MALARIA

Depertment of Public Health

North South University

INTRODUCTION Malaria is a mosquito-borne infectious disease. Four species of protozoan parasite of the

genus Plasmodium that are relevant for human infection:

1. P. falciparum 2. P. vivax 3. P. ovale 4. P. malariae P. vivax is the most widespread malaria

infection in the world.P. falciparum causes the most severe malaria disease in the world and is responsible for the most deaths and morbidity.

LIFE CYCLE

LIFE CYCLE The parasite undergoes several transformations with both the human

host (intermediate) and mosquito host (definitive) Transmitted to humans as sporozoites from the saliva of an infected

female mosquito Sporozoites enter the venous blood system from the subcutaneous

tissues by way of the capillary bed and can invade liver cells within minutes if they successfully evade the reticuloendothelial defenses

Over the next 5 to 15 days, each sporozoite nucleus replicates thousands of times within the liver cells to form a hepatic schizont within the liver cells

When released from the swollen liver cells, each schizont splits into tens of thousands of daughter parasites called merozoites

Merozoites attach to specific erythrocyte receptors and enter the erythrocyte

Each intraerythrocytic meroziote differentiates into a trophozoite that ingests hemoglobin, enlarges, and then divides into 6 to 24 intraerythrocytic merozoites forming a schizont

The red cell swells and bursts, which releases the next batch of approximately 20 merozoites

Theses new merozoites then attach and penetrate new erythrocytes to begin the cycle again

CAUSES 1. The release of merozoites into the

bloodstream 2. Anemia resulting from the destruction of

the red blood cells 3. Large amounts of free hemoglobin being

released into circulation after red blood cells break open

RISK FACTORS African countries south of the Sahara

desert The Indian subcontinent Solomon islands, Papua New Guinea and

Haiti People at increased risk of serious disease

include: Young children and infants Travelers coming from areas with no

malaria Pregnant women and their unborn children

SYMPTOMS Anemia  Bloody stools Chills Coma  Convulsion Fever Headache Jaundice Muscle pain Nausea Sweating Vomiting

DIAGNOSIS In order to make a malaria diagnosis, the healthcare provider may ask a

number of questions concerning:

1.Current symptoms

2.Medical conditions

3.Family medical history

4.Current medications

5.Recent travel history.  A malaria diagnosis can be difficult to make, especially in areas where

malaria is not very common. A number of other conditions share similar symptoms with malaria. Some of these conditions the healthcare provider will consider before diagnosing malaria include:

The flu (influenza)

Common cold

Meningitis

Typhoid fever

Dengue fever

Acute schistosomiasis (disease caused by worms)

Bacteremia/septicemia (infection in blood)

Hepatitis

Viral gastroenteritis (stomach flu)

Yellow fever(disease typically transmitted by mosquitoes).

TESTS The doctor may suspect malaria based on the patient's

symptoms, and the physical findings at examination; however, to make a definitive diagnosis of malaria, laboratory tests must demonstrate the malaria parasites, or their components.

The best test available to diagnose malaria is called a blood smear. In this test, malaria parasites can be identified by examining a drop of the patient's blood under the microscope, spread out as a "blood smear" on a microscope slide. Prior to examination, the specimen (blood) is stained to give to the parasites a distinctive appearance.

COMPLICATIONSMalaria can be fatal, particularly the variety that's common in tropical parts of Africa. The Centers for Disease Control and Prevention estimate that 90 percent 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 of these serious complications:

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.

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.

Severe anemia. Malaria damages red blood cells, which can result in severe anemia.

Low blood sugar. Severe forms of malaria itself can cause low blood sugar, as can quinine — one of the most common medications used to combat malaria. Very low blood sugar can result in coma or death.

Recurrence may occur Some varieties of the malaria parasite, which typically cause milder forms of the disease, can persist for years and cause relapses.

MALARIA SITUATION IN BANGLADESH Malaria has been a major public health

problem in Bangladesh. Approximately 33.6% of the total

population are at risk of malaria Majority of malaria cases are reported from 13 out of the total 64 districts in the country.

About 4 million populations living in 34 upazillas of eight of the thirteen districts live in the epidemic-prone border areas

Focal outbreaks occur every year, and the response to control the epidemic is inadequate.

ISSUES AND CHALLANGES Inadequate access to treatment and diagnostic

facilities especially in the remote areas Inadequate programme management capacity at

various level and management of severe malaria in hospitals

Poor coverage of prevention and control methods (IRS, ITN/LLIN coverage still low) in the community

Referral system is weak and pre-referral treatment provisions are limited;

Optimum treatment of cases of severe malaria in different categories of hospitals are inadequate

Cross-border malaria at the Bangladesh India and Ban- Myanmar border

PARTNERS AND DONORS  WHO                                                  World Bank                Global fund      BRAC and 14 member NGO Consortium 4 Local NGOs in Chittagong Hill Tract(CHT)

TREATMENTSPreventing malaria - four steps

There is an ABCD for prevention of malaria. This is:

Awareness of risk of malaria. Bite prevention. Chemoprophylaxis (taking antimalarial

medication exactly as prescribed). Prompt Diagnosis and treatment.

MALARIA DRUGSThe 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

SPECIAL SITUATIONS Pregnant women are at particular risk of

severe malaria and should, ideally, not go to malaria-risk areas.

Non-pregnant women taking mefloquine should avoid becoming pregnant.

If you have epilepsy, kidney failure, some forms of mental illness, and some other uncommon illnesses, you may have a restricted choice of antimalarial medication.

Travellers going to remote places far from medical facilities sometimes take emergency medication with them.

MAKE SURE THAT YOUR MALARIA VACTINATION IS UP TO

DATE

THANK YOU