Malaria

1. MALARIA
KARINAH M. LUTANGU
BSC NURSING LAMU

2. INTRODUCTION
• Malaria is a major public health concern in
Zambia, especially among the pregnant
women and children under the age of five
years. It is a leading cause of morbidity and
mortality in Zambia.
• It accounts for 36.7% of all OPD attendances
in Zambia, with 10% pregnant women, 49% of
under five OPD cases attributed to malaria.
(MoH 2009)

3. INTRODUCTION CONT’
• Malaria is also a major cause of admission to
health facilities in Zambia today with an
average of 62.1% of in-patient cases (MoH
2009).

4. GENERAL OBJECTIVES
• At the end of the lecture/discussion, the
students should be able to demonstrate an
understanding of malaria and be able to
manage a patient with malaria .

5. SPECIFIC OBJECTIVES
• Define malaria.
• State the causes of malaria.
• State the mode of transmission.
• State the signs and symptoms of malaria.

6. SPECIFIC OBJECTIVES CONT’
• State the treatment for malaria.
• Describe the nursing management of a patient
with malaria.
• State the complications of malaria.
• State the preventive measures of malaria.

7. DEFINITION OF TERMS
• Merozoite: The form of malaria parasite that
invades the red blood cells .
• Schizont: The mature form of the malaria
parasite within the red blood cells that
ruptures and releases the merozoites.
• Sporozoites: Infectiously actively moving form
of the malaria parasite which is injected into
the human host.

8. DEFINITION OF TERMS CONT’
• Oocyst: A stage of the parasite within the
mosquito which is produced when the male
and female gametes fuse.
• Ookinete: The actively moving zygote of the
malaria organism that penetrates the
mosquito stomach to form an oocyst under
the outer gut lining.
• Trophozoite: The ring stage.

9. DEFINITION OF TERMS CONT’
• Sporogony: is the sexual phase in the life cycle
taking place in the mosquito.

10. DEFINITION OF MALARIA
• Malaria is protozoa infection caused by a
genus plasmodium species that is transmitted
by an infected anopheles mosquito,
characterized by regular cycles of chills and
fever. (Cook C.G & Zumla A.I 2003)

11. CAUSES
• The four species of plasmodium are:
• Ovale
• Malariae
• Falciparum
• Vivax

12. MODE OF TRANSMISSION
• A bite from a blood feeding female infected
anopheles mosquito.
• Blood transfusion of infected donor blood.
• Trans-placental from mother to fetus.

13. LIFE CYCLE
HUMAN HOST
• During a blood meal, a malaria infected
female Anopheles mosquito inoculates
sporozoites into a human host.
• The sporozoites infect liver cells and mature
into schizonts.

14. LIFE CYCLE CONT’
• After 1-2 weeks the schizont rupture releasing
thousands of merozoites into the circulation.
• The merozoites penetrate RBC where they
transform into ring forms.
• These enlarge to become trophozoites.
• Some merozoites develop into male and
female gametes.

15. LIFE CYCLE CONT’
MOSQUITO
• The gametes are ingested by the mosquito.
• The male and female gametes fuse(zygote-
Oocyst in the stomach wall of the mosquito.
• Sporozoites form in the Oocyst.
• The Oocyst ruptures and the sporozoites reach
the salivary glands of the mosquito.

16. LIFE CYCLE CONT’
• At this point if the mosquito bites another
human, the sporozoites will be injected into
that person.

18. SIGNS AND SYMPTOMS
UNCOMPLICATED MALARIA
• Fever
• Headache
• Joint pains
• Sweating
• Body chills
• Acute gastroenteritis

19. SIGNS AND SYMPTOMS CONT’
MODERATELY SEVERE MALARIA
• Nausea
• Vomiting
• Diarrhoea
• Dehydration
• Extreme weakness

20. SIGNS AND SYMPTOMS CONT’
SEVERE AND COMPLICATED MALARIA
• Severe anemia
• Jaundice
• Drowsiness and lethargy
• Shock
• Respiratory distress
• Unconscious or coma
• Hepatosplenomegally

21. SIGNS AND SYMPTOMS CONT’
CHILDREN’S GENERAL SIGNS AND SYMPTOMS
• Poor appetite
• Restlessness
• Cough
• Diarrhoea
• Loss of interest in the surrounding

22. SIGNS AND SYMPTOMS CONT’
Cold stage
• It is characterized by
• shivering
• Intense feeling of cold.
• lips and fingers are cyanotic, dry and pale
• In children there may be seizures.

