Hello T-Fans,

Today, let's look at a very common and deadly illness, Malaria. I am 100% sure that every person reading this has had Malaria at some point or the other. But how much do you know about this illness spread by our tiny neighbors, the mosquitoes?

MALARIA

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable. There are 5 parasite species that cause malaria in humans, and 2 of these species, Plasmodium falciparum, and vivax, pose the greatest threat.

TYPES

Malaria is usually classified as asymptomatic, uncomplicated, or severe. The severity is usually determined by which of the Plasmodium species is responsible for the ailment. The specifies include the following:

✓ Plasmodium falciparum (or P. falciparum)

✓ Plasmodium malariae (or P. malariae)

✓ Plasmodium vivax (or P. vivax)

✓ Plasmodium ovale (or P. ovale)

✓ Plasmodium knowlesi (or P. knowlesi)

And the types of Malaria they cause are as follows:

1. Asymptomatic malaria: can be caused by all Plasmodium species. The patient has circulating parasites but no symptoms.

2. Uncomplicated malaria: can be caused by all Plasmodium species. Symptoms generally occur 7-10 days after the initial mosquito bite. Symptoms are non-specific and can include fever, moderate to severe shaking chills, profuse sweating, headache, nausea, vomiting, diarrhea, and anemia, with no clinical or laboratory findings of severe organ dysfunction.

3. Severe malaria: is usually caused by infection with Plasmodium falciparum. Although less frequently, it can also be caused by Plasmodium vivax or Plasmodium knowlesi. Complications include severe anemia and end-organ damage, including coma (cerebral malaria), pulmonary complications, and hypoglycemia or acute kidney injury. Severe malaria is often associated with hyperparasitaemia (having more than 5% of the red blood cells infected with malaria parasites) and is associated with increased mortality.

4. Falciparum malaria: is potentially life-threatening. Patients with severe falciparum malaria may develop liver and kidney failure, convulsions, and coma. Although occasionally severe, infections with P. vivax and P. ovale generally cause less serious illness, but the parasites can remain dormant in the liver for many months, causing a reappearance of symptoms months or even years later.

How is Malaria Transmitted?

In most cases, malaria is transmitted through the bites of the female Anopheles mosquitoes. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.

Anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a blood meal to nurture their eggs. Each species of Anopheles mosquito has its own preferred aquatic habitat; for example, some prefer small, shallow collections of freshwater, such as puddles and hoof prints, which are abundant during the rainy season in tropical countries.

Transmission is more intense in places where the mosquito lifespan is longer (to give the parasite sufficient time for its development inside the mosquito) and where it prefers to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why approximately 90% of the world's malaria cases are in Africa.

The transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature, and humidity. In many places, the transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favor transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance, to find work, or as refugees.

Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.

What are the symptoms of malaria?
Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, Plasmodium falciparum malaria can progress to severe illness, and lead to death.

Children with severe malaria frequently develop one or more of the following symptoms: severe anemia, respiratory distress in relation to metabolic acidosis (increased amount of acid in the body), or cerebral malaria. In adults, multi-organ failure is also frequent. In malaria-endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.

Symptoms of uncomplicated malaria typically last 6 to 10 hours and recur every second day.

Some strains of the parasite can have a longer cycle or cause mixed symptoms. As symptoms resemble those of flu, they may remain undiagnosed or misdiagnosed in areas where malaria is less common. In uncomplicated malaria, symptoms progress as follows, through cold, hot, and sweating stages;

✓ fever, headaches, and vomiting

✓ a sensation of cold with shivering

✓ seizures sometimes occur in younger people with the disease

✓ sweats, followed by a return to normal temperature, with tiredness

In areas where malaria is common, many people recognize the symptoms as malaria and treat themselves without visiting a doctor.

Severe malaria

In severe malaria, clinical or laboratory evidence shows signs of vital organ dysfunction.

Symptoms of severe malaria include:

✓ fever and chills

✓ impaired consciousness

✓ prostration, or adopting a prone position

✓ multiple convulsions

✓ deep breathing and respiratory distress

✓ abnormal bleeding and signs of anemia

✓ clinical jaundice and evidence of vital organ dysfunction

Severe malaria can be fatal without treatment. People who get infected many times may have the disease but have few or no symptoms. How bad malaria symptoms are can vary depending on your age, general health, and the kind of malaria parasite that you have.

In rare cases, malaria can lead to impaired function of the brain or spinal cord, seizures, or loss of consciousness. The most serious types of malaria infection can be deadly.

When symptoms appear

The time from the initial malaria infection until symptoms appear (incubation period) is usually 7 to 30 days. But with infections from some parasite species, signs of illness may not appear for many months after exposure. For example, you may get a fever up to a year after traveling to a country where malaria is found.

The incubation period may also be longer if you are taking medicine to prevent infection. If you have some immunity due to previous infections, your symptoms may be less severe, or you may not have any symptoms.

Symptoms may appear in cycles. The time between episodes of fever and other symptoms varies with the specific parasite infection that you have.

PREVENTION

Vector control is the main way to prevent and reduce malaria transmission. If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.

WHO recommends protection for all people at risk of malaria with effective malaria vector control. Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying – are effective in a wide range of circumstances.

Insecticide-treated mosquito nets

Sleeping under an insecticide-treated net (ITN) can reduce contact between mosquitoes and humans by providing both a physical barrier and an insecticidal effect. Population-wide protection can result from the killing of mosquitoes on a large scale where there are high access and usage of such nets within a community.

In 2018, about half of all people at risk of malaria in Africa were protected by an insecticide-treated net, compared to 29% in 2010. However, ITN coverage has been at a standstill since 2016.

Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is another powerful way to rapidly reduce malaria transmission. It involves spraying the inside of housing structures with an insecticide, typically once or twice per year. To confer significant community protection, IRS should be implemented at a high level of coverage.

Antimalarial drugs

Antimalarial medicines can also be used to prevent malaria. For travelers, malaria can be prevented through chemoprophylaxis, which is the administration of a drug to prevent the development of a disease. In this case, it suppresses the blood stage of malaria infections, thereby preventing malaria disease.

For pregnant women living in moderate-to-high transmission areas, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine(trade name Fansidar or Fanlar) at each scheduled antenatal visit after the first trimester.

Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended, delivered alongside routine vaccinations.

TREATMENT

Treatment aims to eliminate the Plasmodium parasite from the bloodstream.

How is malaria treated?

Malaria is treated with medicine. Several things influence the choice of medicine. They include:

✓ Whether the medicine is being used to prevent or to treat malaria.

✓ Your condition (such as your age, your health, or whether you are pregnant).

✓ How sick you are from malaria.

✓ Whether the malaria parasite may be resistant to certain medicines.

✓ Side effects of the medicine.

Your age and health condition are important factors in selecting a medicine to prevent or treat malaria. Pregnant women, children, people who are very old, people who have other health problems, and those who didn't take medicine to prevent malaria infection need special consideration. Exchange blood transfusions may be considered for treating severe cases of malaria. They are the quickest way to remove parasites. Blood is taken from you at the same time that you receive donor blood. You also get medicine to treat the infection.

If you are going to areas where there is no medical care available, you can get medicine before you leave and carry it with you while you travel. Your doctor will give you instructions on how to use the medicine if you should get malaria symptoms. This is a short-term measure until you can get medical care. Seek medical care as soon as you can (ideally within 24 hours).

Make sure to take the necessary preventive measures against malaria. And if you happen to fall ill, seek medical attention immediately. Thank you for reading this far.