The Menace of Malaria

-Dr. Nikhita Kalra, Intern, Maulana Azad Medical College

You and your popcorn are ready for a movie night but an eager mosquito decides to flap its wings and whine in your ear. How do you feel? Irritated and impatient perhaps, not scared though! But the diseases it can transmit definitely evoke fear- dengue, malaria, chikungunya, zika, yellow fever, Japanese encephalitis among others.

Malaria is a preventable disease caused by a parasite, Plasmodium that is transmitted by the bite of an infected female Anopheles mosquito. Plasmodium has five species- P. falciparum, P. malariae, P. vivax, P. ovale, and P. knowlesi. Out of these, P.falciparum is the most dangerous and the cause of complicated malaria. In the year 2020 when the world was preoccupied with COVID-19, 241 million new cases of malaria were reported, out of which 627,000 malaria-related deaths occurred in 85 countries.[1]

World Malaria Day

World Malaria Day is celebrated on 25 April every year. This year, the theme is “Harness innovation to reduce the malaria disease burden and save lives.” WHO is encouraging novel approaches to control malaria, from methods to control the population of mosquitoes to diagnostics and medications.[1]

What’s new?

RTS, S is the world’s first malaria vaccine, and the first vaccine recommended for combatting a parasitic disease in humans. WHO has recommended its widespread use since 6 October 2021 for children below the age of five years. Before we mark this year’s World Malaria Day, more than 1 million children in Ghana, Kenya and Malawi have received at least one dose of RTS, S. This vaccine is safe and decreases the incidence of severe malaria. Newer malarial vaccines in the pipeline include R21/Matrix-M and mRNA-based vaccines by BioNTech. Some of the newer vector control methods include spatial mosquito repellents, gene-drive methods, and sugar baits for Anopheles mosquitoes. With rampant resistance to antimalarial drugs, there is an urgent requirement for newer drugs. Tafenoquine was approved by the US Food and Drugs Administration (FDA) in 2018 for prophylaxis of malaria as well as the first single-dose drug for the radical cure (prevent relapse) of acute P.vivax infection.[2]

Presentation

  • Fever with chills
  • Headache
  • Fatigue
  • Joint and muscle pain
  • Abdominal pain, nausea, and vomiting
  • Complicated malaria could cause low blood sugar, convulsions, anemia, jaundice, organ failure, and even coma.

Diagnosis and Treatment

Blood smears and rapid tests are used to diagnose malaria. The goal is to establish the diagnosis and the causative species of malaria before initiating the treatment.

There are multiple antimalarials but certain factors that determine the regimen to be used are drug resistance, patient’s condition, pregnancy, and allergies to drugs. Some of the antimalarials are chloroquine, artemisinin-based combination therapy, quinine, doxycycline, mefloquine, proguanil, and atovaquone.

Prevention at Individual Level

There’s a lot that the government does on a large scale to control mosquito-borne diseases, but the onus falls on your shoulders as well. 

  • Do not allow stagnation of water around your home, it could be the water in the cooler or in discarded bottles or tin cans.
  • Use mosquito nets and repellents.
  • Wear clothes with long sleeves to prevent mosquito bites.
  • Use medications for the prevention of malaria if you’re traveling from a non-endemic to an endemic area (chemoprophylaxis).

Malaria is responsible for great morbidity and mortality, this burden can be reduced with diligent efforts toward both prevention and management. 

References

  1. World Health Organisation. World Malaria Day 2022 [Internet]. [cited 2022 Apr 24]. Available from: https://www.who.int/campaigns/world-malaria-day/2022
  2. World Health Organisation. Over 1 million African children are protected by the first malaria vaccine [Internet]. [cited 2022 Apr 24]. Available from: https://www.who.int/news/item/21-04-2022-over-1-million-african-children-protected-by-first-malaria-vaccine
  3. Image: Endemic areas for Malaria. Centers for Disease Control and Prevention. [Internet]. [cited 2022 Apr 24]. https://www.cdc.gov/malaria/malaria_worldwide/impact.html
  4. Image: Symptoms of Malaria. International Marine Contractors Association. [Internet]. [cited 2022 Apr 24]. https://www.imca-int.com/safety-events/malaria-hasnt-gone-away/

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