About Malaria

EPIDEMIC IN AFRICA

Malaria is a disease  that is caused by a parasite transmitted from person to person by certain types of mosquitoes (Anopheles). Malaria symptoms, which appear about 9 to 14 days after the infectious mosquito bite, include fever, headache, vomiting and other flu-like symptoms. If medicines  are not available for treatment or if the parasites are resistant to them, the infection can lead to coma, severe life-threatening anemia, and death by infecting and destroying red blood cells and by clogging the capillaries that carry blood to the brain (cerebral malaria) or other vital organs. Worldwide, malaria causes around 250  million illnesses and approximately 850,000 deaths annually, 89% of these deaths occur in Africa

Malaria is particularly devastating in Africa, where it kills an African child every 45 seconds.

Many children who survive an episode of severe malaria may suffer from learning impairments or brain damage. Pregnant women and their unborn children are also particularly vulnerable to malaria, which, during pregnancy, is a major cause of mortality, low birth weight and maternal anemia. And while we know malaria is preventable, the lack of resources, coupled with a climate very hospitable to the deadliest strain of malaria, and the most efficient mosquito vector, has made the disease a leading cause of death among African children.

In addition to the human toll malaria exacts, the economic and social impacts are also devastating: Sick children miss school, tourism suffers, and foreign investment is stifled. Annual economic loss in Africa due to malaria is estimated to be $12 billion, representing a crippling 1.3 percent annual loss in GDP growth in endemic countries. Malaria becomes a self-perpetuating problem, where the disease prevents the human and economic capital necessary to bring the disease under control. Moreover, malaria disproportionately affects the rural poor who can neither afford a bed net for prevention, nor access appropriate treatment when they fall sick.

Malaria is a preventable and treatable disease. As Senegalese president Abdoulaye Wade expressed recently, in order to be successful the fight against malaria must be a comprehensive one, which includes giving families and individuals. insecticide-treated mosquito  nets to sleep under, taking steps to kill mosquitos when they enter houses to feed at night, and making anti-malarial medicines  such as artemisinin-based combination therapies more widely available. At the same time, we must continue the search for a vaccine.

Diagnosis and Treatment

Malaria case management (encompassing prompt diagnosis and treatment with an effective antimalarial) is one of the key strategies in the control of malaria. Prompt treatment—preferably within 24 hours of fever onset—with an effective antimalarial agent is necessary to prevent life-threatening complications.

Malaria diagnosis

WHO recommends prompt parasitological confirmation by microscopy or Rapid Diagnostic Tests (RDTs) in all patients suspected of malaria before treatment is started. Treatment based solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible.

Malaria Treatment

Increasing resistance of the malaria parasite to chloroquine and sulphadoxine-pyrimethamine, which were previously the most widely used antimalarial treatments, has prompted all sub Saharan African countries to change their national treatment protocols to incorporate the new and highly-effective artemisinin-based combination therapies or ACTs. ACTs are based on an active ingredient extracted from the Artemisia annua plant, which was used for the treatment of fevers for centuries in China. Artemisinin-based combination therapies (ACTs) are the treatment recommended for treatment of uncomplicated falciparum malaria. The following five ACTs are presently recommended as first line treatments:

• artemether + lumefantrine
• artesunate + amodiaquine
• artesunate + mefloquine
• artesunate + sulfadoxine-pyrimethamine
• dihydroartemisinin + piperaquine

The following options are recommended for the treatment of uncomplicated malaria in pregnancy:

• 1st Trimester:  Quinine + clindamycin
• 2nd and 3rd trimesters: any recommended ACTs as listed above;  artesunate + clindamycin,  quinine + clindamycin

Any of the following antimalarial medicines are recommended for initial treatment of Severe falciparum malaria

• artesunate (i.v. or i.m.)
• quinine (i.v. infusion or i.m. injection)
• artemether (i.m.)
• artesunate (rectal in children)

WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries to strengthen their efforts in this important area of work.

MALARIA VECTOR CONTROL

There are two main vector control interventions, Indoor Residual Spraying (IRS) and Long Lasting Insecticidal Nets (LLINs). Vector control is the primary public health intervention for reducing malaria transmission. In some context-specific situations, where the vector breeding sites are limited and easily idenitified, these core interventions can be locally complemented by other methods (e.g. larval control or environmental management) in the context of Integrated Vector Management (IVM).

Insecticide Treated Mosquito Nets (ITNs): When a mosquito tries to bite a personsleeping under a treated mosquito net, it lands on the net and comes into contact with a lethal dose of insecticide and dies. Current recommendations for malaria-endemic settings are that all people should regularly sleep under an LLIN. Long-lasting Insecticidal Nets (LLINs) maintain their effectiveness and do not require re-treatment during their 3 year lifespan. Sleeping under insecticide treated nets can reduce overall child mortality in Africa by 20 per cent. LLINs, when consistently and correctly used, have been demonstrated to save six child lives per year for every one thousand children sleeping under them. LLINs are distributed through a variety of mechanisms including through campaign approaches as well as through routine heath services such as with EPI, specifically targeting infants and young children and through antenatal care targeting pregnant women.

Indoor Residual Spraying (IRS): IRS involves applying a long-lasting insecticide to the inside walls of houses and other structures where people sleep to kill mosquitoes when they rest on the walls. IRS is a highly effective malaria prevention method in settings where it is epidemiologically and logistically appropriate. IRS must be applied prior to the transmission season (either annually or twice a year if there are continuous or multiple seasons of transmission) and is carried out by a trained cadre of workers who move through a community spraying all appropriate structures. Its full potential is realized when at least 80% of houses in targeted areas are sprayed. Indoor spraying is effective for 3–6 months, depending on the insecticide used and the type of surface on which it is sprayed. DDT can be effective for 9–12 months in some cases. Longer-lasting forms of IRS insecticides are under development.

Malaria in pregnancy

Pregnant women are at high risk of malaria due to their decreased immunity to disease. In particular, women in their first and second pregnancies are at increased risk. Non-immune pregnant women risk acute and severe clinical disease, resulting in up to 60% fetal loss and even maternal deaths, including 50% mortality for severe disease. Even, semi-immune pregnant women with malaria infection risk severe anaemia and impaired fetal growth, even if they show no signs of acute clinical disease. An estimated 10,000 women and 200,000 of their infants die annually as a result of malaria infection during pregnancy. HIV-infected pregnant women are at increased risk. WHO recommends that all endemic countries provide a package of interventions for prevention and management of malaria in pregnancy, consisting of

1. diagnosis and treatment for all episodes of clinical disease and anaemia and
2. provision of vector control either through the use of LLINs or protection provided through coverage by an IRS programme. The above strategies should be complemented by
3. intermittent preventive treatment with sulfadoxine–pyrimethamine (SP/IPTp) in countries in sub-Saharan Africa with stable malaria transmission.

Intermittent preventive treatment means that all pregnant women at risk of P. falciparum infection in countries in sub-Saharan Africa with stable malaria transmission receive at least 2 doses of SP as IPT, given at the first and second scheduled ANC visit (at least one month apart) after "quickening" (the first noted movement of the fetus). IPT-SP should be taken under direct observation (DOT) during the ANC visit.More information on the disease, and efforts to reverse the course of it can be found in the 2009 WHO World Malaria Report

http://www.who.int/malaria/world_malaria_report_2009/en/index.html