HEALTH TIPS: MALARIA

WORLD MALARIA DAY – “Zero Malaria – Draw the Line against Malaria”

Dr Tariq Jagnarine
Fam Med, Endocrinology / Diabetes

World Malaria Day, observed annually on 25 April, is intended to bring global attention to the efforts being made to bring an end to malaria, and encourage action to reduce suffering and death from the disease. World Malaria Day is an occasion to highlight the need for continued investment and sustained political commitment to malaria prevention and control. Fortunately, with the right medical equipment and precautionary measures, the disease is treatable and preventable. Due to the best practice steps that have been taken in recent years, countries previously affected by the disease have now been certified malaria-free. Because of this, many charities and organisations, such as the World Health Organization (WHO), are optimistic that, with appropriate coordination and support from international governments, a world free from malaria is possible.

WHAT IS MALARIA?
Malaria is a life-threatening infectious disease. It’s typically transmitted through the bite of an infected Anopheles mosquito. Infected mosquitoes carry the Plasmodium parasite, and once a person has been bitten, that parasite can enter the person’s blood stream and result in malaria illness.
Once the parasites are inside their victim’s body, they travel to the liver, where they mature. After several days, the mature parasites re-enter the bloodstream, and begin to infect red blood cells.
Within 48 to 72 hours, the parasites inside the red blood cells multiply, causing the infected cells to burst open. The parasites continue to infect other red blood cells, resulting in symptoms that occur in cycles that last for two to three days at a time.
Malaria is typically found in tropical and subtropical climates, where the parasites can live. The World Health Organization’s (WHO’s) Trusted Source states that, in 2016, there were an estimated 216 million cases of malaria in 91 countries.
In the United States, the Centers for Disease Control and Prevention (CDC) reports 1,700 cases of malaria annually. Most cases of malaria develop in people who travel to countries where malaria is more common, or live in an area endemic to malaria, like Guyana.
In Guyana, the number of cases reported in 2019 nationally was 39, which represents a slight increase (of 1%) compared with the same period in 2018. In contrast, Regions 7 and 8 reported increases of 51% and 23% respectively.

CAUSES OF MALARIA
Malaria can occur if a mosquito infected with the Plasmodium parasite bites someone. There are four kinds of malaria parasites that can infect humans:
• Plasmodium vivax,
• P. ovale,
• P. malariae,
• P. falciparum.
P. falciparum causes a more severe form of the disease, and those who contract this form of malaria have a higher risk of death. An infected mother can also pass the disease to her baby at birth. This is known as congenital malaria.
Malaria is transmitted by blood, so it can also be transmitted through:
• Organ transplant
• Transfusion
• Sharing needles or syringes

SYMPTOMS OF MALARIA
The symptoms of malaria typically develop within 10 days to 4 weeks following the infection. In some cases, symptoms may not develop for several months. Some malarial parasites can enter the body but will be dormant for long periods of time.
Common symptoms of malaria include:

• Shaking chills that can range from moderate to severe
• High fever
• Profuse sweating
• Headache
• Nausea
• Vomiting
• Abdominal pain
• Diarrhea
• Anemia
• Muscle pain
• Convulsions
• Coma
• Bloody stools
• Hysteria and Confusion

DIAGNOSIS
A careful review of a person’s health history, including any recent travel to tropical climates, and physical examination can help healthcare professionals to determine the likelihood of someone having malaria. Additional blood tests are then ordered to confirm the diagnosis of malaria.
These tests will show:
• Confirmation of malaria; type of malaria
• Some test can also determine if the infection is caused by a parasite that’s resistant to certain types of drugs
• Presence of anaemia ad as a result of Malaria
• Organ damage from the infection
COMPLICATIONS
Malaria can cause a number of life-threatening complications, such as:
• Cerebral malaria, with brain injury and damage
• Pulmonary edema – an accumulation of fluid in the lungs that causes breathing problems
• Organ failure of the kidneys, liver, or spleen
• Anaemia due to the destruction of red blood cells
• low blood sugar
• Dehydration and shock

TREATMENT
Malaria can be a life-threatening condition, especially if the infection is caused by the parasite P. falciparum. Treatment for the disease is typically provided in a hospital. Medications are prescribed based on the type of parasite causing the malaria and the severity of the symptoms.
In some instances, the medication prescribed may not clear the infection, because parasites can be resistant to drugs. If this occurs, more than one medication may need to be utilised, or medications can be changed altogether to treat the condition.
Additionally, certain types of malaria parasites, such as P. vivax and P. ovale, have liver stages where the parasite can live in the body for an extended period of time and reactivate at a later date, causing a relapse of the infection. In this case, additional medication is given to prevent a relapse in the future.

PROGNOSIS
People with malaria who receive treatment typically have a good long-term outlook. If complications arise as a result of malaria, the outlook may not be as good. Cerebral malaria, which causes swelling of the blood vessels of the brain, can result in brain damage. The long-term outlook for patients with drug-resistant parasites may also be poor. In these patients, malaria may reoccur. This may cause other complications.

PREVENTION
There’s no vaccine available to prevent malaria. However, prophylaxis medication exists that can help to prevent the occurrence of malaria. These medications are the same as those used to treat the disease, and should be taken before, during, and after a trip to an endemic zone.
Sleeping under a mosquito net may help prevent someone from being bitten by an infected mosquito. Covering the skin, or using bug sprays containing DEET may also help prevent infection.
While malaria is a highly infectious and deadly disease that can cause many serious complications, it is readily treatable and preventable. The fight against elimination of malaria starts with you. Draw the line!