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Malaria

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By Isatou Jasseh
6th Year Medical Student
UTG

UTG Medical Students’ Association

What is malaria?

Malaria is an acute febrile life-threatening illness which has claimed so many lives in the past decade. 

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EPIDEMIOLOGY

According to WHO, in 2021, there was an estimated number of 247 million cases worldwide and an estimated number of 619000 deaths in 2021. The African region was home to 95% malaria cases and 96% malaria deaths. Children under 5 accounted for about 80% of all deaths in the region. 

Over the 2 peak years of the pandemic(2020 – 2021), Covid-related disruptions led to about 13 million more malaria cases and 63 000 more malaria deaths. 

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 The Gambia has made a considerable progress in the fight against malaria. The overall malaria parasite prevalence in The Gambia is only 0.2% compare to  4%  in 2011 indicating significant decline of more than 90% in all the health regions in the country but however, according to WHO latest published data in 2020 shows that The Gambia recorded 674 or 5.24% of total deaths.

Prevalence is higher in older children than younger ones, but however, it remain same in both sexes.

Globally 3.3 billion people are at risk for malaria.

HIGH RISKS GROUPS

o          Children under 5 years

o          Pregnant women (maternal anemia, still birth, LBW)

o          HIV/AIDS

o          Non-immune travellers

CAUSE? 

Is cause by plasmodium specie. There are 5 known species. The illness caused by each species and the predominant geographic location differs.

Malaria is usually transmitted by the bite of the anopheles mosquito.

o          Plasmodium falciparum (most common type)

o          Plasmodium malariae

o          Plasmodium ovale

o          Plasmodium vivax

o          Plasmodium knowlesi (monkey malaria parasite, potential cause of malaria for travellers)

EFFECT OF MALARIA ON PREGNANCY

o          Malaria 4-12 times more common in pregnant women Pregnancy (especially primigravidae). 

o          increased susceptibility to malaria despite pre-existing clinical immunity 

o          Parasitized maternal placental blood

o          Specific parasite variants bind in placenta (Variant Surface Antigens).

o          200,000 LBW babies due to pre-term delivery or intra-uterine foetal growth restriction 

o          maternal anaemia, premature birth, IUGR, LBW.

HIV AND MALARIA

o          HIV increases risk and severity 

o          Increased parasite burdens higher transmission rates   Semi-immune adults develop clinical malaria 

o          Anti-malarial treatment failure more likely. 

o          Infection more severe in HIV-positive pregnant women, maternal anaemia, premature birth, IUGR, LBW. Impact of malaria on HIV

o          Viral load increases during episodes of malaria through T cell activation and cytokine release 

o          Malaria a leading cause of HIV-associated morbidity in sub-Saharan Africa

o          Greater risk of mother to child transmission

SIGNS AND SYMPTOMS

o          Fever 

o          Malaise 

o          Headache 

o          Loss of appetite

o          Vomiting

o          Bitter taste in the mouth

o          Impaired consciousness

o          Multiple convulsion

o          Acidosis

o          Hypoglycemia

o          Several malaria anaemia 

DIAGNOSIS

o          RDT (rapid diagnostic tests)

o          Blood film (thick and thin)

o          Molecular methods: DNA probes and PCR (polymerase chain reaction)

o          Full blood count

o          Liver function test

o          Blood urine nitrogen and electrolye

o          Blood gases  Lactate

o          Blood sugar

o          Urinalysis

o          Cerebrospinal fluid(cerebral malaria)

TREATMENT

o          Chloroquine

o          Quinine

o          ACTs

SEVERE MALARIA 

o          > 90% children in sub-Saharan Africa 

o          > 99% secondary to P. falciparum 

o          5-10% of children who recover from Cerebral Malaria suffer significant neurological sequelae – hemi-paresis, blindness etc.

CONTROL 

1. Sustained Control: Malaria is no longer a significant clinical/public health problem. 

2. Elimination: Regional or national interruption of malaria transmission.

3. Eradication: Worldwide cessation of all natural transmission. 

4.  The pillars of malaria control:

o          Attack vectors so transmission does not occur 

o          Identify and treat cases early so they do not transmit, and do not progress to die Control Ways to reduce mosquito number.

Ways to reduce mosquito numbers:

o          Remove their breeding sites 

o          Kill them as larvae

o          Kill them before they bite a human Reduce probability they will bite a human Insecticide-treated mosquito nets

o          Screened windows/doors

o          Alternative food sources (animals) Indoor spraying with residual insecticides:

o          Insecticide coils

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