Seven Things You Ought To Know About Malaria

As a Medical officer in a Nigerian hospital, perhaps one of the most striking issues you will have is simply how many cases of malaria you manage on a daily basis. From folks who waltz into your consulting room sure they have malaria to cases of children paper-white, death pale from anemia secondary to severe malaria and women with miscarriages caused by malaria, you immediately begin to realize that malaria still remains an illness of very significant public health concern.

In commemoration of the 2017 world malaria day with the global theme, “End Malaria For Good” by “Pushing for Prevention” this article like most public health interventions seeks to put power in the hands of the people twin efforts of health education and health promotion.

In the spirit of the World Health Organisation, I believe our generation can be the one who ultimately ends malaria for good.

So here are seven things you ought to know about Malaria Click To Tweet

1.  Malaria is one of the oldest and deadliest diseases in human history.

Malaria is at least 4,000 years old, it was once thought that the disease came from fetid marshes hence deriving its name from the Italian for “bad air”-“mal-aria”. From ancient
Chinese medical corpus that described the symptoms of malaria to Hippocrates, the father of Medicine who noted the principal symptoms malaria has been responsible for the decline and demise of many populations, especially in Rural communities. In the Susruta, a Sanskrit medical treatise, malaria symptoms were described and attributed to the bite of certain insects though a number of Roman writers attributed the disease to the Swamps as earlier noted above.

2. Malaria is a Parasitic Infection transmitted by Mosquitoes.

Malaria is a blood infection caused by Plasmodium parasites borne by female Anopheles Mosquitoes. Ronald Ross, a British officer in the Indian Medical Service was the first to demonstrate and solve the problem of Malaria transmission for which he won a Nobel Prize in 1902; he revealed how malaria parasites could be transmitted from infected patients to mosquitoes and working with birds, how mosquitoes could transmit malaria parasites from one bird to another. Malaria parasites are microorganisms that belong to the Genus Plasmodium with more than a 100 different species that could infect mammals, birds, and reptiles; of these, there are five recognized as naturally human infecting-Plasmodium falciparum (causes severe malaria and anemia), Plasmodium vivax (most prevalent, could cause malaria relapse several months or years after initial bite), Plasmodium ovale(prevalent in West Africa), Plasmodium malariae (found worldwide and could cause long-lasting chronic infection), Plasmodium knowlesi (a cause of Zoonotic malaria).

3. The Current Epidemiology of Malaria

Malaria affects 3.3 billion people or half of the World’s population in 106 countries and territories; however, according to the World Malaria Report 2016, there was a 21% drop in rate of malaria cases globally between 2010 and 2015 and a 29% fall in malaria death rates in the same5 year period; in Sub-Saharan Africa, new malaria cases fell by 21% and death rates from malaria by 31%. In Africa, between 2000 and 2015, there was an 88% decline in the number of malaria cases and a 90% fall in malaria death rates.

Malaria affects 3.3 billion people or half of the world’s population in 106 territories. Click To Tweet

While this is commendable, malaria still remains a major public health threat with a child dying from malaria every two minutes, a global death rate of 429,000 and 212 million new cases of malaria in 2015with most cases and most deaths occurring in the WHO African region. About 97% of Nigerians are at risk with more than 76% of the population reporting more than 1 case per 1,000 population; Nigeria and the Democratic Republic of Congo account for more than 35% of the global total of estimated malaria deaths. The prevalence of malaria in rural population is three times that in urban populations(12% vs 36%)and when compared to the highest socioeconomic group, the prevalence of the lowest socioeconomic group is 10 times higher(4% vs 43%).

4. Transmission of Malaria

The commonest mode of transmission of malaria is through the bite of different species of female anophelines, however, there are other forms of transmission and these include, blood transfusions, congenitally, from mother to child, from sharing of needles among intravenous drug abusers, accidentally among health workers from needle-stick injuries and instrument punctures and occasionally in organ transplantation. “Airport malaria” occurs when vectors who survived journeys from malaria endemic regions to nonendemic regions transmit Plasmodium to airport workers or people who live around airports. This can also occur via taxis (“taxi-rank malaria”) or baggage originating from malaria endemic regions (“baggage malaria”).

