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INTRODUCTION
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Malaria is a potentially life threatening parasitic disease. caused by
parasites known as Plasmodium viviax (P.vivax), Plasmodium falciparum
(P.falciparum), Plasmodium malariae (P.malariae) and Plasmodium
ovale (P.ovale)
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It is
transmitted by the infective bite of Anopheles mosquito
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Man
develops disease after 10 to 14 days of being bitten by an infective
mosquito
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There
are two types of parasites of human malaria, Plasmodium vivax, P.
falciparum, which are commonly reported from India.
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Inside
the human host, the parasite undergoes a series of changes as part of
its complex life cycle. (Plasmodium is a protozoan parasite)
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The
parasite completes life cycle in liver cells (pre-erythrocytic
schizogony) and red blood cells (erythrocytic schizogony)
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Infection with P.falciparum is the most deadly form of malaria.
HISTORICAL PERSPECTIVE
Malaria
has been a major public health problem in India. Intermittent fever, with
high incidence during the rainy season, coinciding with agriculture,
sowing and harvesting, was first recognized by Romans and Greeks who
associated it with swampy areas. They postulated that intermittent fevers
were due to the ‘bad odour’ coming from the marshy areas and thus gave the
name ‘malaria’ (‘mal’=bad + ‘air’) to intermittent fevers. In spite of the
fact that today the causative organism is known, the name has stuck to
this disease.
MAGNITUDE OF THE PROBLEM
1.87 million
cases of malaria (including 0.86million P.falciparum cases) and 1006
deaths were reported from the country in 2003.
Provisional data for the year 2004 reveals
that the largest numbers of cases in the country were reported by Orissa, followed by Gujarat, Chhattisgarh, West Bengal, Jharkhand,
Karnataka, Uttar Pradesh and Rajasthan and the largest numbers of deaths were reported by Orissa,
followed by West Bengal, Mizoram, Jharkhand, Meghalaya, Karnataka, Tripura
and Assam.
SYMPTOMS OF MALARIA
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Typically, malaria produces fever, headache, vomiting and other flu-like
symptoms.
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The
parasite infects and destroys red blood cells resulting in easy
fatigue-ability due to anemia, fits/convulsions and loss of
consciousness.
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Parasites are carried by blood to the brain (cerebral malaria) and to
other vital organs.
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Malaria in pregnancy poses a substantial risk to the mother, the fetus
and the newborn infant. Pregnant women are less capable of coping with
and clearing malaria infections, adversely affecting the unborn fetus.
SYMPTOMS OF SEVERE AND COMPLICATED MALARIA
The
priority requirement is the early recognition of signs and symptoms of
severe malaria that should lead to prompt emergency care of patient.
The signs and symptoms that can be used are non-specific and may be due to
any severe febrile disease, which may be severe malaria, other severe
febrile disease or concomitant malaria and severe bacterial infection.
The
symptoms are a history of high fever, plus at least one of the
following:-
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Prostration (inability to sit), altered
consciousness lethargy or coma
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Breathing difficulties
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Severe anaemia
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Generalized convulsions/fits
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Inability to drink/vomiting
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Dark and/or limited production of urine
Patients
with prostration and/or breathing difficulties should, if at all possible,
be treated with parenteral antimalarials and antibiotics. Oral treatment
should be substituted as soon as reliably possible. Frequent monitoring
of laboratory parameters is essential – blood sugar, blood urine, fluid balance,
associated infection, etc. Drugs that increase gastro intestinal bleeding
should be avoided.
SIGNS OF SEVERE AND COMPLICATED MALARIA
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Cerebral malaria, defined as unarousable coma not attributable to any
other cause in a patient with falciparum malaria.
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Generalized convulsions.
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Normocytic anaemia.
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Renal
failure.
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Hypoglycaemia.
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Fluid,
electrolyte and acid-base disturbances.
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Pulmonary oedema.
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Circulatory collapse and shock (“algid malaria”).
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Spontaneous bleeding (disseminated intravascular coagulation).
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Hyperpyrexia.
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Hyperparasitaemia.
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Malarial haemoglobinuria.
RISK FOR SEVERE COMPLICATIONS
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In
areas of low transmission – all age groups are vulnerable but adults
develop more severe and multiple complications. The transmission
pattern in most parts of India is usually low, but intense transmission
is seen in north-eastern states and large areas of Orissa, Chattisgarh,
Jharkhand and Madhya Pradesh.
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In
areas of high transmission – children below 5 years, visitors, migratory
labour.
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Association of pregnancy-pregnant women are less capable of coping with and clearing malaria
infections, adversely affecting the unborn fetus.
LIFE CYCLE OF MALARIA PARASITE IN MAN AND MOSQUITO
Trend of Malaria Cases and Deaths in India
VECTORS OF MALARIA
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There
are many vectors of malaria
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Anopheles culicifacies
is the main vector of malaria
in rural India and Anopheles stephensi in urban India
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Anopheles minimus is an efficient vector in the North-Eastern region
and Anopheles fluviatilis in hill and foot hill areas.
1. Feeding
habits
2. Resting
habits
3. Breeding
places
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Breeds
in rainwater pools and puddles, borrowpits, river bed pools, irrigation
channels, seepages, rice fields, wells, pond margins, sluggish streams
with sandy margins.
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Extensive breeding is generally encountered following monsoon rains.
4. Biting
time
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Biting
time of each vector species is determined by its generic character, but
can be readily influenced by environmental conditions.
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Most
of the vectors, including Anopheles culicifacies, start biting
soon after dusk. Therefore, biting starts much earlier in winter than in
summer but the peak time varies from species to species.
MALARIA CONTROL STRATEGIES
1.
Early case Detection and Prompt Treatment (EDPT)
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EDPT
is the main strategy of malaria control – radical treatment is necessary
for all the cases of malaria to prevent transmission of malaria.
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Chloroquine is the main anti-malaria drug for uncomplicated malaria.
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Drug
Distribution Centres (DDCs) and Fever Treatment Depots (FTDs) have been
established in the rural areas for providing easy access to
anti-malarial drugs to the community.
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Alternative drugs for chloroquine resistant malaria are recommended as
per the drug policy of malaria.
2.
Vector Control
(i)
Chemical Control
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Use of
Indoor Residual Spray (IRS) with insecticides recommended under the
programnme
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Use of
chemical larvicides like Abate in potable water
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Aerosol space spray during day time
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Malathion fogging during outbreaks
(ii)
Biological Control
(iii)
Personal Prophylatic Measures that individuals/communities can take up
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Use of
mosquito repellent creams, liquids, coils, mats etc.
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Screening of the houses with wire mesh
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Use of
bednets treated with insecticide
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Wearing clothes that cover maximum surface area of the body
4.
Community Participation
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Sensitizing and involving the community for detection of Anopheles
breeding places and their elimination
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Involving
NGOs in programme strategies
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Collaboration with CII/ASSOCHAM/FICCI
5.
Environmental Management & Source Reduction Methods
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Source
reduction i.e. filling of the breeding places
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Proper
covering of stored water
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Channelization of breeding source
6.
Monitoring and Evaluation of the programme
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Monthly
Computerized Management Information System (CMIS)
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Field
visits by State and National Programme Officers
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Field
visits by Malaria Research Centres and other ICMR Institutes
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Feedback to states on field observations for corrective action.
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