23. SIGNS AND SYMPTOMS CONT’
Hot stage
• Patient feels very hot
• Intense headache
• Nausea
• Vomiting

24. SIGNS AND SYMPTOMS CONT’
Sweating stage
• This stage lasts about 2-4 hours and it is
characterized by
• Profuse sweating
• Temperature falls rapidly below normal

25. INVESTIGATIONS
• medical history
• Rapid diagnostic test
• Blood slide for malaria parasite
• However malaria may be present even when
the microscopy result is negative.

26. OTHER INVESTIGATIONS
• Blood glucose estimation.
• Hemoglobin estimation.
• Lumber puncture
• Urine examination .

27. TREATMENT
• FIRST LINE OF UNCOMPICATED MALARIA
1. Artemisin
• Artemether 20mgs +Lumefantrine 120 mgs
• Children 5-14kgs – One tablet stat, then 1
tablet after 8hours then 12 hourly for 2days.

28. TREATMENT CONT’
• 35kg and above – Four tablets per dose as
above.
SIDE EFFECTS
• Dizziness
• Palpitation

29. TREATMENT CONT’
2.Sulphadoxine 500mg+ Pyrimethamine 25mg
(SP)
• This is the first line medicine for the treatment
of uncomplicated malaria in children below
5kg.
• It is also recommended for Intermittent
Presumptive treatment in pregnancy.

30. TREATMENT CONT’
• 3 tablets of Sulphadoxine + Pyrimethamine
are given after 16 weeks following LMP.
• Two more doses are given at least 4 weeks
apart during the second and third trimester.
• A total of 3 doses should be given during the
entire duration of pregnancy.

31. TREATMENT CONT’
SIDE EFFECTS
• Stevenson- Johnson Syndrome.
• Toxic Epidermal Necrosis (TEN).

32. TREATMENT CONT’
SEVERE MALARIA
1. ARTESUNATE INJ
DOSE
• 2.4mg/kg body weight IV or IM given on
admission (time=0) then at 12 Hours and 24
Hours, then once a day.
SIDE EFFECTS
• Anorexia
• Dizziness

33. TREATMENT CONT’
2. QUININE
DOSE
• By IV injection : loading dose of 20mg/kg body
weight (Max. 1200mg) diluted in 10ml/kg of
5% or 10% Dextrose ( or isotonic fluid if
hypoglycaemia is excluded) per kg body
weight by infusion over 4 hours.
• Then give a maintenance dose of 10mg/kg
over 4 hours.

34. TREATMENT CONT’
SIDE EFFECTS
• Hot and flushed skin
• Abdominal pain

35. TREATMENT CONT’
Supportive treatment include
• Analgesics – Paracetamol
• Antipyretic – Aspirin
• Multivitamins
• Haematinics – Ferrous sulphate and folic acid
• Antiemetics - Promethazine

36. NURSING MANAGEMENT
COLD STAGE
• Provide the patient with extra linen
• Offer a warm drink
• Close nearby windows
• Provide hot water bottle
• Monitor the temperature changes

37. NURSING MANAGEMENT CONT’
HOT STAGE
• Reduce the number of bed linen.
• Provide cold drink.
• Open nearby windows.
• Use a fan if possible.
• Tepid spongy the patient to reduce
temperature.
• Administer the prescribed antipyretic.

38. NURSING MANAGEMENT CONT’
SWEATING STAGE
• Provide a towel to wipe the sweat.
• Give a bath to promote comfort.
• Provide hydrotherapy.
• Change bed linen to promote comfort.

