patient is conscious and can drink. Although treatment may start at the health centre, the patient should then be immediately referred to a district hospital. Artemisinin, if available, can be given in suppository form in young children and to patients who are unconscious. To bring down the fever, give paracetamol or aspirin. Take off most of the patients clothes. Moisten the body with slightly warm water, using a sponge or cloth. Ask someone to fan the patient continuously (including during the journey to the hospital). Protect the patient from direct sunlight. A note should be sent with the patient which clearly states the drugs already given with the dosage, route, date and time of administration. A brief clinical history and details of examination findings should also be included in the note. Findings from laboratory tests for parasite counts, haemoglobin or haematocrit, and glucose levels are also useful. At the hospital, the patients condition should be quickly assessed with the help of the note from the health centre and by checking present clinical symptoms and signs of other diseases. Regular checks of the intravenous drip, urine output and hydration, pulse, respiratory rate and rhythm and coma score, haemoglobin or haematocrit, and blood sugar level need to be made. The patient must be monitored closely to recognize, prevent and treat complications such as severe anaemia, convulsions and hypoglycaemia. Avoid blood transfusions wherever possible. Even adults and children with extremely low haemoglobin (less than 5g/dl) who are clinically stable do not require transfusion. Carefully transfuse with whole blood or with packed cells if there are signs of cardiac or respiratory insufficiency.

MALARIA IN PREGNANCY
Pregnant women in malaria endemic areas are more susceptible to malaria infections because of their reduced Natural immunity and may therefore develop complications such as fever and severe anemia. In some countries, national policies recommend routine use of anti-malarial drugs during pregnancy. When pregnant women become ill with malaria, treatment depends on national guidelines. Chloroquine, amodiaquine and quinine can all be safely given during pregnancy. Concern has been expressed about the safety of mefloquine use during pregnancy. However clinical trials have shown that it can be given with

confidence during the second and third trimesters. Artemisinin and its derivatives are also safe from the fourth month of pregnancy onwards, though it is not recommended during the first 3 months of pregnancy.

MALARIA IN CHILDREN
Chloroquine is the recommended treatment for uncomplicated cases in areas where resistance is low or non-existent. Fansidar is the recommended treatment in areas of high chloroquine resistance where Fansidar is still effective. To mask the bitter taste of chloroquine, crushed tablets can be given to the child with banana or other local food. Quinine is the standard treatment for children with severe malaria . All children with high fever (over 38.5 degrees centigrade) should be given paracetamol (15mg/kg). When the fever has reduced and the child is calm, give the anti-malaria drug with a spoon, after the tablets have been crushed and mixed with water. A sweet drink or breastmilk should be given immediately after the medicine has been swallowed. The child should be observed for 1 hour. If the child vomits during that time, treatment should be repeated (full dose if the drug is vomited before 30 minutes, half dose if vomited between 30 minutes and 1 hour). If the child vomits repeatedly, he or she must be hospitalized.

PREVENTION OF MALARIA
USE OF INSECTICIDE-TREATED MOSQUITO NETS
The promotion and use of insecticide-treated mosquito nets has become a leading strategy in malaria prevention and control. Surveys have shown dramatic reductions in the number of cases of malaria in Ilara Mokin using insecticide treated mosquito nets. Regular use of treated nets has been shown to reduce child mortality by about 25%. Children sleeping under treated mosquito nets are less prone to anemia, malnutrition and severe malaria. In communities where a substantial proportion of people are using nets, fewer people are being bitten and this provides some community protection. In many countries mosquito nets and their re-treatment are still relatively costly. This is often due to high taxes and import duties levied on mosquito netting materials and insecticides by governments. To be most effective, mosquito nets must be re-treated with recommended insecticides at least every 6 months to give maximum protection. They also protect against bites and stings of other insects. However, studies Shown that if people have to pay for the net retreatment service, they are less likely to spend the necessary time and money having their nets dipped regularly in insecticides. This issue of The Prescriber describes how to treat nets with insecticide, and describes an example of involving community funds in managing bed net sales and treatments Local communities can lobby their municipalities, governments, non-governmental organizations (NGOs), private companies etc. to mitigate the effects of public works projects, to fill up pits dug in the ground, to drain swamps, and to minimize deforestation and mining projects and/or movements of people which may trigger malaria epidemics. Health workers can encourage use of bed nets and organize community action to fill in pools of water around the village, keep houses clean and put up curtains or screens on windows and doors.

