Presentation on World Malaria Day, 2013

1. WORLD MALARIA
DAY
(25th April, 2013)
Md. Kabiul Akhter Ali
VBD Consultant
Malda

2. World Malaria Day - April 25
 Malaria remains a killer disease with nearly
1 million people losing their lives every
year. Eighty five per cent of deaths are
children under 5 years of age.
 Most malaria cases occur in Africa but it
nevertheless remains a global problem
also affecting countries in large parts of
Asia and Latin America.

3. Importance of
World Malaria Day
 World Malaria Day was established in May 2007
by the 60th session of the World Health
Assembly, the decision-making body of the
World Health Organization (WHO). The day was
established to provide education and
understanding of malaria and disseminate
information on malaria-control strategies,
including community-based activities for malaria
prevention and treatment in endemic areas.

4. Past World Malaria Day Themes
•2008: Malaria – a disease without borders
•2009: Counting malaria out
•2010: Counting malaria out
•2011: Achieving progress and impact
•2012: Sustain Gains,Save Lives: Invest in
Malaria

5. INVEST IN THE FUTURE :
DEFEAT MALARIA
World Malaria Day Theme, 2013

6. Malaria – Early History
 The symptoms of
malaria were
described in ancient
Chinese medical
writings. In 2700 BC,
several characteristic
symptoms of what
would later be named
malaria were
described in the Nei
Ching,

7. Hippocrates and Malaria
 Hippocrates, a
physician born in
ancient Greece, today
regarded as the
"Father of Medicine",
was the first to
describe the
manifestations of the
disease, and relate
them to the time of
year and to where the
patients lived.

8. Malaria
 Name is derived from Italian
Mal’ aria or bad air
Malaria continues to be most important
cause of fever and morbidity in the
Tropical world
Malaria has been eradicated from Europe,
Most of North America, USA South
America Korea and Japan,

9. Malaria-endemic Areas
2000

10. MALARIA AND THE WORLD

11. Why it is important in Medicine
 Malaria remains the world's most
devastating human parasitic
infection. Malaria affects over 40%
of the world's population. WHO,
estimates that there are 350 - 500
million cases of malaria worldwide,
of which 270 - 400 million are
Falciparum malaria, the most severe
form of the disease.

12. Malaria Kills more people than
AIDS
 Malaria kills in one year what AIDS
kills in 15 years. For every death due
to HIV/AIDS there are about 50
deaths due to malaria. To add to the
problem is the increasing drug
resistance to the established drug.

13. History – Events on Malaria
 1880 - Charles Louis Alphose Lavern
discovered malarial parasite in wet mount
 1883 - Methylene blue stain - Marchafava
 1891 - Polychrome stain- Romanowsky
 1898 - Roland Ross - Life cycle of parasite
transmission, wins Nobel Prize in 1902
 1948 - Site of Exoerythrocytic development in
Liver by Shortt and Garnham

14. Major Developments in 20th
Century
 1955 - WHO starts world wide malaria
eradication programme using DDT
 1970 – Mosquitos develop resistance to
DDT Programme fails
 1976 – Trager and Jensen in vitro
cultivation of parasite

15. Charles Louis Alphonse
Laveran,
 Charles Louis Alphonse
Laveran, a French army
surgeon stationed in
Constantine, Algeria, was
the first to notice
parasites in the blood
of a patient suffering
from malaria. This
occurred on the 6th of
November 1880. For his
discovery, Laveran was
awarded the Nobel
Prize in 1907.

16. Ronald Ross
 In August 20th, 1897,
Ronald Ross, a British
officer in the Indian
Medical Service, was the
first to demonstrate that
malaria parasites could
be transmitted from
infected patients to
mosquitoes For his
discovery, Ross was
awarded the Nobel
Prize in 1902.

17. Nobel Prizes in Malaria
 The discovery of this
parasite in mosquitoes
earned the British
scientist Ronald Ross the
Nobel Prize in Physiology
or Medicine in 1902. In
1907, Alphonse Lavern
received the Nobel prize
for his findings that the
parasite was present in
human blood.

18. Parasites Cause of Malaria
 Malaria is caused by an infection by
one of four single celled Plasmodia
species, they are: falciparum,
vivax, malariae, and ovale. The
most dangerous of
the four is:
P.falciparum

19. Newer species of Mosquito
 A fifth species,
Plasmodium
knowlesi, causes
malaria in humans.

25. Malaria the disease
 9-14 day
incubation
period
 Fever, chills,
headache, back
and joint pain
 Gastrointestinal
symptoms
(nausea,
vomiting, etc.)

