Malaria is a protozoan disease transmitted through mosquito bites and characterized by periodic fevers. It is caused by Plasmodium parasites and affects half the world's population, killing over 2 million people annually, mostly young children in Africa. Symptoms include shaking chills, fever and sweating. Prevention focuses on avoiding mosquito bites through clothing, nets and repellents while treatment requires rapid diagnosis and antimalarial drugs to eliminate the infection.

1. Malaria

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INTRODUCTION
A protozoan disease caused by Plasmodium species of the phylum Apicomplexa.
Transmitted by the bite of infected female anophese mosquitoes.
It is characterized by periodic paroxysm with shaking chills, high fever, heavy sweating.
Anemia and splenomegaly may also occur in cases.
Malaria is an ancient scourge of humanity. Although almost eradicated from the
industrialized nations, malaria continues to extract a heavy toll of life and health in a
substantial part of the world. Almost half the world's population lives in countries where the
disease is endemic, and almost every country in the world encounters malaria. Malaria is
the number one cause of morbidity in the countries of Africa and one of the major
contributors to childhood deaths and the leading cause of mortality in the vulnerable group
(children less than five years and pregnant women) in Sub-Saharan Africa.

3. Epidemiology
The WHO estimated that about 2100 million people are at risk from Malaria, and the
disease kills about 2 million people every year. (Half of these being children less than 5
years old). In addition, 3000 people die from malaria each day, ten new cases occurring
every second.
Malaria is reported to account for ten percent of Africa’s disease burden. Five hundred and
fifty cases are estimated to occur annually (75% stable transmission, 17% epidemic, 8%
unstable transmission and non-malarial transmission areas).
Incidentally, 80% of malaria cases and 90% of deaths are recorded in Africa. They die
because they lack access to health care, life-saving drugs and insecticide-treated –bednets.

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ETIOLOGY
Malaria in humans is caused by plasmodium. .The species include
P falciparum;
P. malariae,
P. ovale,
P. vivax.
P. Knowlesi
It is however worthy of note that transmission of the parasite can also be transplacentally
acquired and by blood transfusion

6. Pathophysiology
The erythrocytic phase causes extensive hemolysis, which results in anemia and
splenomegaly.
The most serious complications usually are associated with P. falciparum infections. Infants
and children younger than 5 years of age and non-immune pregnant women are at high risk
for severe complications from falciparum malaria.
The complications associated with falciparum malaria are primarily a result of the high
parasitemia and the ability of the parasites to sequester in capillaries and post-capillary
vessels of organs such as the brain and the kidney.
It has been postulated that tissue hypoxia from anemia, together with P. falciparum-
parasitized red blood cell adherence to endothelial cells in capillaries, contributes to
extensive vascular disease and severe metabolic effects.

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Incubation Period
Incubation period in malaria covers the time between infection and the first appearance of
clinical signs. The length of the incubation period is usually between 9 and 30 days,
depending on the infecting species (shortest for P.falciparum, longer for P.malariae). In
some strains of P.vivax the incubation period may last some 8-9 months

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CLASSIFICATION OF MALARIA
Malaria can be classified into two main types
Simple / uncomplicated malaria.: This is a type of malaria that has no life threatening
manifestation
Severe / complicated malaria.: Malaria with life threatening manifestation and
complication.

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RISK FACTORS
1. ENVIRONMENTAL FATORS
The environment in Nigeria is favourable for transmission
Rain the amount of rain and the number of rainy days are important 10 cm
Low Altitude 200m meters above sea level
High temperature 20-28 C
High humidity 60%
2. AGE FACTOR: Partial immunity is developed after repeated attacks of malaria. Thus,
older children and adults often have asymptomatic parasitemia, i.e, presence of plasmodia
in the bloodstream without clinical manifestations of malaria. Most deaths resulting from
malaria occur in children younger than 5 years.
3. Socio-economic conditions like large scale population movements eg labour force
coming from endemic areas to develop project areas.
4. Immune status as in Pregnancy

10. Symptoms of
malaria:

11. Stages of disease
• Cold stage
• Hot stage
• Sweating stage

12. Cold stage

13. Hot stage

14. Sweating stage

15. Diagnosis
Microscopic Diagnosis
Blood smear
Fluorescent microscopy
Quantitative Buffy coat
Antigen detection
Immunochromatographic dipstick
Serology
ELISA
Molecular Diagnosis
PCR

16. Treatment
1. DESIRED OUTCOME
The primary goal in the management of malaria is the rapid diagnosis of the Plasmodia spp.
by blood smears (repeated every 12 hours for 3 days) so as to initiate timely antimalarial
therapy to eradicate the infection within 48 to 72 hours and to avoid complications such as
hypoglycemia, pulmonary edema, and renal failure that are responsible for increased
mortality in malaria.

17. Treatment
2. PHARMACOLOGIC THERAPY
a. Falciparum malaria (treatment): chloroquine is the drug of
choice in this malignant malaria. Fansidar (sulfadoxine +
pyrimethamine) and doxycycline (or clindamicin) are also
given in combination with quinine. Alternative to quinine +
fansidar are atovaquone plus proguanil or artemether with
lumefantrine can be given orally.
b. Benign malarias (treatment): Benign malaria is usually
caused by Plasmodium vivax and less commonly caused by
P. ovale and P. malariea. primaquine is the drug of choice.

18. Prevention
1. Avoiding mosquito bites: wear long sleeves and trousers, Repellent creams and sprays can
be used. Use of mosquito nets and burning repelling coils also reduce the risk.
2. Travelling in endemic areas: In areas where chloroquine-resistant P. falciparum strains exist,
travelers should receive mefloquine for prophylaxis.
3. Chemoprophylaxis: in chloroquine resistance high areas mefloquine or doxycycline or
proguanil plus atovaquone are drug of choice. In choloroquine resistance absent areas
chloroquine or proguanil is drug of choice.
4. 4% Malaria control in endemic areas: WHO now has a "Roll back malaria" programme. New
combination drugs such as artemether-lumefantrine and pyronaridine are being assessed in
trials. Trial vaccines are being evaluated. .