Doris Obinna
Today is the World Malaria Day (WMD). The theme, “Zero Malaria Starts with Me,” the World Health Organisation (WHO) and other partner agencies, in collaboration with governments across the world, will step up grassroots campaign to keep malaria high on the political agenda, mobilise additional resources and empower communities to take ownership of malaria prevention and care.
Malaria is a serious, sometimes fatal, disease spread by mosquitoes and caused by a parasite. The Anopheles mosquito carries the parasite and is where the parasite starts its life cycle. The parasite (Plasmodium) has multiple subspecies, each causing a different severity of symptoms and responding to different treatments.
The malaria parasite is transmitted to humans through the bites of infected mosquitoes. People who have malaria usually feel very sick, with a high fever and shaking chills. Each year, approximately 210 million people are infected with malaria, and about 440, 000 people die from the disease. Most of the people who die from the disease are young children in Africa.
Once the parasites are inside your body, they travel to the liver, where they mature. After several days, the mature parasites enter the bloodstream and begin to infect red blood cells. Within 48 to 72 hours, the parasites inside the red blood cells multiply, causing the infected cells to burst open.
The parasites continue to infect red blood cells, resulting in symptoms that occur in cycles that last two to three days at a time.
Malaria is not a communicable disease but can spread without a mosquito. Though, not common there could be transmission from mother to unborn child, which is known as congenital malaria by blood transfusion or when intravenous-drug users share needles.
Malaria is endemic in Nigeria, and the population at highest risk includes: children, pregnant women, and the non-immune. Since Plasmodium ovale is more prevalent in non-endemic areas, in these areas the burden of disease is less than in endemic areas where malaria is due to the fatal Plasmodium falciparum.
While the disease is uncommon in temperate climates, malaria is still common in tropical and subtropical countries. World health officials are trying to reduce the incidence of malaria by distributing bed nets to help protect people from mosquito bites as they sleep. Scientists around the world are working to develop a vaccine to prevent malaria.
After more than a decade of steady advances in fighting malaria, progress has levelled off. According to WHO’s latest World malaria report, no significant gains were made in reducing malaria cases in the period 2015 to 2017. The estimated number of malaria deaths in 2017, at 435 000, remained virtually unchanged over the previous year.
Urgent action is needed to get the global response to malaria back on track and ownership of the challenge lies in the hands of countries most affected by malaria.
The WMD gives people the chance to promote or learn about the efforts made to prevent and reduce malaria around the world. It is observed on April 25 each year, good healthcare is important to prevent and treat diseases such as malaria. It is an international observance that recognises global efforts to control malaria. Globally, 3.3 billion people in 106 countries are at risk of malaria. In 2012, malaria caused an estimated 627, 000 deaths, mostly among African children.
“Malaria may cause anemia and jaundice (yellow colouring of the skin and eyes) because of the loss of red blood cells. If not promptly treated, the infection can become severe and may cause kidney failure, seizures, mental confusion, coma, and death,” says an expert.
In the WHO Western Pacific Region, countries reported a 47 per cent increase of malaria cases and a 43 per cent increase of malaria deaths during the period 2015 to 2017. The increase was largely due to outbreaks reported from Papua New Guinea, Cambodia and Solomon Islands, which jointly account for 92 per cent of the malaria burden in the region. The region is also seeing incredible progress in some endemic countries. China and Malaysia have reported no indigenous human malaria cases in 2018 and Cambodia has reported zero deaths from malaria in 2018, all very significant achievements.
The Regional Action Framework for Malaria Control and Elimination in the Western Pacific 2016-2020 highlights the need to build on past successes and to accelerate progress through prioritising investments through targeted deployment of interventions based on strengthened surveillance systems.
The “Zero malaria starts with me” campaign aims to engage all members of society: political leaders who control government policy decisions and budgets; private sector companies that will benefit from a malaria-free workforce; healthcare providers working towards controlling and eliminating malaria and most importantly communities affected by malaria, whose buy-in and ownership of malaria control interventions is critical to success.
Urgent action is needed to address outbreaks in the highest burden countries. Ownership of the challenge lies in the hands of countries most affected by malaria and community empowerment is critical to support grassroots engagement across the region.
Where malaria is hitting hardest
In 2017, approximately 70 per cent of all malaria cases (151 million) and deaths (274 000) were concentrated in 11 countries: 10 in Africa (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania) and India. There were 3.5 million more malaria cases reported in these 10 African countries in 2017 compared to the previous year, while India, however, showed progress in reducing its disease burden.
Despite marginal increases in recent years in the distribution and use of insecticide-treated bed nets in sub-Saharan Africa – the primary tool for preventing malaria – the report highlights major coverage gaps. In 2017, an estimated half of at-risk people in Africa did not sleep under a treated net. Also, fewer homes are being protected by indoor residual spraying than before, and access to preventive therapies that protect pregnant women and children from malaria remains too low.
High impact response needed
In line with WHO’s strategic vision to scale up activities to protect people’s health, the new country-driven “High burden to high impact” response plan has been launched to support nations, with most malaria cases and deaths. The response follows a call made by Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, at the World Health Assembly in May 2018 for an aggressive new approach to jump-start progress against malaria. It is based on four pillars:
• Galvanising national and global political attention to reduce malaria deaths;
• Driving impact through the strategic use of information;
• Establishing best global guidance, policies and strategies suitable for all malaria endemic countries; and
• Implementing a coordinated country response.
Catalysed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be easily prevented and diagnosed, and that is entirely curable with available treatments.
“There is no standing still with malaria. The latest World malaria report shows that further progress is not inevitable and that business as usual is no longer an option,” said Dr. Kesete Admasu, CEO of the RBM Partnership.
