Here i have disscussed about the prevention and cure of malariya

1. MALARIA
Sriloy Mohanty
2nd sem,BNYS
S-VYASA

2. Contents…
• Introduction • Vector of malaria
• Problem statement • Mode of transmission
• Epidemiological • Incubation period
determinants • Clinical features
• Life cycle • Diagnosis
• Host factor • Control
• Environmental factor • Global policy for diagnosis and
treatment of malaria
• Malaria vaccine

3. Introduction
• It is a protozoal disease
• Infected with parasite of the genus Plasmodium
• Transmits to man mainly by female Anopheline
mosquito
• Attack occurs in three stages

4. Problem statement (world)
• 109 countries are endemic for malaria
• 3.3 billion people were at risk of malaria in 2006
• 1.2 billion at higher risk(WHO African and SE Asia)
• 247 episodes of malaria in 2006
• 8,81,000 deaths in 2006,of this 91% in Africa, among
them 85% were children under 5yrs
• Childhood death occurs mainly due to cerebral
malaria and anemia

5. Cont.…(India)
• It is a major problem in India
• Mainly falciparum is prone
• About 27% people lives in high transmission area
• 53% people live in low transmission area
• Most affected states are-
Chhatisgrah,Jharkhand, Madhya Pradesh, Andra
Pradesh, Odissa, Maharasta Karnataka, Gujurat And
West Bengal

7. Epidemiological types of malaria
• Tribal malaria
– About 44 million population of tribal area contrbute about
50% of cases
– Infants,pregnant women, and young children are at high risk
• Rural malaria
– It includes irrigated areas arid and semi-aridplains of
hariyana panjab and plain desert areas and subcostal areas
• Urban malaria
– Major 15 cities including 4 metropolitan cities covers about
80% of malaria cases covered in rural malaria

8. • Malaria in project area
– Means construction and developmental activites are taken
up
– It provides vector breeding place, increased man-mosquito
contact
• Border line malaria
– High transmission malaria belt along with international and
state borders
– B’coz of mixing of population
– Poor administrative control

9. Epidemiological determinant
• Agent
– Caused by 4 species
• P.vivax(widest geographic distribution,in india 70% infection)
• P.falcifarum(25-30% infections)
• P.malariae(less then 1% infection,karnataka)
• P.ovale(very rare)

10. Lifecycle…

11. • Reservoir of infection
– Infection Chimpanzees in tropical Africa
– No other animals are reservoirs
– Human is a reservoir
– Children are more likely to be gametocyte carriers

12. • Period of communicability
– Malaria is communicable as long as mature, viable
gametocytes in the circulating blood in sufficient density to
infect vector mosquitoes
– In vivax infection-gametocytes appears in blood in 4-5 days
– In falcifarum infections gametocytes appear after 10-12
days
– The gametocytes always appear after the asexual lifecycle
of the parasites
– Gametocytes mainly found in the peripheral blood
•

13. • Relapse
– Usual for vivax and ovale malariato relapse more then 3
years after the first attack(due to original, sporozoit
induced, liver schizonts)
– Recurrence of falciparum malaria usually disappear after 1-
2 years
– P.malaria has a tendency to caused prolonged low-level
asymptomatic parasitaemia(persist for 40yrs)
– In p.falciparum and p.malaria is due to chronic blood
infection

14. Host factor
• Age
– Affects all age
– Infants have resistant to infection with p.palcifarum due to high
concentration of hemoglobin during first few months
• Sex
– Males are more exposed to the risk of acquiring malaria then
female
• Race
– indivisuals with sickle-cell trait have milder illness to falciparum
then those do normal heamoglobin

15. • Pregnancy
– Increased risk
– May cause intrauterine death,abortion
– Primigravid women are at higher risk

16. `
• Socio-Economic Devlopment
– Malaria has disappeared from socio-economic development
– Because of the improved sanitation
• Housing
– If the house have ill-ventilated and ill-lighted provide ideal indoor
resting place for mosquito
• Population mobility
– Migration from one place to another
– Labors connected with engineering, irrigation, agricultural and
other projects and periodic migration of wondering tribes

