Malaria |ICDS Supervisor Kerala Study Materials
Malaria has been in the limelight ever since about 90 years ago when Sir Ronald Ross showed how it was transmitted.
Malaria is an infectious disease caused by the presence of a parasitic protozoa of the genus plasmodium within the red blood cells.
The disease is transmitted by a type of female mosquito called Anopheles.
The disease is mainly confined to tropical and subtropical areas.
What Causes Malaria?
The disease is caused by the plasmodium parasite and is
transmitted by the anopheles mosquito.
How Does Malaria Spread?
Malaria is transmitted by the bites of certain species of infected female anopheles mosquitoes.
In India, the mosquito vectors of importance are Anopheles culicifacies and Anopheles fluviatilis.
Anopheles stephensi is considered an important vector (carrier of infective agent from one
host to another) of malaria in the urban areas.
These female anopheles mosquitoes ingest human blood containing malarial parasites.
The male and female unite in the stomach of the mosquito and multiply and then invade
the salivary glands.
When the mosquito bites the man and takes blood meals the parasites are injected into the blood stream and migrate to the liver and other organs where they multiply. (In the liver the parasites penetrate into a liver cell and after considerable development the original single infective form sub-divides into as many as several thousands of new individual forms). The liver cell ruptures liberating the new individuals into the blood stream.
Some of these enter cells and undergo a process of multiplication and development.
Rapid multiplication of the parasite results in destruction of the red cell and the new forms are free in the blood stream and enter fresh red cells.
Red cell destruction results in anaemia and at this stage of the life cycle of parasite the patient experiences periodic bouts of shivering, fever and sweating.
From this stage, sexual forms (gametocytes) of the parasite develop which on ingestion
in a blood feed by an anopheles mosquito to carry on the life cycle of the parasite in that insect.
In the susceptible individuals, after undergoing cycle, parasites usually appear in blood within 3 to 14 days after onset of symptoms.
Malaria is also transmitted by blood transfusion.
Symptoms and Complications of Malaria
Malaria is characterised clinically by 3 stages:
Cold Stage: The patient will have fever of sudden onset with rigor (shaking chills) and a feeling of extreme cold which is accompanied by shivering.
Hot Stage: The patient complains of sensation of burning and tries to take off all the clothes on him. The patient will have splitting headache.
Sweating Stage: The fever subsides accompanied by profuse sweating.
After an interval free of fever, the cycle of chills followed by fever and sweating is repeated either daily, alternate day or every third day.
If untreated, the primary attack may last from a week to more than a month. Relapses occur at irregular intervals for several years.
Enlargement of spleen is common in areas where malaria is persistent.
The patients may also have anaemia (reduction of haemoglobin in blood).
4 types of malaria
Actually there are 4 types of malaria. They are quite similar in their symptoms and often it is difficult to differentiate them without laboratory studies.
The most serious is malignant tertian malaria or falciparum malaria.
Apart from the symptoms mentioned above, it can affect central nervous system leading to loss of orientation, delirium and may even lead to coma.
The other human malaria—benign tertian or vivas, quartan and ovale—are not dangerous as to lead to death, except perhaps in very young children.
Complications of Malaria
Cerebral malaria is an extremely dangerous complication of falciparum malaria The patients may have convulsions (fits) and end up in coma.
Fatality is very high in such cases.
Diarrhoea and malnutrition are also considered to be common complications of malaria.
Chronic anaemia also is common in children with malaria.
Prevention/Control of Malaria
Prevention and control of malaria mainly depend on—
(a) control of mosquitos through spraying of insecticides like DDT or malathion
(b) active and passive surveillance of the areas where annual parasite incidence is more than 2 and
(c) presumptive and radical treatment of cases of malaria.
Spraying of Pesticides: The spraying of insecticides like DDT or malathion is done twice or thrice in an year wherever the annual parasite incidence (number of confirmed cases of malaria during one year per 1000 population) is more than 2.
Active Surveillance: Under active surveillance one health worker will visit each house in his area, consisting of 1000 households, once every fortnight.
He will enquire whether anyone in the house had fever during the previous fortnight or at the time of the visit.
In both the instances, blood film is collected. He then distributes a single dose of four tablets of chloroquin (drug used for malaria treatment). This is known as presumptive treatment.
Radical Treatment: If the blood film is positive, appropriate radical treatment is given. This consists of giving chloroquin along with primquin to kill the parasite. In addition to the above measures other methods of prevention/control include :
Protection against mosquitos: Protection against mosquitoes can be done by adopting the following four measures:
To do away with the conditions which render possible the breeding of mosquitoes.
To destroy mosquitoes at some period of their life. This can be done by spraying DDT or
spraying kerosene oil, diesel or fuel oil on the surface of stagnant water (this suffocates the
larvae, as they cannot breathe) or by introducing larvicid al fish into poo ls of water where
mosquitoes breed.
To prevent the mosquito from biting the man. In endemic areas, the person must be advised to sleep under mosquito nets to prevent mosquito bites. Insect repellents (such as odomos) which are applied to the skin may also help.
To attack the parasite as it circulates in the blood o f man . Anti-malarial drugs (chloroquin ,
pyrimethamine) can be used for the purpose.
Environmental Sanitation: Improvement of environmental sanitation through filling of drains
and stagnant pools is one of the permanent ways of reducing mosquito breeding. In the rural areas, the household drain water should be let into soak pits instead of letting out into open drains.
Malaria Important points
Malaria is caused by a parasite of the genus plasmodium i.e., Plasmodium vivax, P. Malariae, P. Falciparum, P. Ovale.
The parasite is transmitted by bites of certain species of infected female anopheles mosquito.
Malaria is characterised by the cycle of chills followed by fever and sweating repeated either daily, alternate day or every third day.
The incubation period is around 10 days.
Prevention and control mainly depend on the control of mosquitos and environmental sanitation.
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