WORLD MALARIADAY(25th April, 2013)Md. Kabiul Akhter AliVBD ConsultantMalda
World Malaria Day - April 25 Malaria remains a killer disease with nearly1 million people losing their lives everyyear. Eighty five per cent of deaths arechildren under 5 years of age. Most malaria cases occur in Africa but itnevertheless remains a global problemalso affecting countries in large parts ofAsia and Latin America.
Importance ofWorld Malaria Day World Malaria Day was established in May 2007by the 60th session of the World HealthAssembly, the decision-making body of theWorld Health Organization (WHO). The day wasestablished to provide education andunderstanding of malaria and disseminateinformation on malaria-control strategies,including community-based activities for malariaprevention and treatment in endemic areas.
Past World Malaria Day Themes•2008: Malaria – a disease without borders•2009: Counting malaria out•2010: Counting malaria out•2011: Achieving progress and impact•2012: Sustain Gains,Save Lives: Invest inMalaria
INVEST IN THE FUTURE :DEFEAT MALARIAWorld Malaria Day Theme, 2013
Malaria – Early History The symptoms ofmalaria weredescribed in ancientChinese medicalwritings. In 2700 BC,several characteristicsymptoms of whatwould later be namedmalaria weredescribed in the NeiChing,
Hippocrates and Malaria Hippocrates, aphysician born inancient Greece, todayregarded as the"Father of Medicine",was the first todescribe themanifestations of thedisease, and relatethem to the time ofyear and to where thepatients lived.
Malaria Name is derived from ItalianMal’ aria or bad airMalaria continues to be most importantcause of fever and morbidity in theTropical worldMalaria has been eradicated from Europe,Most of North America, USA SouthAmerica Korea and Japan,
Why it is important in Medicine Malaria remains the worlds mostdevastating human parasiticinfection. Malaria affects over 40%of the worlds population. WHO,estimates that there are 350 - 500million cases of malaria worldwide,of which 270 - 400 million areFalciparum malaria, the most severeform of the disease.
Malaria Kills more people thanAIDS Malaria kills in one year what AIDSkills in 15 years. For every death dueto HIV/AIDS there are about 50deaths due to malaria. To add to theproblem is the increasing drugresistance to the established drug.
History – Events on Malaria 1880 - Charles Louis Alphose Laverndiscovered malarial parasite in wet mount 1883 - Methylene blue stain - Marchafava 1891 - Polychrome stain- Romanowsky 1898 - Roland Ross - Life cycle of parasitetransmission, wins Nobel Prize in 1902 1948 - Site of Exoerythrocytic development inLiver by Shortt and Garnham
Major Developments in 20thCentury 1955 - WHO starts world wide malariaeradication programme using DDT 1970 – Mosquitos develop resistance toDDT Programme fails 1976 – Trager and Jensen in vitrocultivation of parasite
Charles Louis AlphonseLaveran, Charles Louis AlphonseLaveran, a French armysurgeon stationed inConstantine, Algeria, wasthe first to noticeparasites in the bloodof a patient sufferingfrom malaria. Thisoccurred on the 6th ofNovember 1880. For hisdiscovery, Laveran wasawarded the NobelPrize in 1907.
Ronald Ross In August 20th, 1897,Ronald Ross, a Britishofficer in the IndianMedical Service, was thefirst to demonstrate thatmalaria parasites couldbe transmitted frominfected patients tomosquitoes For hisdiscovery, Ross wasawarded the NobelPrize in 1902.
Nobel Prizes in Malaria The discovery of thisparasite in mosquitoesearned the Britishscientist Ronald Ross theNobel Prize in Physiologyor Medicine in 1902. In1907, Alphonse Lavernreceived the Nobel prizefor his findings that theparasite was present inhuman blood.
Parasites Cause of Malaria Malaria is caused by an infection byone of four single celled Plasmodiaspecies, they are: falciparum,vivax, malariae, and ovale. Themost dangerous ofthe four is:P.falciparum
Newer species of Mosquito A fifth species,Plasmodiumknowlesi, causesmalaria in humans.