17. • Occupation
– It is predominantly a rural disease
– Closely related to agriculture practice
• Human habitat
– Sleeping outdoors, not using bed nets, refusal to accept spraying
in house, plastering the walls after spraying
• Immunity
– Immunity in human is Acquired after repeated exposure over
several years
– Infants born from immune mothers are protected by the maternal
IgG antibody during 3-5 months

18. Environmental factors
• Season
– Maximum in between july-november
• Temperature
– Affects the life cycle of the malaria parasite
– Optimum temp. is 20-30*C in the insect vector
– If the temp.is bellow 16* C then parasite development ceases and
above 30* is lethal to the parasite
• Humidity
– Direct effect o n life span of the mosquito, but not in the mosquito
– Relative humidity of 60%is considered necessary for the mosquito

19. • Altitude
– In high altitudes above 2000-2500m due to unfavorable
conditions anophelines mosquitos are not found
• Rainfall
– Provides opportunities for the breeding of the mosquitoes
and may give rise to endemic of malaria
– However heavy rain may have adverse effect
• Man made malaria
– Burrow pits, garden pools, irrigation channels, engineering
projects have led to the breeding of mosquito

20. Vector of malaria
• 45 species of Anopheline mosquitos in India
• Few are regarded as vector of primary importance
• Those are
– An.culicifaciaes(vector of rural area)
– An.fluviatilts
– An.stephensi(vectors of urban areas)
– An.minimus
– An.phillipinensis
– An.sundicus
– An.maculatus

21. • Main factors which determines the vectorial
importance of mosquitoes are
– Density
– Life span
– Choice of host(An.culicifaciaes in india,2-80%)
– Resting habitat
– Breeding habitats
– Time of biting
– Resistance to insecticides

22. Mode of transmission
• Vector transmission
– By mosquito bite
• Direct transmission
– Blood transfusion, they can live for 14 days in blood bottles
under -4*C
• Congenital transmission
– Mother to newborn

23. Incubation period
• 12 (9-14)days for farucifarum malaria
• 14 (8-17)days for vivax malaria
• 28 (18-40)days for quartan malaria
• 17 (16-18)days for ovale malaria

24. Clinical features
• The peaks of fever coincide with the release into
blood stream
• Typical attack comprises in three stages
– Cold stage
• Lasts for 1hr
• Onset with headache, nausea and chilly sansation
• Temp. rises upto 39-41*C

25. Hot stage
Lasts for 2-6hrs
Feels burning hot and casts off his cloths
Skin becomes hot and dry
Respiration is high
Sweating stage
Lasts for 3-4hrs
Fever comes down with profuse sweating
Skin becomes normal and cool

26. • P.vivax infection symptoms are same but more
regularly divide into hot and cold stage
• P.malariae attack resembles to P.vivax but the cycle
is of 72hrs instead of 48hrs
• P.ovale infection is same as P.vivax infection but can
cease after a few paroxysms even if no treatment is
given

27. Diagnosis
• Demonstration of the parasite in the blood
– Two types of blood films are needed
– Thick for searching the parasite
– Thin is for identifying the species
• Malaria fluorscent antibody test
– Usually becomes positive after primary infection is cured
– It is not for a current case
– It helps in epidemic studies

28. Control
• National Drug Policy on Malaria,2007
– Emphasis on complete treatment in diagnosed cases of
malaria rather then one single dose presumptive treatment
to suspect the case of malaria to avoid choloroquine
resistance in p.palcifarum
– The first line of treatment is choloroquine

29. Sever and complicated malaria
• Choice of antimalarial is quinine injection
– 10mg/kg body wt.
– I.V drip in 5% dextrose saline to be runover 4hrs
– Total duration of treatment is of 7 days
• Injectable form of artemisinine derivatives may be
used for the management of the sever complicated
malaria in adult and non-pregnant women only
• The recommended injectable dosages are…
•

30. • Artesunate
– 2.4mg/kg bw
– IM or IV followed by 1.2mg/kg bw once daily for 4 days
– Total duration is 5 days
• Artemether
– 1.6mg/kg bw
– IM followed by 1.6mg/kg bw daily for total 6 injection or
twice for 3 days

