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Introduction
Definition
Epidemiology
Causes
Transmission and risk factors
Sign and symptoms
Diagnosis
Treatment
Preventions and precaution
4. At the end of this session students are expected to:
Define malaria
Describe the Epidemiology of malaria
Discuss the Causative agents for malaria
List Transmission and risk factors of malaria
list Sign and symptoms of malaria
Identify Diagnosis modality of malaria
List Treatment of malaria
describe Preventions and precaution of malaria
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5. Ancient Egyptians (around 1550 B.C.) and ancient Greeks (around 413
B.C.) documented symptoms associated with malaria. These descriptions
noted the connection between fevers and wet ground.
In 1880, Alphonse Laveran, a French army doctor, described the malarial
parasite and proposed that it caused malaria. got Novel prize
1894 mason hypothesized mosquito transmitted the diseases
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6. Malaria” Italian phrase
Mala bad
Aria.air linked to marshes and swamps.
It is a communicable diseases caused by protozoal parasite
Transmitted anopheles mosquito
Malaria, a mosquito-borne disease, is caused by Plasmodium
parasites.
Protozoans belong to the genus Plasmodium
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7. GLOBALLY
In 2023, WHO reported 247 million cases and 245 million in 2020
619 thousand deaths
Over 95 percent of the burden occurs in the WHO defined African region,
Twenty-nine countries account for 96 percent of cases;
Nigeria (27 percent),
Democratic Republic of Congo (12 percent),
Uganda (5 percent),
Mozambique (4 percent), and
Angola and Burkina Faso (each 3 percent)
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9. According to the Ethiopian National Malaria Strategic Plan
(NMSP) the population of Ethiopia was 102.8 million in 2020.
Malaria is found in nearly 70 percent of the Ethiopia,
about 52 percent of the population lived in areas at risk of malaria.
Transmission is highly seasonal
Geographically varies across the country.
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malaria distribution of ethiopia - Search Images (bing.com)
11. P. Falciparum (~65 percent) and P. vivax (~35 percent) are the major
malaria parasites.
The highest malaria burden regions are usually areas of stable and
intense malaria transmission with altitudes below 1,000 meters
located mainly in areas of
Gambella
Benishangul- Gumuz
Western Oromia, Amhara,
some parts of (SNNP), and
Tigray Regions.
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12. PREVALENCE
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Very low (<100 cases per 1000 population or <1 percent parasite prevalence),
Low 100 to 250 cases per 1000 or 1 to 10 percent prevalence),
Moderate 250 to 450 cases per 1000 or 10 to 35 percent prevalence
High >450 cases per 1000 or >35 percent prevalence)
13. 1.Plasmodium vivax: It causes a less severe form of malaria.
2.Plasmodium falciparum: The most dangerous species,
responsible for severe malaria.
3.Plasmodium ovale: leading to milder symptoms.
4.Plasmodium malariae: Causes a less common form of malaria
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specious Affinity
Falciparum ALL AGE GROUP
Also adhere to the endothelial lining of blood vessel
result in obstruction, thrombosis and local ischemia
P. vivax Young RBC
P. Ovale Young RBC
P. malarea Old RBC
16. 1. Vector transmission - female anopheles mosquito why not male
2. Direct transmission
Blood transfusion
Use of contaminated needle and syrige
Organ transplant
3. Congenital transmission
Mother to new born
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Blood Meals for Reproduction: Only female mosquitoes require blood to
produce eggs for reproduction.
Transmission Cycle: After feeding on an infected individual, mosquito
becomes a carrier..
Male Mosquitoes: primarily feed on nectar and do not transmit malaria.
18. Environmental factor
Warm humid climate
temperature
Vegetation nearby provide
shed to mosquito
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Human factor
• poor water supply and sanitation
Working
• environment - irrigation system
• Travelers
• Young children
• Pregnant women
19. (1) Plasmodium-infected Anopheles mosquito bites a human and transmits sporozoites into the
bloodstream.
(2) Sporozoites migrate through the blood to the liver where they invade hepatocytes and divide to
form multinucleated schizonts (preerythrocytic stage).
(3) Hypnozoites are a quiescent stage in the liver that exist only in the setting of P. vivax and P.
ovale infection. This liver stage does not cause clinical symptoms, but with reactivation and release
into the circulation, late-onset or relapsed disease can occur up to many months after initial infection.
(4) The schizonts rupture and release merozoites into the circulation where they invade red blood
cells. Within red cells, merozoites mature from ring forms to trophozoites to multinucleated schizonts
(erythrocytic stage).
