1. Management of malaria cases in the
2. Active intervention to control/interrupt
malaria transmission with community
Should be given first priority.
Healthy guides and multipurpose workers are
fully trained to detect and treat malaria cases at
community level with support from referral
Govt have also established drug distribution
centres and fever depot all over the country.
National Drug Policy on Malaria was first formulated
in 1982 and has subsequently been reviewed and
Emphasis on complete treatment in diagnosed
cases of malaria rather then one single dose
presumptive treatment to suspect the case of
malaria to avoid choloroquine resistance in
The first line of treatment is choloroquine
Providing complete cure (clinical and
parasitological) of malaria cases
Prevention of progression of uncomplicated
malaria into severe malaria and thereby
reduce malaria mortality.
Prevention of relapses by administration of
Interruption of transmission of malaria by use
of gametocytocidal drugs
Preventing development of drug resistance
by rational treatment of malaria cases.
Avoid starting Rx on empty stomach.,
1st dose given under observation.,
Dose repeated if vomiting within 30 minutes
Patient should report back if no improvement
after 48 hrs.
Patient should be examined for concomitant
All fever cases suspected to be malaria
should be investigated by microscopy or RDT
All mixed infections should be treated with
full course of ACT and Primaquine 0.25 mg
per kg body weight daily for 14 days
P.vivax cases should be treated with chloroquine
for three days and Primaquine for 14 days
Chloroquine: 25 mg/kg body weight divided over
three days i.e. 10mg/kg on day 1, 10mg/kg on
day 2 and 5mg/kg on day 3.
2. Primaquine: 0.25 mg/kg body weight daily for
Primaquine is used to prevent relapse.
Contraindicated in pregnant women, infants
and individuals with G6PD deficiency
Patients should be instructed to report back
in case of haematuria or high colored urine
/cyanosis or blue coloration of lips and
Primaquine should be stopped in such cases.
Care should be taken in patients with
Chloroquine first drug of choice
If chloroquine resistant, then Artesunate combined
ACT consists of Artesunate combined with a long
acting antimalarial like sulfadoxine and
Artesunate 4 mg/kg body weight daily for 3 days
Sulfadoxine (25 mg/kg body weight) – Pyrimethamine
(1.25 mg/kg body weight) on first day
Primaquine 0.75 mg/Kg body weight on Day 2
Patient resistant to ACT-quinine is drug of
Choice of antimalarial is quinine injection
10mg/kg body wt.
I.V drip in 5% dextrose saline to be runover 4hrs
Total duration of treatment is of 7 days
Injectable form of artemisinine derivatives
may be used for the management of the
sever complicated malaria in adult and non-
pregnant women only
IM or IV followed by 1.2mg/kg bw once daily for 4
Total duration is 5 days
IM followed by 1.6mg/kg bw daily for total 6
injection or twice for 3 days
150mg daily IM for 3 days
Only for adult
10mg/kg bw at 0 and 4 hours followed by 7mg/kg bw
at 24,36,48 and 60 hours
Choloroquine has few side effects like nausea, vomiting,
blurring of vision and headache.
Cases of retinal damage has been reported but only in a
person exposed to large cumulative dose over many years
Choloroquine should not given to empty stomach.
Symptoms may be of three types
Rare toxic manifestation involving the CNS
Cramps,nausea and vomiting
Most serious toxic menifestation
It is recommended for highly infected endemic
It is not recommended to children under 5 :
Impossible to achieve continuous suppression in a
significant proportion of the population
Interfere in the development of promotive immunity
May accelerate devlopment of drugs resistance
May increase the risk of retinopathy
Chemoprophylaxis should be administered only in selective
groups in high P.falciparum endemic areas.
This is recommended for travelers to endemic
areas,soldiers,police and labour forces working in endemic
Recommendations for dosing are:-
1)dose for children should be based on body weight
2)daily anti malarials should started the day before
3)weekly chloroquine started 1 week before arrival
Doxycycline: 100 mg once daily for adults
and 1.5 mg/kg once daily for children
(contraindicated in children below 8 years).
The drug should be started 2 days before
travel and continued for 4 weeks after
leaving the malarious area.
Mefloquine: 250 mg weekly for adults and
should be administered two weeks
before, during and four weeks after
Mefloquine is contraindicated in individuals
with history of convulsions, neuropsychiatric
problems and cardiac conditions.
Therefore, necessary precautions should be
taken and all should undergo screening
before prescription of the drug
1. Stratification of problem
Essential feature for planning and development
of a sound control strategy to maximise
utilization of available resources.
Provide guidelines as to which strategy could
be most suited.
Action For individual and
Reduction of human-
Destruction of adult
Larviciding of water
Source reduction Small scale drainage Environmental
Social participation Motivation for personal
and family protection
2. Vector control strategy
Spraying indoor surface of house with
Discontinuation lead to resurgence of malaria.
Reduces the longevity of vector.
Major anti-epidemic measure
Involves application of pestisidesin the form of fug
or mist using special equipments
Man-vector contact can be reduced by
Using nets, protecting cloth, coils,
repellents,screening of houses.
Oiling the collection of standing water or dusting them
with paris green effectively controlled malaria.
Some moderm larvicides such as temephos which
confer long effect with low toxicity are more widely
Techniques to reduce mosquito breeding sites drainage or
Deepening or flushing
Management of water level
Changing the salt content of water
In order to reduce too much dependence
residual insecticides, increasing emphasis is
being put on integrated vector control
methodology which includes bio-environmental
and personal protection measure
The Govt of every country affected by malaria has a
National control policy covering prevention and case
Ensure rapid cure of infection
Reduce morbidity and mortality, including malarial
Prevent the progression of uncomplicated malaria into
Reduce the impact of malarial infection on the fetus
Reduce the reservoir infection
Prevent the emergence and spreading of drug resistance
and prevent malaria in travellers
Malaria control added impetus as initiative was
launched by WHO,UNICEF,UNDP and world bank
in 1998 .
Aim:-to reduce the Deaths and incidence To 75% by
Vaccination against malaria is a burning issue
Several vaccine candidates are now being
tested in africa, asia and US
A vaccine developed in columbia (SPF 66)
advanced to phase 3 trials in africa but failed
to show efficacy in chiildren under 1
Another vaccine (RTS, S/AS02) with the
potential to prevent infection and ameliorate
disease is being tested by GlaxoSmithKline
and the MVI at PATH in Phase I trial in
In phase II in 2002 trials of the vaccine are
being conducted among the children in
Mozambique, which suffers from year-round
malaria transmission offering a better
opportunity to evaluate vaccine performance
This vaccine has been safely tested in adult
volunteeers in Belgium, Gambia, kenya and
only potential malarial vaccine