26. Malaria stages of the
disease

27. Malaria intensifies
 Symptoms intensify
 Irregular high fever
 Anxiety, delirium and
other mental problems
 Sweating, increased
pulse rate, severe
exhaustion
 Enlarged spleen and liver

28. Malaria the disease

29. Malaria A Major Health
problem of Tropical countries

30. Pernicious Malaria
 Is a life threatening complication in acute
falciparum malaria
 It is due to heavy parasitization
 Manifest with
1 Cerebral malaria – it presents with
hyperpyrexia, coma and paralysis. Brain is
congested
2 Algid malaria – presents with clammy skin
leading to peripheral circulatory failure.

31. Complication in Malaria
 Pulmonary edema (fluid buildup in the
lungs) or acute respiratory distress
syndrome (ARDS), which may occur even
after the parasite counts have decreased
in response to treatment
 Abnormalities in blood coagulation and
thrombocytopenia (decrease in blood
platelets)
 Cardiovascular collapse and shock

32. Black water Fever
 It is a manifestation of infection with
P.falciparum occuring in persons who have been
previously infected and have had been
inadequate dose of quinine
 It is characterized by intravascular hemolysis
fever, and Haemoglobunuria
 Cardiovascular collapse and shock
 Abnormalities in blood coagulation and
thrombocytopenia (decrease in blood platelets)

33. Other Complications In Malaria
 Acute kidney failure
 Hyperparasitemia, where more than 5% of
the red blood cells are infected by malaria
parasites
 Metabolic acidosis (excessive acidity in the
blood and tissue fluids), often in
association with hypoglycemia

34. World Health Organization
Recommends
 In endemic areas, the World Health
Organization recommends that treatment
be started within 24 hours after the first
symptoms appear. Treatment of patients
with uncomplicated malaria can be
conducted on an ambulatory basis
(without hospitalization) but patients with
severe malaria should be hospitalized if
possible.
 Doctortvrao’s ‘e’ learning series

35. What is Presumptive
Treatment?
 Presumption - In an area with high transmission of
malaria, it should be presumed that ALL cases of fever
are due to malaria.
 Treatment - First loading dose of Chloroquine should
be administered immediately after collecting the blood
specimen, even without waiting for its report.
 If the fever is indeed malaria, this treatment alleviates
symptoms early, may be well before the test result is
available.
 If it is malaria, Chloroquine also prevents the spread of
malaria by destroying the gametocytes of P. vivax (the
more common malaria).
 If it is not malaria, nothing is lost, for Chloroquine at this
dose is safe and has no adverse effects!

36. Radical treatment
 Radical treatment is administration of Primaquin
to all confirmed cases of malaria.
 In P. vivax malaria, 2 weeks' therapy with
Primaquin completely cures the infection in the
host by its tissue schizonticidal activity and
thereby prevents relapses.
 In P. falciparum malaria, a single dose of
primaquine destroys the gametocytes, thereby
prevents the spread of the infection into the
mosquito.

37. Use of Primaquine
Primaquine is active against the dormant
parasite liver forms (hypnozoites) and
prevents relapses. Primaquine should not
be taken by pregnant women or by people
who are deficient in G6PD (glucose-6-
phosphate dehydrogenase). Patients
should not take primaquine until a
screening test has excluded G6PD
deficiency.

38. Resistance to Chloroquine -
1960

39. Resistance to Chloroquine
- 1970

40. Resistance to Chloroquine - 1980

41. Resistance to Chloroquine -
2000

42. Anti-malarials Resistance –
1998 (excluding CQ)
SP, Mefloquine, Halofantrine,
Quinine
SP
Mefloquine
SP, Mefloquine

43. Reports of Chloroquine
Resistance in P.vivax
19891990
1995
1995
1991
1995

44. Future Ambitions
 The malaria vaccine community aims to
license—by 2015—a first-generation vaccine that
has 50 percent efficacy against severe disease
and death, with protection lasting at least one
year without the need for boosting. They also
aim to license—by 2025—a second-generation
malaria vaccine that has a protective efficacy of
at least 80 percent against clinical disease and
with protection lasting for many years without a
booster.

46. Goals to achieve : Control Malaria
 Sustaining malaria control efforts is an investment in
development. Continued investment in malaria control now will
propel malaria-endemic countries along the path to achieving
the 2015 Millennium Development Goals, especially those
relating to improving child survival and maternal health,
eradicating extreme poverty and expanding access to
education.
 Just by scaling up efforts to prevent malaria, including universal
coverage of mosquito nets, WHO estimates that three million
African children can be saved by 2015, while many more lives
can be saved through a combination of proven and innovative
malaria control tools including access to effective prevention,
accurate diagnosis and prompt, reliable anti-malaria treatment
 Successful malaria control has a dramatic impact on the health,
productivity and well-being of people living in malaria risk
areas.