(5) Some merozoites differentiate into male or female gametocytes. These cells are ingested by
the Anopheles mosquito and mature in the midgut, where sporozoites develop and migrate to the
salivary glands of the mosquito. The mosquito completes the cycle of transmission by biting another
host
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22. 1. Liver Stage (Exoerythrocytic Phase):
1. When an infected mosquito bites a person, sporozoites in the
mosquito’s saliva enter the bloodstream and migrate to
the liver.
2. In the liver, they infect liver cells and mature into schizonts.
3. These schizonts rupture, releasing merozoites.
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23. 2. Blood Stage (Erythrocytic Phase):
1. Merozoites infect red blood cells (erythrocytes).
2. Inside the red blood cells, the parasites multiply asexually, leading to the
destruction of the cells.
3. The ring stage trophozoites mature into schizonts, which then rupture,
releasing more merozoites.
4. Some parasites differentiate into sexual erythrocytic
stages called gametocytes.
5. When a female Anopheles mosquito feeds on an infected person, it ingests
these gametocytes.
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24. 3. Mosquito Stage (Sporogonic Cycle):
1. Inside the mosquito’s stomach, microgametes
penetrate macrogametes (female), generating zygotes.
2. Zygotes elongate into ookinetes, which invade the mosquito’s midgut wall and
develop into oocysts.
3. Oocysts grow, rupture, and release sporozoites.
4. Sporozoites migrate to the mosquito’s salivary glands.
5. When the mosquito bites another human, it injects sporozoites, perpetuating
the malaria life cycle
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25. Non specific symptoms - first symptoms
Headache, fatigue
Abdominal discomfort, muscle and joint aches, diarhea
Fever- irregular/ intermittent
Nausea, vomiting and orthostatic hypotension
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26. Severe malaria is defined as presence of P. falciparum parasitemia
and one or more of the manifestations
Sever anemia
Impaired consciousness
Convulsion
Hypoglycemia
Jaundice
Shock
Renal impairment
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Stages characteristics
Cold stages • Duration – 15 to 60 min
• Shivering and feeling of cold
Hot stage • 2- 6 hours
• High grade fever up to 41 OC
• Flushed, dry skin and often headache, nausea and
vomiting
Sweeting
stage
• 2- 4 hours
• Fever drops rapidly
• Sweeting
CORRESPONDING WITH THE RELEASE OF FRESH MEROZOITE
28. Anemia in malaria
Severe anemia is very common during malaria (Hb become <6 g/dl)
Anemia may caused by :
A. intravascular hemolysis,
B. increased clearance of malaria infected RBC (iRBC), and
C. decrease in RBC production through dysregulated
erythropoiesis
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30. Hyperendemic area and endemic area
No laboratory resources not needed
Fever or history of fever
Poor sensitive and poor predictive value
Overlap with other syndromes
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32. Direct Diagnosis
This involves the direct demonstration of the malaria parasite. It can be done
through:
Peripheral Blood Smear (PBS): A thin or thick blood smear is stained
and examined under a microscope to identify the presence of malaria
parasites.
Quantitative Buffy Coat (QBC) Test: A fluorescent stain is used to detect
malaria parasites in the buffy coat layer of centrifuged blood.
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33. Rapid Diagnostic Tests (RDTs): detect specific malaria
antigens (such as histidine-rich protein 2 or lactate
dehydrogenase) in blood samples.
PCR (Polymerase Chain Reaction): Molecular technique to
detect and identify malaria DNA or RNA.
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34. Indirect Diagnosis:
1. These tests assess the host’s immune response to malaria infection:
1.Serological Tests: Detect antibodies against malaria parasites.
Useful for epidemiological studies but not for
immediate diagnosis or treatment decisions.
2.Antigen Detection Tests: Detect malaria-specific antigens (e.g.,
Plasmodium lactate dehydrogenase) in blood or urine samples.
