#Health

Malaria

By Faozat Aragbaiye

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Malaria is a mosquito-borne disease and that does not spread from person to person (except in pregnancy as noted below) but spreads in certain circumstances without a mosquito. This occurs rarely and is usually found in a transmission from a pregnant woman to an unborn child (congenital malaria), by blood transfusions, or when intravenous-drug users share needles.
Disease burden
According to the latest World malaria report, released on 30 November 2020, there were 229 million cases of malaria in 2019 compared to 228 million cases in 2018. The estimated number of malaria deaths stood at 409 000 in 2019, compared with 411 000 deaths in 2018.
In 2019, 6 countries accounted for approximately half of all malaria deaths worldwide: Nigeria (23%), the Democratic Republic of the Congo (11%), United Republic of Tanzania (5%), Burkina Faso (4%), Mozambique (4%) and Niger (4% each).
Children under 5 years of age are the most vulnerable group affected by malaria; in 2019 they accounted for 67% (274 000) of all malaria deaths worldwide.
Causes
Malaria is caused by a single-celled parasite of the genus plasmodium. The parasite is transmitted to humans most commonly through mosquito bites.
A mosquito becomes infected by feeding on a person who has malaria. The parasites enter the body, they travel to the liver — where some types can lie dormant for as long as a year.
In the bloodstream. When the parasites mature, they leave the liver and infect the red blood cells. This is when people typically develop malaria symptoms.
On to the next person. If an uninfected mosquito bites you at this point in the cycle, it will become infected with your malaria parasites and can spread them to the other people it bites.
Other modes of transmission
Because the parasites that cause malaria affect red blood cells, people can also catch malaria from exposure to infected blood, including:
From mother to unborn child
Through blood transfusions
By sharing needles used to inject drugs
*Risk factors
The greatest risk factor for developing malaria is to live in or to visit areas where the disease is common. These include the tropical and subtropical regions of:
Sub-Saharan Africa
South and Southeast Asia
Pacific Islands
Central America and northern South America
The degree of risk depends on local malaria control, seasonal changes in malaria rates and the precautions you take to prevent mosquito bites.
Risks of more-severe disease
People at increased risk of serious disease include:
Young children and infants
Older adults
Travelers coming from areas with no malaria
Pregnant women and their unborn children
In many countries with high malaria rates, the problem is worsened by lack of access to preventive measures, medical care and information.
*Symptoms
Malaria has a wide spectrum of symptoms. After the bite by the infected mosquito occurs, it can take between seven and 30 days (average is seven to 15 days) before symptoms start (incubation period).
Health care professionals classify malaria as uncomplicated or complicated (severe).
Uncomplicated malaria
The most common symptoms are
fever and chills,
headaches,
nausea and vomiting, and
The classic description of a malaria attack (which is rarely observed), would be a six- to 12-hour period of cold and shivering alternating with fever and headaches and then a stage of sweating and tiredness (sometimes divided into the cold and hot stage).
Complicated or severe malaria
This occurs when malaria affects different body systems.
Severe anemia (due to destruction of red blood cells)
Kidney failure
Cerebral malaria — seizures, unconsciousness, abnormal behavior, or confusion
Cardiovascular collapse
Low blood sugar (in pregnant women after treatment with quinine)
*Diagnosis
To diagnose malaria, the doctor will likely review the medical history and recent travel, conduct a physical exam, and order blood tests. Blood tests can indicate:
The presence of the parasite in the blood, to confirm that you have malaria
Which type of malaria parasite is causing your symptoms
If your infection is caused by a parasite resistant to certain drugs
Whether the disease is causing any serious complications
Some blood tests can take several days to complete, while others can produce results in less than 15 minutes. Depending on the symptoms, the doctor may order additional diagnostic tests to assess possible complications.
*Treatment
Besides supportive care, the medical team needs to decide on the appropriate antimalarial drug(s) to treat malaria. The choice will depend on several factors, including
the specific species of parasite identified,
the severity of symptoms, and
determination of drug resistance based on the geographic area where the patient traveled.
Physicians will administer the medication in pill form or as an intravenous antimalarial depending on above factors.
The most commonly used medications are
chloroquine (Aralen),
doxycycline (Vibramycin, Oracea, Adoxa, Atridox),
quinine (Qualaquin),
mefloquine (Lariam),
atovaquone/proguanil (Malarone),
artemether/lumefantrine (Coartem), and
primaquine phosphate (Primaquine).
*Complications
Malaria can be fatal, particularly when caused by the plasmodium species common in Africa. The World Health Organization estimates that about 94% of all malaria deaths occur in Africa — most commonly in children under the age of 5.
Malaria deaths are usually related to one or more serious complications, including:
Cerebral malaria. If parasite-filled blood cells block small blood vessels to your brain (cerebral malaria), swelling of your brain or brain damage may occur. Cerebral malaria may cause seizures and coma.
Breathing problems. Accumulated fluid in your lungs (pulmonary edema) can make it difficult to breathe.
Organ failure. Malaria can damage the kidneys or liver or cause the spleen to rupture. Any of these conditions can be life-threatening.
Anemia. Malaria may result in not having enough red blood cells for an adequate supply of oxygen to your body’s tissues (anemia).
Low blood sugar. Severe forms of malaria can cause low blood sugar (hypoglycemia), as can quinine — a common medication used to combat malaria. Very low blood sugar can result in coma or death.
Prevention
Prevention of malaria is currently based on two complementary methods: chemoprophylaxis and protection against mosquito bites. While several malaria vaccines are under development, none is available yet.
Chemoprophylaxis
In Europe, malaria chemoprophylaxis is only for travellers to malaria endemic countries, which are classified in three (or four) groups, to determine which drug is recommended for chemoprophylaxis. The choice of drugs depends on the travel destination, the duration of potential exposure to vectors, parasite resistance pattern, level and seasonality of transmission, age and pregnancy. In endemic countries, chemoprophylaxis could also be recommended for autochthonous young children and pregnant women, depending on endemicity level and seasonality of transmission.
Personal protection measures against mosquito bites
Because of the nocturnal feeding habits of most of Anopheles mosquitoes, malaria transmission occurs primarily at night. Protection against mosquito bites include the use of mosquito bed nets (preferably insecticide-treated nets), the wearing of clothes that cover most of the body, and use of insect repellent on exposed skin. Type and concentration of repellents depend on age and status.

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