MALARIA

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MALARIA

• Dr Samuel Girma, Internist
• Center for National Health Development in Ethiopia

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WHAT IS MALARIA?

• COMMUNICABLE disease caused by a parasite of
  the genus PLASMODIUM that is transmitted by a
  FEMALE ANOPHELES MOSQUITO. Its main manifestation
  is FEVER when not complicated and will have
  different manifestations when complicated.

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Etiology (Cause)

• A parasite known as plasmodium.
• Lives and feeds on red blood and liver cells.
• There are four types of plasmodium species that
  develop and proliferate in human body
• P. falciparum, P. vivax, P.ovale and P. malariae.

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Etiology, contd

• These species have different
• physical shapes,
• life cycles,
• level of severity,
• varied level of effectiveness of antimalaria
  drugs.
• Plasmodium falciparum and vivax are the dominant
  species in Ethiopia.

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Clinical presentation

• Non complicated (all four species) or complicated
  (P. falciparum)
• Non complicated
• Usually begin in the past 2-3 days
• Chills, shivering, fever, sweating
• Poor appetite, vomiting
• Severe head ache, thirst
• Back pain, pain in the joints

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Clinical presentation, contd

• Complicated (LIFE IN DANGER)
• Altered consciousness (confusion, coma,
  convulsion)
• Severe anemia
• Very small urine out put
• Fast breathing
• Low blood glucose
• Bleeding

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Factors affecting severity

• Parasite factor-P. falciparum
• Host factor-
• Endemicity,
• Pregnancy,
• HIV
• Treatment factor
• Delay, inadequate, efficacy of drug

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Vulnerable Groups

• Children under five years of age.
• Pregnant women and their unborn children.
• HIV positive people.
• Any one in low malaria transmission setting.

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Malaria Diagnosis Methods

• Clinical Sign Symptoms
• Microscopy Clinical sign symptoms
• Rapid Diagnostic Tests (RDTs) Clinical sign
  symptoms

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1.Clinical

• Malaria mimics many diseases.
• Fever in the past 48 hours travel history.
• For such patients, check danger signs.
• Ask
• Is patient unable to eat or drink?
• Has the patient had convulsions (fits)?
• Does the patient vomit repeatedly?
• How much urine did the patient pass?

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Clinical contd

• Look
• Is the patient abnormally sleepy, difficult to
  wake or confused?
• Does the patient have anemia?
• Does the patient have severe dehydration (sunken
  eye ball, dry mouth, loose skin)?
• Is the patient unable to sit or stand?
• Any of these means, the patient should be treated
  in health center or hospital

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2.Rapid Diagnostic Test

• RDTs are used to detect plasmodium specific
  antigens in a finger prick blood sample.
• There are different types of RDTs that can be
  used to detect only P. falciparum or P. f and
  other non P. f plasmodium species.

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Basic Components of the RDT
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TEST DESCRIPTION
TEST WINDOW T
BUFFER WELL B
CONTROL WINDOW C
SAMPLE WELL (BLOOD) A
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3. Microscopy
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TREATMENT

• Non complicated
• P. vivax, P. ovale, P. malariaechloroquine
• P. falciparum
• Prompt treatment saves lives
• Prompt treatment reduces the duration of disease
  and its harmful effect on the human body.
• Attention to vulnerable groups.
• Arthemeter-lumefantrene (coartem)

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Treatment contd

• Supportive treatment
• Paracetamol, fluid intake
• Health education
• What is malaria?, how is it transmitted?, is it
  preventable?, treatable?, importance of early
  treatment
• Follow up

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Treatment contd

• Complicated
• In health center or hospital.
• Quinine through the veins.
• Supportive treatment
• Health education

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Summary

• Malaria is curable and preventable disease, but
  it still kills many people.
• Reasons
• People not coming for treatment
• They dont realize they have malaria
• They dont realize malaria is dangerous
• They live far away from health institution
• People going to local medicine sellers.
• People dont protect themselves because they
  dont know how malaria is transmitted.

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The Challenge

• To avail early malaria diagnosis and prompt
  treatment to the community.
• Ethiopian strategy- health extension program.