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35. Other Investigations
• Complete Blood Count (CBC): for anemia and thrombocytopenia
• Liver Function Tests (LFTs): Elevated liver enzymes
• Renal Function Tests (RFTs): Assess kidney function,
• G6PD (Glucose-6-Phosphate Dehydrogenase) Testing: Important
before using primaquine for radical cure (P. vivax and P. ovale)
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37. TREATMENT
Objectives
Treat the patient and restore quality of life and productivity
Prevent complication
Prevent death
Prevent the development and transmission of medicine resistance
Decrease malaria transmission to others
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38. Control fever Apply tepid sponging
Correct the fluid and electrolyte imbalance
Correct hypoglycemia,
Identify the causative species and treat appropriately
Treat the malaria aggressively to prevent complications
Treat secondary bacterial infections
Provide supportive care
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40. uncomplicatedP. Falciparummalaria
First line
Artemether + Lumefantrine, 20mg + 120mg in a fixed dose combination
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Wieght in kg age dases
5- 14 kgs From 4 months to 2 years 1 tablet bid for 3 days
15- 24 kgs From 3 to 7 years 2 tablets bid for 3 days
25- 34 kgs From 8 to 10 years 3 tablets bid for 3 days
> 35 kgs 10 years & above 4 tablets bid for 3 days
It is not recommended for infants weighing < 5 KG and 1st TM Px mothers
Alternative
Quinine dihydrochloride, 10mg quinine sulphate salt/kg TID for 7 days
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uncomplicated P. Vivax malaria
First line
• Chloroquine phosphate, 1 g, then 500mg in 6 hours followed by 500mg
P.O., QD for 2 days, or 1g at 0 and 24 hrs followed by 0.5g at 48 hrs P.O.,
Followed by
• Primaquine, 15mg base P.O., QD for 14 days.
It is recommended for patients with limited risk of malaria infection in the
future;
Alternatives
• Artemether + Lumefantrine, 20mg + 120mg in a fixed dose combination
OR
• Quinine dihydrochloride, 10mg quinine sulphate salt/kg TID for 7 days
42. uncomplicated Mixed infection
First line
Artemether + Lumefantrine
Alternative
Quinine dihydrochloride, 10mg quinine sulphate salt/kg
TID for 7 days
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43. Severe and complicated P. falciparum malaria
Objectives
Administer medicines parenterally
Provide urgent treatment for life threatening problems e.g.
convulsions, hypoglycemia, dehydration, renal impairment
Prevent death from malaria
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44. Treatment of Severe MALARIA
NON- PHARMACOLOGICAL
A- Clear and maintain the airway.
Position semi-prone or on side.
Weigh the patient and calculate dosage.
Make rapid clinical assessment.
Exclude or treat hypoglycemia (more so in pregnant women).
Assess state of hydration.
Measure and monitor urine output.
If necessary insert urethral catheter.
Measure urine specific gravity.
Open IV line for 8 hours of intravenous fluids including diluents for antimalarial
medicine, glucose therapy and blood transfusion.
If rectal temperature exceeds 39°C, remove patient's clothes, use tepid sponge,
Consider other infections.
Consider need for anti-convulsant treatment
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45. Treatment of Severe MALARIA
First line
Artesunate, 2.4mg/Kg IV on admission (time = 0), then repeat at 12
hours, and 24 hours, then once a day for up to 5 days.
Alternatives
Artemether, IM 3.2mg/kg loading dose on the first day followed by
1.6mg/kg daily for five days
OR
Quinine dihydrochloride: Loading dose: 20mg/kg in 500ml of isotonic
saline or 5% dextrose ( Better for pregnant women)
The parenteral treatment should be changed to P.O., only after 24 hours
and if tolerate
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46. Maternal mortality is 50% higher than in the non-pregnant period.
The commonest complications are;
maternal anemia
spontaneous abortion,
still birth,
premature labors, and
low birth weight.
.
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47. Severe or complicated: P. falciparum and P. vivax:
First line
Artesunate, IV, 2.4mg/kg at 0, 12 and 24 hours, then daily thereafter.
oral artesunate 2mg/kg (or IM artesunate 2.4mg/kg) once daily, plus
clindamycin.
If oral artesunate is not available, use quinine 600mg TID and clindamycin at
450mg TID for 7 days.
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48. Alternative
Quinine, IV 20mg/kg loading dose (no loading dose if patient
already taking quinine or mefloquine) in 5% dextrose over 4 hours
and then 10mg/kg IV over 4 hours TID plus clindamycin IV 450mg
TID (max. dose quinine 1.4g).
Oral quinine 600mg TID 5–7 days and oral clindamycin 450mg
TID for 7 days.
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49. PREVENTIONS
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Integrated vector control approach
Integrated vector control approach is the present trend for vector control
defined as utilization of all appropriate technological and management
techniques to bring out an effective degree of vector suppression in a cost
effective manner and also to avoid the over use of one of the methods
50. VECTOR CONTROL
1. Habitat and environment control
Removing or reducing areas where vectors can easily bred can limit their
growth
stagnant water removal mosquito breed environment
2. Personal protection
prevent contact between the human body and insects
Repellents
Protect clothing
Insecticide
Impregnated mosquito nets
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51. CHEMICAL CONTROL
1. Larvicides: used to control larvae of mosquitoes. They target the
immature stages of insects before they become adults.
