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According to a study published in World Hospitals and Health Services Journal, issued by the International Hospital Federation, malaria is a major threat to global health and is one of the leading causes of death worldwide. It is estimated that upwards of 2.3 billion people reside in areas where malaria is a constant risk. Each year, 300-500 million cases of Plasmodium falciparum malaria occur in the globe.
In 2015, The WHO reported that 212 million clinical cases of malaria occurred, and 429,000 people died as a result. Most casualties were children living in Africa. In the same year, nearly half of the world's population was at risk of malaria.
Most malaria cases occur in sub-Saharan Africa, but other regions, including South-East Asia, Latin America and the Middle East, are also at risk. The number of countries and areas that had ongoing malaria transmission in 2015 was reported to be 91, according to WHO.
Numbers released by the Centers for Disease Control and Prevention (CDC) show that malaria was responsible for 627,000 deaths in 2012, most were young children in sub-Saharan Africa.
Malaria deals a considerable blow to many national economies, and since many countries affected by malaria are poor nations, the disease maintains a cycle of disease and poverty.
On a more positive note, the CDC says that malaria control efforts and strategies have improved in the last 10 years, saving the lives of 3.3 million individuals globally, and reducing malaria mortality by 45%.
Malaria, a potentially fatal disease, is caused by a type of parasite transmitted to humans through infected mosquitoes of the genus Anopheles, also called malaria vectors. It should be noted that malaria is not contagious as it cannot be passed down from person to person through interpersonal contact.
Plasmodium parasites carried by malaria vectors are responsible for the disease. There are several parasite species that cause malaria in humans, two of which are the deadliest, Plasmodium falciparum and Plasmodium vivax. Cases of malaria spreading through contact with infected blood have been documented, but are very rare.
Living or visiting tropical areas where the disease is common puts the individual at a high risk of getting malaria. Children under 5 years of age, pregnant women and patients with HIV/AIDS are at a much higher risk of getting malaria than others.
Once a person is bitten, the parasite travels through the bloodstream to the liver. The parasites infect the liver before reenter the bloodstream and invade red blood cells. In red blood cells, the parasites grow and multiply until the infected red blood cells burst, releasing more parasites into the blood and causing malaria symptoms to appear. Infected blood cells usually burst every 48-72 hours.
Usually, malaria causes flu-like symptoms, such as a high fever, chills, and muscle pain. Symptoms of malaria tend to be intermittent. Some types of malaria can be deadly as they may cause damage to the heart, lungs, kidneys, or brain.
Early diagnosis and treatment of malaria prevents deaths and reduces transmission of the disease. The World Health Organization (WHO) recommends that patients who are suspected to have malaria should be quickly diagnosed either by microscopy or malaria rapid diagnostic test (RDT) before treatment can begin; this improves the overall management of the disease, and helps in reducing the chance of drug resistance by reserving antimalarials for those who actually have the disease.
Malaria is a medical emergency and should be treated accordingly. The type of medication prescribed and for how long the treatment needs to last depend on the type of malaria, where it was caught and the severity of symptoms. Antimalarials are usually given as tablets or capsules, but may also be given intravenously in the hospital for severe cases.
Complications of severe malaria, such as sudden drop of blood pressure or liver failure, can occur within days or even hours after symptoms start to appear. Pregnant women, babies, young children and the elderly are at the highest risk of complications. The Plasmodium falciparum parasite, mainly found in Africa, causes the most severe malaria symptoms and most deaths.
Prevention of malaria mainly involves protection against mosquito bites, but using antimalarial medicines may also be used for prevention. Despite malaria being preventable, public health officials strongly advise that young children and pregnant women should avoid going to places where malaria is common. Pregnant women who need to travel to an area where malaria is a risk should speak with a doctor to prescribe the right antimalarial medicine that does not cause side effects for both mother and baby.
With treatment, the prognosis is good in most cases of malaria, but is poor in Plasmodium falciparum infections with complications.
The Centers for Disease Control and Prevention (CDC) estimates that 90% of all malaria deaths occur in Africa and most commonly in children under the age of five.
According to reports released by the WHO in December 2016, there were 212 million cases of malaria documented in 2015 and 429,000 deaths. Malaria cases and deaths mostly occur in sub-Saharan Africa, but, there are other regions that are also at risk, such as South-East Asia, Latin America and the Middle East.
Malaria, which predominantly occurs in tropical areas, is life-threatening disease that can cause flu-like symptoms. Malaria is transferred to humans through the bite of female Anopheles mosquitoes, or malaria vectors, that were previously infected by Plasmodium parasites.
There are four major species of malaria parasites that can be transmitted from mosquitoes to infect humans:
Plasmodium falciparum: This is the most common type of malaria-causing parasite and is primarily found in Africa. According to the WHO, this species is responsible for most malaria deaths worldwide.
Plasmodium vivax: Malaria symptoms caused by this parasite tend to be milder than those caused by Plasmodium falciparum; however, this species can remain in the liver for up to three years, which can result in relapses. It is mainly found in Asia and South America.