USE OF MOSQUITO COILS

Mosquito coils and body repellents (sprays and lotions) are often used for individual protection but they are not effective for general use as a control measure and are relatively expensive. In particular, they may be useful to protect an individual from a non-endemic area or a primigravida. It is advisable for everyone to wear long protective clothing while outdoors to prevent mosquito bites and to put wire screens on windows. The vector of malaria is the Anopheles mosquito; the aim was to eradicate this mosquito, mainly through spraying with insecticides. Three problems arose: spraying was expensive; there were environmental problems with insecticides and the mosquitoes became increasingly resistant to the insecticides.

PRECAUTIONS THAT SHOULD BE TAKEN TO MINIMISE INSECTICIDE PROBLEMS:

Apply repellent sparingly to exposed skin or clothing11. Repeat applications at intervals according to the duration of action of the particular repellent Do not inhale or ingest Keep repellents out of the reach of children.

PERSONAL PROTECTION MEASURES TO PREVENT MOSQUITO BITES

Remain indoors between dusk and dawn

Wear long-sleeved clothing, long trousers and socks when going put at night Cover doorways and windows with screens, but if not available, windows and doors should be closed at night. Apply a DEET-containing insect repellent to exposed skin; repeat as recommended on the container label. Avoid eyelids, lips, sun burnt or damaged skin, do not spray on the face and do not overdose young children. Use mosquito mats, impregnated with an insecticide (heated electrically or by a non-electric lamp), or burn mosquito coils in living and sleeping areas during the night. Use a mosquito-proof bed net over the bed, with edges tucked in. Spray inside the house with an aerosol insecticide (for flying insects) at dusk, especially the bedrooms, after closing the windows. Ceiling fans and air conditioners are very effective.

REFERENCES:
World Health Organization. 84. Global Strategic Framework for Integrated Vector Management. 2013; WHO/CDS/CPE/PVC/2013.10. World Health Organization, Geneva. Available from: http://whqlibdoc.who.int/hq/2013/WHO_CDS_CPE_PVC_2013_10.pdf, accessed on July 13, 2013. Hughes GL, Koga R, Xue P, Fukatsu T, Ragson JL. 93. Wolbachia infections are virulent and inhibit the human malaria parasite Plasmodium falciparum in Anopheles gambiae. PLoS Pathog 2012; 7 : e1002043. Worrall, E., Basu, S., & Hanson, K. (2005). Is malaria a disease of poverty? A review of the literature. Tropical Medicine & International Health, 10(10), 10471059.PMID: 16185240 Fegan, G., Noor, A., Akhwale, W., Cousens, S., & Snow, R. (2007). Effect of expanded insecticide-treated bednet coverage on child survival in rural community: a longitudinal study. Lancet, 370(9592), 10351039. [Comments in: Lancet, 370(9592), 1007; Lancet, 370(9592),10091010; Lancet, 371(9607),115116.] PMID: 17889242 [PubMed indexed for MEDLINE] Noor, A., Omumbo, J., Amin, A., Zurovac, D., & Snow, R. (2006). Wealth, mother's education and physical access as determinants of retail sector net use in rural community, ILARA MOKIN. Malaria Journal, 5(1), 5. Retrieved from http://www.malariajournal.com/content/pdf/1475-2875-5-5.pdf PMID: 16436216 [PubMed indexed for MEDLINE]