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Malaria: Fight it today to live tomorrow

..Dr Amit Singht says it is a disease which is not self-limiting but can be treated with the use of available medicines

Dr. Singh

By Dr Amit Singh- Dean School of Medicine at Texila American University

In 1880, a French surgeon called Charles Louis Alphonse Laveran stationed in Algeria (North Africa) was the first person to see the parasites that cause malaria in the blood of an infected person.

After nearly two and half centuries still we are struggling to prevent the disease and the morbidity caused by it.

Every 75 seconds, a child under five somewhere in the world dies of malaria and many of these deaths are preventable and treatable.

In 2019, there were 229 million malaria cases globally that led to 558,000 deaths in total.

Of these deaths, 74 per cent (416,000) were children under 5 years of age. This translates into a daily toll of nearly 750 children under age 5.

Zambia also remains a highly endemic malaria country, with the entire population considered to be at risk of contracting malaria.

It is among the top 10 countries with the highest malaria incidence and mortality globally, the first six countries are from Africa only.

Zambia carries 2% of the global malaria case burden and 6.1% of the case burden in East and Southern Africa.

Risk is highest in the wetter, rural, impoverished provinces of Luapula, Northern,

Muchinga and North Western (11–30% prevalence in 2018), and lowest in Lusaka Province (0.1% and Southern Province (<0.1%).

Human malaria is caused by one or more of four parasites: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. 

It is typically transmitted by the bite of an infective female Anopheles mosquito, the infected mosquito carries the parasite which is transmitted during the mosquito bite,

Malaria can also be transmitted transplacentally, as a result of blood transfusion, or by needle sharing.

The mosquito thrives in tropical and subtropical regions. It is very rarely, if ever, found at high altitudes, in deserts, or during cold seasons.

Malaria is preventable and treatable. The majority if these new cases and 90% of the resulting deaths occur in Africa. 

Uganda, for example, reported the highest number of new infections with 10.3 million.

This figure is followed by Ghana with 8.8 million and another 6.3 million in the Democratic Republic of Congo.

Some population groups are at considerably higher risk of contracting malaria and developing severe disease: infants, children under 5 years of age, pregnant women, and patients with HIV/AIDS, as well as people with low immunity moving to areas with intense malaria transmission such as migrant workers, mobile populations and travellers.

Poor housing condition, increased breeding places for the mosquito, Lack of protection from the mosquito bite, sleeping without Bed nets, increased construction sites and rapid urbanization are some of the contributing factors for Malaria.

7-18 days after the mosquito bite the patients presents with Severe shivering and chills, high fever, sweating, nausea and vomiting, diarrhoea, loss of appetite, general discomfort and weakness, abdominal pain, muscle pain.

Malaria is a disease which is not self-limiting as it can only be treated with the use of medicines, so if anyone suspect or feel the above-mentioned symptoms the patient is supposed to immediately contact the nearest health facility as its complication can be life threatening.

As soon as the diagnosis is made, drugs are available to treat malaria. The common medicines used to treat the disease is Primaquine, Lumefantrine, Artemether, Arteether, Quinine etc.

Since October 2021, WHO also recommends broad use of the RTS,S/AS01 malaria vaccine among children living in regions with moderate to high P. falciparum malaria transmission. P. falciparum is the deadliest malaria parasite and the most prevalent on the African continent.

The complication of Malaria is life threatening and includes Cerebral Malaria which affects brain and can lead to permanent brain damage, it can also lead to liver failure and jaundice.

Common complications which are reported is Anaemia, shock, renal failure, ARDS etc.

Blackwater fever is a complication of malaria infection in which red blood cells burst in the bloodstream (haemolysis), releasing haemoglobin directly into the blood vessels and into the urine, frequently leading to kidney failure.

The disease was first linked to malaria by the Sierra Leone Creole physician John Farrell Easmon.

A patient generally presents with chill and  rigor, high fever, jaundice, vomiting, rapidly progressive anaemia, and dark red or black urine.

Malaria during pregnancy is a serious concern and should be diagnosed as soon as possible, as it can be treated with the available drugs.

The complications of Malaria during pregnancy includes: premature birth – birth before 37 weeks of pregnancy, low birth weight, restricted growth of the baby in the womb, stillbirth, miscarriage and can even lead to the death of the mother.

Malaria can often be avoided using the ABCD approach to prevention, which stands for: Awareness of risk – find out whether you’re at risk of getting malaria, Bite prevention – avoid mosquito bites by using insect repellent, covering your arms and legs if you are exposed to frequent mosquito bite, and using a mosquito net while sleeping, Check the availability of health care facility and talk to your health care provider to know more about Malaria., Diagnosis – seek immediate medical advice if you have malaria symptoms and finish the course of the medicine as advised by the physician.

Zambia launched its National Malaria Elimination Strategic Plan (NMSP) in April 2018 to serve as a strategy towards a malaria-free Zambia.

Key tenets of the plan are equitable access to quality-assured, cost-effective malaria prevention and control interventions.

In March 2019, Zambia launched its first End Malaria Council (EMC), designed to increase resource mobilization to achieve and sustain malaria elimination.

The EMC convenes senior-level, multi-sectoral stakeholders (government, business, and community leaders) to complement Zambia’s National Malaria Elimination Programme.

The WHO Global technical strategy for malaria 2016–2030, updated in 2021, provides a technical framework for all malaria-endemic countries.

It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

(Source: WHO, UNICEF, Internet)

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