Plasmodium ovale: This species can survive in the liver for many years without leading to any symptoms. It is usually found in West Africa, but is uncommon.
Plasmodium malariae: This species is rare and is only found in Africa.
There is a fifth species, known as Plasmodium knowlesi, that can be transmitted to humans from macaques, but it is considerably rare and is confined to certain parts of Southeast Asia.
Malaria is caused by Plasmodium parasites that reach human through the bite of malaria vectors. The parasites infect red blood cells after they infect and leave the liver. If a mosquito bites an already infected person, it can become infected and transmit it to other people.
Because parasite infect red blood cells, the disease cannot be transmitted sexually, nor can it be spread like the flu. Contracting malaria from contact with malaria-infected people is also not possible.
Malaria can be transmitted through blood, however, either through transfusions or the shared use of needles contaminated with blood. It can also be spread via organ transplant, or be transmitted from a mother to her unborn infant before or during delivery, a condition called congenital malaria.
People at the highest risk of getting sick with malaria are those who live in or travel to tropical areas where the disease is common. Other risk factors put certain groups at a higher risk. These include:
After the parasites enter the bloodstream following a bite, they travel to the liver where they mature. When the parasites mature, they return to the bloodstream and infect red blood cells. The parasites then begin to grow and multiply until red blood cells burst and release more parasites into the blood. Red blood cells burst at regular intervals, usually every 48-72 hours, causing the intermittent symptoms of malaria.
Symptoms are similar to those of the flu and are often mild at first, so they can be difficult to identify as belonging to malaria. These symptoms include:
Other signs and symptoms may include:
The symptoms of malaria usually appear 10–15 days after the parasite enters the body; however, in some cases, symptoms may not appear for as long as a year following the bite.
The fever occurs in 48-hour cycles in some types of malaria. During these cycles, the patient feels cold and shivers before a fever develops. The fever is usually accompanied by severe sweating and fatigue. These symptoms usually last between 6 and 12 hours.
The most serious type of malaria, caused by Plasmodium falciparum, if not treated within 24 hours, it can become severe and potentially fatal because it can lead to breathing problems and organ failure.
In Plasmodium vivax and Plasmodium ovale infections, patients who recovered from the first episode of illness may suffer relapses; This reemergence of symptoms can occur months or even years after the first episode because these two parasite species can remain dormant in the liver without causing symptoms. Treatments that help reduce the chance of such relapses is available and should be followed.
Rapid and effective malaria management is possible with an early and accurate diagnosis, which also contributes to reducing malaria transmission. Malaria can be diagnosed through the following:
Clinical diagnosis
The clinical diagnosis of malaria is based on the patient's travel history, symptoms, and the physical findings at examination. The first symptoms are not malaria-specific because they resemble those that occur in other diseases, such as the flu. In severe cases of malaria, however, symptoms such as confusion, coma, neurologic focal signs, severe anemia, and respiratory difficulties are more striking and may increase suspicion in malaria. Clinical findings should always be confirmed by a laboratory test for malaria.
Microscopic Diagnosis
Microscopic examination remains the standard for a laboratory confirmation of malaria. Malaria parasites can be identified by examining a sample of the patient’s blood under the microscope. The test can determine if malaria parasites are present in the patient’s blood and the percentage of the patient’s red blood cells infected with malaria parasites.
This test is vital in that health-care providers receive results within hours to appropriately treat their patients. However, results depend on the quality of the reagents and the microscope, and on the experience of the laboratorian.
Antigen Detection
Antigen Detection also known as Dipsticks or Rapid Diagnostic Tests, simply RDT, are an alternate way to quickly establish a diagnosis of malaria by detecting specific malaria antigens in a person's blood and provide results in 2-15 minutes. RDT offers a useful alternative to microscopy in situations where reliable microscopic diagnosis is not available.
The currently approved RDT detects two different malaria antigens; one is specific for Plasmodium falciparum and the other is found in all four species of malaria that infect humans. Thus, microscopy is needed to determine the species of malaria detected by the RDT.
Molecular Diagnosis
This technique uses polymerase chain reaction (PCR) to detect the presence of parasite nucleic acids. Although PCR is more sensitive than other tests, it does not provide results quick enough to be useful in establishing a diagnosis of malaria. It is most useful for confirming the species of the parasite causing the diseases after a diagnosis has been established by either microscopy or RDT.
Serology
Indirect immunofluorescence, or enzyme-linked immunosorbent assay are the most common serology tests. These tests reveal past exposure by detecting the presence of antibodies against malaria parasites.it
In the event that the person does have positive results for malaria, a complete blood count and a routine chemistry panel tests are important to determine if the patient has uncomplicated or severe manifestations of malaria. Specifically, these tests can detect severe anemia, hypoglycemia, renal failure, hyperbilirubinemia, and acid-base disturbances.
Treatment of malaria mostly involves the use of antimalarial medications that target the parasite in the blood. The most commonly used antimalarials include:
Other antimalarial medications, such as primaquine, target the parasites dormant in the liver to protect against relapses.