Signs and symptoms
A malaria infection is generally characterised by the following signs and symptoms: fever, chills, headache, nausea and vomiting, and muscle pain and fatigue.
Other signs and symptoms may include: sweating, chest or abdominal pain and cough.
Some people who have malaria experience cycles of malaria “attacks.” An attack usually starts with shivering and chills, followed by a high fever, followed by sweating and a return to normal temperature.
Malaria signs and symptoms typically begin within a few weeks after being bitten by an infected mosquito. However, some types of malaria parasites can lie dormant in your body for up to a year.
Malaria home remedies/home cure
Artemisia Annua: Also known as sweet wormwood is one of the most effective natural remedies for malaria. The herb has to be steeped in cold water, and the water should be consumed directly in order to get optimum results.
Cinnamon: Cinnamon is a valuable remedy for treating malaria. One teaspoon of powdered cinnamon should be boiled in a glass of water with a pinch of pepper powder and a teaspoon of honey. This needs to be taken every day, which is a beneficial medicine for malaria.
Diagnosis and treatment
Olalekan said: “With proper treatment, symptoms of malaria usually go away quickly, with a cure within two weeks. Without proper treatment, malaria episodes (fever, chills, sweating) can return periodically over a period of years. After repeated exposure, patients will become partially immune and develop milder disease.
“Patients who have severe malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion. Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include the following: Chloroquine. Atovaquone-proguanil (Malarone).”
To diagnose malaria, your doctor will likely review your medical history, conduct a physical exam and order blood tests. Blood tests are the only way to confirm a malaria diagnosis. Certain blood tests can help your doctor by showing:
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
Other blood tests help determine 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.
Malaria is treated with prescription drugs to kill the parasite. The types of drugs and the length of treatment will vary, depending on:
• Which type of malaria parasite you have;
• The severity of your symptoms;
• Your age;
• Whether you›re pregnant.
Medication
The most common antimalarial drugs include:
Artemisinin-based combination therapies (ACTs). ACTs are, in many cases, the first line treatment for malaria. There are several different types of ACTs. Examples include artemether-lumefantrine (Coartem) and artesunate-amodiaquine. Each ACT is a combination of two or more drugs that work against the malaria parasite in different ways.
Chloroquine phosphate. Chloroquine is the preferred treatment for any parasite that is sensitive to the drug. However, in many parts of the world, the parasites that cause malaria are resistant to Chloroquine, and the drug is no longer an effective treatment.
Other common antimalarial drugs include:
• Combination of atovaquone and proguanil (Malarone)
• Quinine sulfate (Qualaquin) with doxycycline (Vibramycin, Monodox, others)
• Mefloquine
• Primaquine phosphate
Possible future treatments
New antimalarial drugs are being researched and developed. Malaria treatment is marked by a constant struggle between evolving drug-resistant parasites and the search for new drug formulations. For example, one variety of the malaria parasite has demonstrated resistance to nearly all of the available antimalarial drugs.
Prevention
If you are travelling to a location where malaria is common, talk to your doctor a few months ahead about whether you should take drugs before, during and after your trip to help protect you from malaria parasites.
In general, the drugs taken to prevent malaria are the same drugs used to treat the disease. Your doctor needs to know when and where you will be travelling so that he or she can help you evaluate your risk for infection and, if necessary, prescribe the drug that will work best on the type of malaria parasite most commonly found in that region.
Also, if you live in an area where malaria is common, take steps to avoid mosquito bites. Mosquitoes are most active between dusk and dawn. To protect yourself from mosquito bites, you should:
Cover your skin: Wear pants and long-sleeved shirts.
Apply insect repellant to skin and clothing: Sprays containing DEET can be used on skin and sprays containing Permethrin are safe to apply to clothing.
Sleep under a net: Bed nets, particularly those treated with insecticide; help prevent mosquito bites while you are sleeping.
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.
Complications
Malaria can be fatal, particularly that caused by the variety of parasite that’s common in tropical parts of Africa. The Centers for Disease Control and Prevention (CDC) estimates that 91 per cent of all malaria deaths occur in Africa, most commonly in children under the age of 5.
In most cases, malaria deaths are 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 cause your kidneys or liver to fail, or your spleen to rupture. Any of these conditions can be life-threatening.
• Anemia: Malaria damages red blood cells, which can result in anemia.
• Low blood sugar: Severe forms of malaria itself can cause low blood sugar (hypoglycemia), as can quinine — one of the most common medications used to combat malaria. Very low blood sugar can result in coma or death.
How malaria kills:
If drugs are not available or if the parasites are resistant to them, malaria infection can develop to anemia, hypoglycemia or cerebral malaria, in which capillaries carrying blood to the brain are blocked. Cerebral malaria can cause coma, life-long-learning disabilities and death.
However, reductions in malaria cases have stalled after several years of decline globally, according to the new world malaria report 2018. To get the reduction in malaria deaths and disease back on track, WHO and partners are joining a new country-led response to scale up prevention and treatment, as well as increased investment, to protect vulnerable people from the deadly disease.
For the second consecutive year, the annual report produced by WHO reveals a no significant change in numbers of people affected by malaria. In 2017, there were an estimated 219 million cases of malaria, compared to 217 million the year before. But in the years prior, the number of people contracting malaria globally had been steadily falling, from 239 million in 2010 to 214 million in 2015.
“Nobody should die from malaria, but the world faces a new reality. As progress stagnates, we are at risk of squandering years of toil, investment and success in reducing the number of people suffering from the disease,” says Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.
“We recognise we have to do something different – now. So we are launching a country-focused and -led plan to take comprehensive action against malaria by making our work more effective where it counts most – at local level,” he said.