Malaria A Major Healthproblem of Tropical countries
Pernicious Malaria Is a life threatening complication in acutefalciparum malaria It is due to heavy parasitization Manifest with1 Cerebral malaria – it presents withhyperpyrexia, coma and paralysis. Brain iscongested2 Algid malaria – presents with clammy skinleading to peripheral circulatory failure.
Complication in Malaria Pulmonary edema (fluid buildup in thelungs) or acute respiratory distresssyndrome (ARDS), which may occur evenafter the parasite counts have decreasedin response to treatment Abnormalities in blood coagulation andthrombocytopenia (decrease in bloodplatelets) Cardiovascular collapse and shock
Black water Fever It is a manifestation of infection withP.falciparum occuring in persons who have beenpreviously infected and have had beeninadequate dose of quinine It is characterized by intravascular hemolysisfever, and Haemoglobunuria Cardiovascular collapse and shock Abnormalities in blood coagulation andthrombocytopenia (decrease in blood platelets)
Other Complications In Malaria Acute kidney failure Hyperparasitemia, where more than 5% ofthe red blood cells are infected by malariaparasites Metabolic acidosis (excessive acidity in theblood and tissue fluids), often inassociation with hypoglycemia
World Health OrganizationRecommends In endemic areas, the World HealthOrganization recommends that treatmentbe started within 24 hours after the firstsymptoms appear. Treatment of patientswith uncomplicated malaria can beconducted on an ambulatory basis(without hospitalization) but patients withsevere malaria should be hospitalized ifpossible. Doctortvrao’s ‘e’ learning series
What is PresumptiveTreatment? Presumption - In an area with high transmission ofmalaria, it should be presumed that ALL cases of feverare due to malaria. Treatment - First loading dose of Chloroquine shouldbe administered immediately after collecting the bloodspecimen, even without waiting for its report. If the fever is indeed malaria, this treatment alleviatessymptoms early, may be well before the test result isavailable. If it is malaria, Chloroquine also prevents the spread ofmalaria by destroying the gametocytes of P. vivax (themore common malaria). If it is not malaria, nothing is lost, for Chloroquine at thisdose is safe and has no adverse effects!
Radical treatment Radical treatment is administration of Primaquinto all confirmed cases of malaria. In P. vivax malaria, 2 weeks therapy withPrimaquin completely cures the infection in thehost by its tissue schizonticidal activity andthereby prevents relapses. In P. falciparum malaria, a single dose ofprimaquine destroys the gametocytes, therebyprevents the spread of the infection into themosquito.
Use of PrimaquinePrimaquine is active against the dormantparasite liver forms (hypnozoites) andprevents relapses. Primaquine should notbe taken by pregnant women or by peoplewho are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patientsshould not take primaquine until ascreening test has excluded G6PDdeficiency.
Reports of ChloroquineResistance in P.vivax198919901995199519911995
Future Ambitions The malaria vaccine community aims tolicense—by 2015—a first-generation vaccine thathas 50 percent efficacy against severe diseaseand death, with protection lasting at least oneyear without the need for boosting. They alsoaim to license—by 2025—a second-generationmalaria vaccine that has a protective efficacy ofat least 80 percent against clinical disease andwith protection lasting for many years without abooster.
Goals to achieve : Control Malaria Sustaining malaria control efforts is an investment indevelopment. Continued investment in malaria control now willpropel malaria-endemic countries along the path to achievingthe 2015 Millennium Development Goals, especially thoserelating to improving child survival and maternal health,eradicating extreme poverty and expanding access toeducation. Just by scaling up efforts to prevent malaria, including universalcoverage of mosquito nets, WHO estimates that three millionAfrican children can be saved by 2015, while many more livescan be saved through a combination of proven and innovativemalaria control tools including access to effective prevention,accurate diagnosis and prompt, reliable anti-malaria treatment Successful malaria control has a dramatic impact on the health,productivity and well-being of people living in malaria riskareas.