Depertment of Public Health North South University
Malaria is a mosquito-borne infectious disease. Four species of protozoan parasite of the genus Plasmodium that are relevant for human infection: 1. P. falciparum 2. P. vivax 3. P. ovale 4. P. malariae P. vivax is the most widespread malaria infection in the world.P. falciparum causes the most severe malaria disease in the world and is responsible for the most deaths and morbidity.
The parasite undergoes several transformations with both the human host (intermediate) and mosquito host (definitive) Transmitted to humans as sporozoites from the saliva of an infected female mosquito Sporozoites enter the venous blood system from the subcutaneous tissues by way of the capillary bed and can invade liver cells within minutes if they successfully evade the reticuloendothelial defenses Over the next 5 to 15 days, each sporozoite nucleus replicates thousands of times within the liver cells to form a hepatic schizont within the liver cells When released from the swollen liver cells, each schizont splits into tens of thousands of daughter parasites called merozoites Merozoites attach to specific erythrocyte receptors and enter the erythrocyte Each intraerythrocytic meroziote differentiates into a trophozoite that ingests hemoglobin, enlarges, and then divides into 6 to 24 intraerythrocytic merozoites forming a schizont The red cell swells and bursts, which releases the next batch of approximately 20 merozoites Theses new merozoites then attach and penetrate new erythrocytes to begin the cycle again
1. The release of merozoites into the bloodstream 2. Anemia resulting from the destruction of the red blood cells 3. Large amounts of free hemoglobin being released into circulation after red blood cells break open
African countries south of the Sahara desert The Indian subcontinent Solomon islands, Papua New Guinea and Haiti People at increased risk of serious disease include: Young children and infants Travelers coming from areas with no malaria Pregnant women and their unborn children
In order to make a malaria diagnosis, the healthcare provider may ask a number of questions concerning: 1.Current symptoms 2.Medical conditions 3.Family medical history 4.Current medications 5.Recent travel history. A malaria diagnosis can be difficult to make, especially in areas where malaria is not very common. A number of other conditions share similar symptoms with malaria. Some of these conditions the healthcare provider will consider before diagnosing malaria include: The flu (influenza) Common cold Meningitis Typhoid fever Dengue fever Acute schistosomiasis (disease caused by worms) Bacteremia/septicemia (infection in blood) Hepatitis Viral gastroenteritis (stomach flu) Yellow fever(disease typically transmitted by mosquitoes).
The doctor may suspect malaria based on the patients symptoms, and the physical findings at examination; however, to make a definitive diagnosis of malaria, laboratory tests must demonstrate the malaria parasites, or their components. The best test available to diagnose malaria is called a blood smear. In this test, malaria parasites can be identified by examining a drop of the patients blood under the microscope, spread out as a "blood smear" on a microscope slide. Prior to examination, the specimen (blood) is stained to give to the parasites a distinctive appearance.
Malaria can be fatal, particularly the variety thats common in tropical parts of Africa. The Centers for Disease Control and Prevention estimate that 90 percent of all malaria deaths occur in Africa — most commonly in children under the age of 5. In most cases, malaria deaths are related to one or more of these serious complications: Cerebral malaria. If parasite-filled blood cells block small blood vessels to your brain (cerebral malaria), swelling of your brain or brain damage may occur. Breathing problems. Accumulated fluid in your lungs (pulmonary edema) can make it difficult to breathe. Organ failure. Malaria can cause your kidneys or liver to fail, or your spleen to rupture. Any of these conditions can be life-threatening. Severe anemia. Malaria damages red blood cells, which can result in severe anemia. Low blood sugar. Severe forms of malaria itself can cause low blood sugar, as can quinine — one of the most common medications used to combat malaria. Very low blood sugar can result in coma or death. Recurrence may occur Some varieties of the malaria parasite, which typically cause milder forms of the disease, can persist for years and cause relapses.
Malaria has been a major public health problem in Bangladesh. Approximately 33.6% of the total population are at risk of malaria Majority of malaria cases are reported from 13 out of the total 64 districts in the country. About 4 million populations living in 34 upazillas of eight of the thirteen districts live in the epidemic-prone border areas Focal outbreaks occur every year, and the response to control the epidemic is inadequate.
Inadequate access to treatment and diagnostic facilities especially in the remote areas Inadequate programme management capacity at various level and management of severe malaria in hospitals Poor coverage of prevention and control methods (IRS, ITN/LLIN coverage still low) in the community Referral system is weak and pre-referral treatment provisions are limited; Optimum treatment of cases of severe malaria in different categories of hospitals are inadequate Cross-border malaria at the Bangladesh India and Ban- Myanmar border
WHO World Bank Global fund BRAC and 14 member NGO Consortium 4 Local NGOs inChittagong Hill Tract(CHT)
Preventing malaria - four steps There is an ABCD for prevention of malaria. This is: Awareness of risk of malaria. Bite prevention. Chemoprophylaxis (taking antimalarial medication exactly as prescribed). Prompt Diagnosis and treatment.
The types of drugs and the length of treatment will vary, depending on: Which type of malaria parasite you have The severity of your symptoms Your age Whether youre pregnant
Pregnant women are at particular risk of severe malaria and should, ideally, not go to malaria-risk areas. Non-pregnant women taking mefloquine should avoid becoming pregnant. If you have epilepsy, kidney failure, some forms of mental illness, and some other uncommon illnesses, you may have a restricted choice of antimalarial medication. Travellers going to remote places far from medical facilities sometimes take emergency medication with them.