31. • Artether
– 150mg daily IM for 3 days
– Only for adult
• Artemisinine
– 10mg/kg bw at 0 and 4 hours followed by 7mg/kg bw at
24,36,48 and 60 hours

32. Toxic hazards of drugs
• Choloroquine has few side effects like nausea
vomiting blurrading of vision headach
• Cases of retinal damage has been reported but only
in a person exposed to large comulative dose over
many years
• Choloqeiune should not give to empty stomach

33. • Symptoms may be of three types
– Plasmosid types
• Rare toxic manifestation involving the CNS
– Gastrointestinal
• Cramps,nausea and vomiting
– Cardiovascular
• Most serious toxic menifestation

34. Mass drug administration
• It is recommended for highly infected endemic areas
• It is not recommended to children under 5 b’coz
– Impossible to achieve continuous suppression in a
significant proportion of the population
– Interfere in the development of promotive immunity
– May accelerate devlopment of drugs resistance
– May increase the risk of retinopathy

35. Chemoprophylaxis
• It is recommended for the travellers from non
endemic areas and as a short term measure for
soldiers, police and labour forces serving in highly
endemic area
• The risk of serious side effects associated with long
term prophylactic use of chloroquine and proguanil is
low
• Anyone who has taken 300mg chloroquine weekly
for over 5 yrs and require further prophylaxis should
be screened twice yearly for early retinal changes

36. • If daily dose of 100mg chloroquine have been taken
screening should start after 3 yrs
• Pregnant women living in areas where transmission
is very intens may lead to parasitaemia, causing low
birth weight, anemia

37. Active intervention measures
• Stratification of problem
• Vector control strategy
– Anti-adult measures
• Residual spray
– Spraying indoor surface of house
– DDT is discovered in 1940
– Most effective measure to kill the mosqueto
• Space application
– Major anti-epidemic measure
– Involves application of pestisidesin the form of fug or mist using
special equipments

38. • Individual protection
– Man-vector contact can be reduce by
• Using nets, protecting cloth, coils, repellents
• Anti-larval measure
– Larvicides
• Using the anti larval measures such as oiling the
collection of standing water or dusting them with paris
green effectively controlled malaria
• Some moderm larvicides such as temephos which
confer long effect with low toxicity are more widely used

39. Source reduction
• Techniques to reduce mosquito breeding sites which
includes drainage or filling, deepening or
flushing, management of water level, changing the
salt content of water and intermittent irrigation are
the classical methods of malaria control

40. • Integrated control
– In order to reduce too much dependence residual
insecticides, increasing emphasis is being put on
integrated vector control methodology which
includes bio-environmental and personal
protection measure

41. Global policy for diagnosis and treatment of malaria
• The Govt of every country affected by malaria has a
National control policy covering prevention and case
management
• Objectives are
– Ensure rapid cure of infection
– Reduce morbidity and mortality, including malarial related
anemia
– Prevent the progression of uncomplicated malaria into
severe disease
– Reduce the impact of malarial infection on the fetus during
pregnancy

42. • Reduce the reservoir infection
• Prevent the emergence and spreading of drug
resistance and prevent malaria in travellers

43. • There are many organization which have worked to
established the goals of WHO are
– Roll Back Back malaria (1998)
– United nations millenium declaration (2000)
– Abuja declaration of african heads of state(2000)
– World Health Assembly (2005)
– RBM global statergy plan 2005-2015

44. Malaria vaccine
• Vaccination against malaria is a burning issue today
• Several vaccine candidates are now being tested in
africa, asia and US
• A vaccine developed in columbia (SPF 66) advanced
to phase 3 trials in africa but failed to show efficacy
in chiildren under 1
• Another vaccine (RTS, S/AS02) with the potential to
prevent infection and ameliorate disease is being
tested by GlaxoSmithKline and the MVI at PATH in
Phase I trial in Gambia

45. • In phase II in 2002 trials of the vaccine are being
conducted among the children in
Mozambique, which suffers from year-round malaria
transmission offering a better opportunity to evaluate
vaccine performance
• This vaccine has been safely tested in adult
volunteeers in Belgium, Gambia, kenya and US
• only potential malarial vaccine

46. Thank you…