2. Insecticides: chemicals designed to kill or repel insects.
3. Repellents: discourage pests from approaching or landing on
surfaces.
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52. BIOLOGICAL CONTROL -
Larvivores fish
Size: small to survive in shallow water where mosquito larvae
breed.
Feeding Behavior: surface feeders and primarily carnivorous,
targeting mosquito larvae.
Survival: These fish should be able to survive even in the absence
of mosquito larvae.
Ease of Rearing: easy to rear
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53. P. Falciparum
First line
Mefloquine, 5mg base per kg weekly (1tablet for adults >50kg,
begin > 2weeks before travel to malariuos area, take weekly on the
same day while in the area and for 4 weeks after leaving the area.
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Chemo-prophylaxis
54. Alternatives
Atovaquone/Proguanil: 250mg/100mg P.O., daily for adults; begin 1-2 days before travel
to malarous area and daily while in the areas and for 7 days after leaving the area.
OR
Doxycycline, 100mg daily for adults; 2.2mg/kg daily for children >8yrs; begin 1-2 days
before travel to malarious areas, to be taken daily while at the area and for 4 weeks after
leaving the area.
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For P. vivax
Primaquine phosphate, 15mg base P.O., QD for 14 days after travel
55. Countries that have achieved at least 3 consecutive years of zero
indigenous cases of malaria are eligible to apply for the WHO
certification of malaria elimination.
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African countries that have been certified malaria-free by the
World Health Organization (WHO):
• Algeria (certified in 2019)
• Cabo Verde (certified in 2024)
• Mauritius (certified in 1973)
56. WHO RESPONSE
The WHO Global technical strategy for malaria 2016–2030,
The strategy sets achievable global targets, including:
• Reducing malaria case incidence by at least 90% by 2030
• Reducing malaria mortality rates by at least 90% by 2030
• Eliminating malaria in at least 35 countries by 2030
• Preventing a resurgence of malaria in all countries that are malaria-
free.
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57. WHO’S GLOBAL EFFORTS TO CONTROL AND ELIMINATE
MALARIA BY:
• Playing a leadership role in malaria,
• Shaping the research agenda and promoting new tools and strategies
• Developing ethical and evidence based global guidance on malaria
• National malaria programme and other relevant stakeholders; and
• Monitoring and responding to global malaria trends and threats
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58. 1.RTS,S (Mosquirix): This is the first approved malaria vaccine. It requires at least three doses in infants by
age 2, and a fourth dose extends protection for another 1–2 years.
RTS,S reduces hospital admissions from severe malaria by around 30%.
It was developed by the PATH Malaria Vaccine Initiative (MVI) and GlaxoSmithKline (GSK) with support
from the Bill and Melinda Gates Foundation. The vaccine consists of the Plasmodium falciparum
circumsporozoite protein (CSP) from the pre-erythrocytic stage. It aims to prevent hepatocyte invasion and
elicit a cellular response to destroy infected hepatocytes.
2.R21/Matrix-M: This vaccine has shown an impressive 77% efficacy rate in initial trials, surpassing the
WHO’s goal of a malaria vaccine with at least 75% efficacy. It is the second malaria vaccine recommended
by the WHO. In April 2023, Ghana approved its use for children aged between five months and three years
old, and Nigeria provisionally approved it as well.
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59. Bill Gates:
“There are more people dying of malaria than any specific cancer.”
Tedros Adhanom Ghebreyesus: “Prevention is the
best cure for malaria.”
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•Eliminating malaria in at least 35 countries by 2030
The experience of the malaria-free African country (voanews.com)
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3. Melkie DA, Internist, Teferra DE, Pediatrician, Assefa DM, Oncologist, et al. Food , Medicine and Healthcare
Administration and Control Authority of Ethiopia Standard Treatment Guidelines For General Hospital Diseases
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4. MoH Ethiopia. Ethiopia Malaria Profile. 2022;2:1–20.
5. Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S. Malaria diagnosis: A brief review. Korean J Parasitol.
2009;47(2):93–102.
6. WHO. World Malaria Report: 20 years of global progress and challenges [Internet]. World Health Organization. 2020.
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7. WHO. Country Disease Outlook- Ethiopia 2023. WHO Reg Off Afric. 2023;17(22):4.
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