Antimalarial medications are usually given as tablets or capsules. The medication may be administered intravenously if the patients have severe Plasmodium falciparum malaria or cannot take oral medications.
Some strains of malaria may become resistant to certain antimalarial medications, so a combination of anitmalarials are used to overcome the disease.
The severity of malaria, the species that caused, and the part of the world in which it was contracted all play a role in determining the best treatment. Factors such as age, weight, and pregnancy may limit the available options for treatment.
Complications of severe malaria are considered a medical emergency and should be treated urgently. Complications include:
Anemia
Severe anemia may occur due to hemolysis, or rupture, of the red blood cells. Anemia is a condition where red blood cells cannot carry enough oxygen to the body's muscles and organs.
Hemoglobinuria
This describes the presence of hemoglobin in the urine as a result of hemolysis. It is also called “black-water fever” because of the dark-colored urine.
Acute respiratory distress syndrome
This is an inflammatory reaction that happens in the lungs. It inhibits oxygen exchange, and may occur even after treatment leads to a decreased parasite counts.
Low blood pressure
This may result from cardiovascular collapse.
Acute kidney failure
It can result from chronic or repeated infections with Plasmodium malariae.
Metabolic acidosis
Excessive acidity in the blood and tissue fluids, often associated with low blodd sugar.
Hypoglycemia
Pregnant women with uncomplicated malaria may develop hypoglycemia, or low blood sugar. Some patients may also have hypoglycemia after treatment with quinine.
Pulmonary edema
A build-up of fluid in the lungs.
Swelling and rupturing of the spleen
Plasmodium vivax malaria can cause rupture of the spleen on rare occasions.
Liver failure and jaundice
A yellowing of the skin and whites of the eyes.
Cerebral malaria
In rare cases, malaria can affect the brain causing abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities
Pregnant women who contract malaria are also prone to other complications related to pregnancy or birth. These include:
Travelling to areas where malaria is common is a significant risk factor for catching the diseases. Therefore, it is very important to take precautions to prevent an infection. These precautions include:
Being aware of the risks
It is important for any one travelling to get advice and find out if prophylactic malaria treatment is necessary for any country they are visiting. Nobody has complete immunity to malaria, and, for those who have already visited an area where malaria is a risk, any level of natural protection against it is quickly lost when moving out of the risk area.
Preventing bites
Avoiding mosquito bites altogether is not possible, but the less a person is bitten, the less likely it is to contract malaria. The following are strategies that help reduce bites:
Antimalarial prevention tablets
Drugs taken to treat malaria can be used as an effective preventative method that significantly reduces the risk of developing the disease. It is recommended to take antimalarial tablets preventively when visiting areas where malaria is a risk.
Checking with a doctor every time you visit an area where malaria is common is important to ensure that you receive a medication you can tolerate; a drug which was suitable for you in the past may not be on future trips. Make sure to follow the doctor’s instructions for the best results.
Vaccines against malaria
Safe and effective malaria vaccines are being developed, but none has been approved for use so far.
An injectable vaccine known as RTS,S/AS01 or Mosquirix, provides partial protection against malaria in young children. The vaccine is being evaluated in sub-Saharan Africa as a complementary malaria control tool that could be added to, but not replace, the preventive, diagnostic and treatment measures recommended by the WHO.
Most patients with uncomplicated malaria show improvement in the first 48 hours after treatment has started and are usually fever free after 96 hours. the prognosis for patients infected with Plasmodium falciparum is generally poor and carries a high mortality rate if left untreated. However, with early diagnosis and treatment, the prognosis improves considerably.
Malaria is preventable and treatable, but the lack of proper prevention and treatment measures because of economic and social instabilities, such as poverty and war, results in millions of deaths annually.
According to a study published in World Hospitals and Health Services Journal, issued by the International Hospital Federation, malaria is a major threat to global health and is one of the leading causes of death worldwide. It is estimated that upwards of 2.3 billion people reside in areas where malaria is a constant risk. Each year, 300-500 million cases of Plasmodium falciparum malaria occur in the globe.
In 2015, The WHO reported that 212 million clinical cases of malaria occurred, and 429,000 people died as a result. Most casualties were children living in Africa. In the same year, nearly half of the world's population was at risk of malaria.
Most malaria cases occur in sub-Saharan Africa, but other regions, including South-East Asia, Latin America and the Middle East, are also at risk. The number of countries and areas that had ongoing malaria transmission in 2015 was reported to be 91, according to WHO.
Numbers released by the Centers for Disease Control and Prevention (CDC) show that malaria was responsible for 627,000 deaths in 2012, most were young children in sub-Saharan Africa.
Malaria deals a considerable blow to many national economies, and since many countries affected by malaria are poor nations, the disease maintains a cycle of disease and poverty.
On a more positive note, the CDC says that malaria control efforts and strategies have improved in the last 10 years, saving the lives of 3.3 million individuals globally, and reducing malaria mortality by 45%.
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