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Saturday, September 14, 2013

What is Malaria?

What is Malaria?

Malaria is a infectious disease transmitted by female mosquito, it is responsible for a good percentage of tropical febrile illnesses. Malaria as a disease has been around for a long time, ancient scrolls from china and the Roman Empire describe a disease with similar features as malaria. Malaria as a word originates from medieval Italian words – mala aria “bad air” as the romans thought that breathing in bad air transmitted malaria.  This is because people living in swamps and mashlands were afflicted more with the disease. The romans were not right but were not exactly wrong.

How is it transmitted?

As stated earlier, malaria is transmitted by the bite of the female anopheles mosquito, which introduces the malaria parasite into the blood stream of its victim. In the blood stream the parasite (Plasmodium. sp) travels to and infects various organs in the body. Once present in these organs the parasites replicates and releases its progeny in a cyclical fashion that is responsible for the fever, which characterizes this disease. There are about 5 different species of Plasmodium, which affect humans: P. vivax, P.malariae, P. ovale, P. faliciparum and P. knowlesi (a zoonotic specie). These parasites have their different geographical distributions, disease severity and/or presentation. In Africa and by extension Nigeria there is a predominance of P. falciparum infection. The vector (anopheles mosquito) breeds in stagnant water, which provides a habitat for its eggs. Tropical countries with its increase rainfalls and warm climates provide the ideal background for the vectors and as such the parasite.

What are the signs of malaria infections?

Following infection by the parasite, it travels in the blood stream and infects several organs depending on its tropism. Symptoms begin to appear 8-25 days following infections and are dependent on the affected organ. Infection of the blood (mostly the red blood cells) produces the cyclical fever, which results when infected red cells rupture and release its components. Similarly the rupture of the red cells will reduce their numbers and cause anemia (low red blood volume). Infection of the gastro-intestinal tracts (stomach and intestines) will cause either a diarrhea or constipation. Musculoskeletal infection causes bone and joint pain, nervous system infections – convulsions and headaches. Infections of the liver may lead to jaundice (yellow discolorations of the eyes). Not all the described symptoms will be present in all infected people; symptoms are dependent on the specie of the parasite and the competence of host immune system.

How to I confirm if I have malaria.

The diagnosis of malaria could be clinical (from symptoms) and/or laboratory based. For patents living in or recently visiting malaria endemic counties in the tropics a febrile illness should immediately suggest malaria. In as much as there are other causes of fever, the multi organ infection pattern of malaria makes it difficult to clearly distinguish it from other fever causing illness. There are several laboratory tests for the diagnosis of malaria, which ranges from the simple to the complex. The availability of test is dependent on the skill and resources available at the health institution. Simple tests like the observation of malaria parasite (plasmodium) in the red blood cells could quickly identify infected persons. Recently there has been an introduction of rapid tests, which detects parasite proteins in the blood. Despite these tests there are still some caveats, in the tropics a good percentage of individuals will have a low level infection of the parasite without any clinical manifestation. As such the detection of the parasite without a corresponding clinical history may be seen. For these patients careful history taking and examination often yields other sources of infection other than the malaria parasite.

How do I treat malaria?

Treatment of malaria has generated a lot of interest due to the “resistance” of the parasite to drugs over time. Presently, Artemisinin (also know as Qinghaosu- a Chinese herb extract) in combination with other antimalarial have been suggested by the WHO as the standard treatment. Treatment is also dependent on the severity and pregnancy. If you do suspect you have malaria visit your nearest hospital for the treatment specific to you.

"I don’t want to ever get malaria"

It is difficult to completely eradicate malaria in tropical regions not only due to economic reasons but also due to physical factors present in the environment. Apart from moving to tropical regions to prevent malaria infection there are other possible interventions, which may reduce an individual’s susceptibility to malaria infection. These include physical (sanitation, mosquito nets, insecticides), chemical (antimalarial prophylactic medications), and biological (vector control). The WHO believes that the use of insecticide treated nets is pivotal to the reduction of malaria infection in tropics.

"I keep on treating my malaria every few weeks?"

Symptoms of malaria may re-appear after a brief symptom free period depending on its timing it may be classified as a recrudescence, relapse or a reinfection. A recrudescence occurs within a short time following past infection and it is usually due to parasites surviving in the blood as a result of inadequate or ineffective treatment. Inadequate treatment may be due to short duration of treatment or the use of mono therapy instead of the advised combination therapy. Also, the most common cause of ineffective treatment is use of fake or substandard medications that do not provide appropriate or optimal drug type or doses to infected sites.  Patients experiencing recrudescence malaria should visit health facilities for appropriate treatment. Also, it is pertinent we all contribute to reducing the scourge of fake and adulterated medicine by providing information to appropriate government agencies for investigation.

Certain strains of plasmodium (P. ovale and P. vivax) could lay dormant in the liver and cause a relapse of malaria 8 – 24 weeks after the index infection. The diagnosis of this is clinical and affected individuals are provided with appropriate treatment when this is discovered. Finally due to its endemic nature in the tropic, susceptible individuals who to don take preventive strategies following index infection can also are re-infected by the parasite. However, it is pertinent to mention that recurrent febrile infection, which fails to respond to appropriate anti-malaria may suggest, missed diagnosis of another febrile infection. As such it is always important to consult with health practitioners before onset of antimalarial treatment.


Malaria is an important disease with huge economic impact on the lives of tropical people. Appropriate treatment and preventions strategies will aid in the reduction of its prevalence. Recurrent malaria should be investigated and managed depending on the findings. 

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