39. NURSING MANAGEMENT CONT’
ENVIRONMENT
• This should suit the condition of the patient.
• Admit patient in acute bay if condition is
serious for easy observations.
• The environment must be conducive for
temperature regulation.

40. NURSING MANAGEMENT CONT’
• The environment must also be equipped with
the necessary instruments and medical
equipment such as suction machine and
emergency trolley.

41. NURSING MANAGEMENT CONT’
OBSEVATIONS
• Record vital signs 4hourly.
• Monitor fluid intake and output .
• Note the pallor, Jaundice and any other
complaint that the patient may present such
as headache.

42. NURSING MANAGEMENT CONT’
NUTRITION
• Give the patient carbohydrates for
replenishing blood glucose levels.
• Proteins for repair of body tissues.
• Give foods rich in iron to promote
erythropoiesis.
•

43. NURSING MANAGEMENT CONT’
• Maintenance of skin and mucous membrane
integrity.
• The meals must be well prepared and served
attractively to promote appetite.

44. NURSING MANAGEMENT CONT’
HYGIENE
• Change the linen frequently to prevent
pressure ulcers.
• Oral care is done to prevent oral complications
and promote appetite by stimulating the taste
buds.
• Bath the patient, bed bath or plunge bath
depending on the patient’s condition.

45. NURSING MANAGEMENT CONT’
PSYCHOLOGICAL CARE
• Explain the disease process to the patient and the
care taker to allay anxiety.
• Involve the patient and the care taker in the care.
• Allow patient and the care taker to ventilate their
concerns and attend to them appropriately.
• Explain all the procedures carried out to the
patient and care taker.

46. NURSING MANAGEMENT CONT’
REST AND ACTIVITY
• Promote adequate rest by avoiding noise on
the ward to avoid irritating the patient
• Introduce exercises slowly as the patient
recovers from passive to active exercises, this
promotes early ambulation, patient self-
esteem in performing activities of daily living
and prevent bed redden complications like
bed sores or hypostatic pneumonia

47. NURSING MANAGEMENT CONT’
ELIMINATION
• The patient is at risk of renal failure, therefore
provide fluids to promote urination
• Provide a diet rich in fiber/roughage to
prevent constipation
• Offer a urinal or bedpan if patient is not
ambulant
• The patient may also need catheterization if
unconscious.

48. NURSING DIAGNOSES
• Hyperthermia related to the disease
characterized by a body temperature of more
than 37.5 degrees Celsius.
• Risk for fluid volume deficit related to active
fluid out put
• Risk for imbalanced body temperature related
to the disease.

49. NURSING DIAGNOSES CONT’
• Hypothermia related to the disease
characterized by having chills evidenced by a
body temperature below 36.5 degrees Celsius.
• Impaired circulation related to Anemia and
destruction of red blood cells needed for
delivery of oxygen and nutrients in the body.

50. COMLICATIONS
• Anemia
• Cerebral malaria
• Cerebral haemorrhage
• Hypotension
• Splenomegaly
• Algid malaria

51. PREVENTIVE MEASURES
• Long lasting insect side treated nets (ITNs).
• Intermittent presumptive treatment) in
pregnant women. (IPT)
• Indoor residual spray IDR.
• Cutting long grass
• Burying stagnant water
• Closing windows early.
• Wearing long sleeved clothes in the evening.

52. SUMMARY
• We have defined Malaria; we have looked at the
causes, the mode of transmission, the life cycle of
malaria, the signs and symptoms, the high risk
groups, and the investigations that are done to
confirm the diagnosis.
• We have also looked at the treatment, the
nursing management and nursing diagnoses of
malaria. We further looked at the complications
and preventive measures of malaria.
•

53. REFERENCES
• Cook G C & Zumla A.I (2003), Tropical
Diseases, 22nd edition, Elsevier ltd.
• Frazer M. D & Cooper M. A (2012) Myles
textbook for midwives, 14th edition.
• MoH, (2014), Guideline for the Treatment of
malaria In Zambia, Lusaka, Zambia.