5. Pushing for Prevention

Prevention is a significant part of malaria management and controls particularly in malaria endemic areas and a veritable public health tool. The prevention of malaria begins with vector control, personal prevention measures and preventive treatment with antimalarials of vulnerable groups (pregnant women, sickle cell disease patients, etc). Vector control is an integral component of malaria prevention and the two broad measures include the use of long-lasting, insecticide-treated mosquito nets and indoor residual spraying. These two measures are the major means of vector control and protection from mosquito bites.

Malaria prevention begins with vector control, prevention & preventive treatment. Click To Tweet

In Nigeria, the primary vector control method is the use of long lasting insecticide treated nets with a 97% population coverage ensuring that every pregnant woman and under-five-year-old children sleep under a mosquito net. Other supplementary vector control methods include the destruction of larvae, environmental manipulation, and sanitation, use of mosquito repellents, etc.Prevention of malaria also includes the use of prophylactic antimalarials in pregnant women who are at increased risk of developing malaria especially in its severe form; the use of preventive antimalarials is facilitated through the Antenatal Care package that includes the use of antihelminthics, nutritional counseling, and daily iron supplements.

6. Early Diagnosis and Treatment.

Since Malaria is a common illness, the average Nigerian has devised means to treat himself and his family and friends without a necessarily visiting a health care provider. Fever is almost always malaria the average Nigerian believes and over the counter medications or locally brewed medicinal concoctions will be deployed in its management. The Nigerian National Guidelines for Diagnosis and Treatment of Malaria are aligned with the WHO recommendations on universal diagnostic testing and treatment with an artemisinin-based combination therapy; in the bid to rid our world of malaria, prompt testing (rapid diagnostic tests with reagent strips or microbiological diagnosis) of patients presenting with fever or other symptoms of malaria and subsequent treatment with an artemisinin-based combination with an emphasis on completion of dosages and regimen will go a long way in reducing morbidity and mortality from malaria and also reduce the incidence of drug resistance and drug failure. This kind of standardized management trumps the illicit use of analgesics, fake or expired drugs procured from local drug sellers and concoctions used in the management of malaria.

In Pregnancy, the recommendation for treating uncomplicated malaria is quinine in the first trimester then artemisinin-based combination therapy n the second and third trimesters.

7. Community Participation, Intersectoral Collaboration and Health Systems Strengthening.

The principle that underpins good public health is the integration of community participation, facilitating intersectoral collaboration and strengthening existing health systems to deliver adequate and excellent services. It becomes clear that nothing much can be done if individuals and families in the community see no need to utilize or participate in public health programmes targeted at reducing the incidence, morbidity, and mortality of malaria; and the effectiveness of such programmes is greatly limited if different sectors involved viz-a-viz the ministries of health, agriculture, transportation, education, etc fail to work together but instead chose to work independently. Ultimately, holistic health the role of the health sector is to plan and deliver health services and mobilizing Intersectoral action, this is made possible when the activities that cut across interventions, training of health care providers, drug quality monitoring, capacity building, etc are deployed with a focus on world best practices through existing health systems and structures with holistic health-oriented policies.

We need increased political commitment for malaria prevention & control in #Africa. Click To Tweet

In conclusion, it is estimated that 40 million Disability Adjusted Life Years (DALYs) are lost annually due to malaria, however the current global trends in the incidence and morbidity /mortality of malaria is a bit reassuring. Nevertheless, the current epidemiological details also are a reminder to us especially as Africans and Nigerians of the need for scaled up investment and an increased political commitment for malaria prevention and control. On this day, with the spotlight shining on global efforts to control malaria, there is the equally important necessity to individually and as a community decide to take decisions that foster good health, promote well-being and productivity and put in place structures and policies that will help in fast tracking a malaria-free world.

Ayomipo Jeremiah Amiola is a Physician who writes from Ibadan, Nigeria. A graduate of the Obafemi Awolowo University MedicalSchool, his twin interests are Public Health and Mental Health.Passionate about Health-Care management and Leadership, he strongly believes that enduring structures that will facilitate a community-based approach to public health (fully functional and sustainable primary health care) is the solution to Nigeria’s health problems.

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