Malaria by Dr Sanaa Ibnouf

Objectives
Description of malaria(infectious agent , case
definition ,mode of transmission, Incubation
period,… etc.
Discuss the epidemiology of malaria in the world.
Discuss the epidemiology of malaria in KSA.
Discuss prevention and control measures .
06/29/18
Prepared by Dr. Sana Abnawf
MD community medicine 2

Introduction
Malaria is a life threatening infection.
And serious public health problem in many parts of
the world.
Communities with high prevalence, have many
chronically ill members, resulting in absenteeism
from work and school.
Although malaria can be a deadly disease, illness and
death from malaria can usually be prevented.
06/29/18

Introduction
• In endemic areas malaria is:
A serious risk to pregnant women .
is responsible for under-weight infants ,and
anemia in the mother .
• In travellers :
 Young children, pregnant women, people who are
immunosuppressed and elderly travellers are
particularly at risk of severe disease.
 Malaria, particularly P. falciparum, in non-immune
pregnant travellers increases the risk of maternal death,
miscarriage, stillbirth and neonatal death.
06/29/18

History of malaria
Malaria word comes from two Italian words(mal and
aria) which means “bad air” .
Malaria or a disease resembling malaria has been
noted for more than 4,000 years.
The symptoms of malaria were described in ancient
Chinese medical writings in 2700 BC.
06/29/18

Discovery of the Malaria Parasite
(1880)
Charles Laveran, a French
army surgeon
Notice parasites in the blood
in 1880.
Was awarded the Nobel Prize
in 1907.
06/29/18

Discovery That Mosquitoes Transmit
Malaria Parasites (1897-1898)
Ronald Ross, a British officer
in the Indian Medical
Service.
Demonstrate that malaria
parasites could be
transmitted from infected
patients to mosquitoes.
Ross was awarded the Nobel
Prize in 1902.
06/29/18

Infectious agent
Malaria in humans is caused by protozoan parasites of
the genus Plasmodium:
( Plasmodium falciparum, P. vivax, P. ovale, or P. malariae).
In addition, P. knowlesi, a parasite of monkeys, has
been documented as a cause of human infections and
some deaths in Southeast Asia.
P. falciparum is responsible for the severe and
complicated cases.
06/29/18

Infectious agent
In KSA:
From total malaria cases :-
P . falciparum was represented 38.80%.
P. vivax 60.80%.
P. ovale 0.20% .
And Plasmodium malariae 0.20%.
06/29/18

Case Definition
Clinical case :
o Uncomplicated malaria :A patient with fever or
history of fever within the past 48 hours (with
or without other symptoms
o Severe malaria: A patient with symptoms as for
uncomplicated malaria, plus drowsiness with
extreme weakness and associated signs and
symptoms related to organ failure.
Confirmed case:
oDemonstration of malaria parasites in blood film .
06/29/18

Mode of transmission
It is Vector-borne disease , all species are transmitted
by the bite of an infective female Anopheles mosquito.
Occasionally, transmission may occurs by:
 blood transfusion.
 organ transplantation.
 needle sharing.
 or congenitally from mother to fetus.
06/29/18

Incubation Period
 The incubation period is approximately 7 days or
longer.
(Thus, a febrile illness developing less than 1 week
after the first possible exposure is not malaria).
 P. vivax and P. ovale can remain dormant in the liver.
(Relapses caused by these persistent liver forms
(“hypnozoites”) may appear months, and rarely several
years ).
06/29/18

Period of communicability
Communicability is related to:-
The presence of infective Anopheles mosquitoes .
And of infective gametocytes in the blood of patients.
(Untreated or insufficiently treated patients may
be a source of mosquito infection for more than
3 years in P. malariae malaria, 1–2 years in P. vivax
malaria and usually no longer than 1 year in P.
Falcipar/malaria).
06/29/18

Epidemiology in the world
About 3.2 billion people – almost half of the world’s
population mainly in the tropical and subtropical
areas is at risk of malaria .
With 149 – 303 millions of acute infections.
And 236000 – 635000 deaths annually.
Many cases of Malaria are in children under 5.
(Every 30 seconds a child dies from Malaria).
06/29/18

Malaria occurs mostly in poor tropical and
subtropical areas of the world.
In many of the countries affected by malaria, it is a
leading cause of illness and death.
The costs of malaria – to individuals, families,
communities, nations – are enormous.
06/29/18

In many malaria-endemic countries, malaria
transmission does not occur in all parts of the
country:-
 At very high altitudes.
 During colder seasons in some areas.
 In deserts (excluding the oases).
 Where transmission has been interrupted through
successful control/elimination programs.
06/29/18

This map shows an approximation of the parts of the
world where malaria transmission occurs
06/29/18

Epidemiology in KSA
In Saudi Arabia, there were 2305 reported malaria
cases in year 2014.
only 51 cases were locally acquired ,and they were all
Plasmodium falciparum infection.
All of locally acquired cases were from the southwest
regions (Jazan & Asser).
while the imported cases were mainly from Yemen,
India and Sudan.
06/29/18 Prepared by Dr. Sana Abnawf
MD community medicine
18

Epidemiology in KSA
Areas with Malaria:
Rare cases in Asir and Jazan emirates by border
with Yemen.
None cases in the cities of Jeddah, Mecca,
Medina, Riyadh, and Ta’if.
06/29/18

06/29/18

Prevention and control measures
A- Case management:
Once Malaria diagnosed, appropriate antimalarial
treatment should be started immediately guided by:
 Type of plasmodium species .
 Clinical status of patient: Uncomplicated or Severe, or
pregnancy.
 Drug sensitivity of the infected parasite: area where
parasite acquired.
 previous exposure to anti-malarials.
06/29/18

B- Prevention and control:
Malaria prevention consists of a combination of
mosquito avoidance measures and chemoprophylaxis
1- Chemoprophylaxis:
All recommended primary chemoprophylaxis
regimens involve taking a medicine before, during,
and after travel to an area with malaria.
It is not recommended on a population wide basis
because can accelerate the development of drug
resistance.
06/29/18

2-Mosquito Avoidance Measures:
Contact with mosquitoes can be reduced by:-
Using mosquito bed nets (preferably
insecticide-treated nets).
Using an effective insecticide spray in living
and sleeping areas .
And wearing clothes that cover most of the
body.
All travelers should use an effective mosquito
repellent.
06/29/18 Prepared by Dr. Sana Abnawf
MD community medicine
23

B- Prevention and Control :
3-Intermittent presumptive treatment (IPT)
•At least twice during pregnancy (2nd and 3rd
trimester)
•Advisable for pregnant women living in areas
where transmission is high.
06/29/18

B- Prevention and Control :
4- Vigorous health education :at community level to
improve rapid treatment-seeking behavior for fever
cases particularly during the transmission season.
5-Fight the vectors: by using proper insecticides
and others control measures.
06/29/18

References
Preventive and social medicine- k . PARK.
Epidemiology Leon Gordis .
https://wwwn.cdc.gov/malaria.
http://www.who.int/malaria
https://www.moh.gov.sa.
06/29/18

Malaria by Dr Sanaa Ibnouf

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