Despite steady advancements in treatment and medication for malaria, it still remains a killer disease in most African countries and also in India. According to the World Health Organisation’s recent World Malaria Report, no important gains were made in reducing malaria cases from 2015 to 2017. The estimated number of malaria deaths in 2017, were 435,000, that remained the same mostly over the last year. WHO estimates that India accounts for over 89 percent of malaria cases in southeast Asia. In order to raise more awareness about the disease, the World Malaria Day is observed on April 25 all across the globe with an aim to raise mass awareness about the disease and also to ensure the required treatment or preventive measures. This year, the theme of World Malaria Day is “Zero malaria starts with me”.
“Malaria is one of the major public health problems of our country till date and India reports around one million malaria cases annually. In 2017, an estimated 219 million cases of malaria occurred worldwide, compared with 239 million cases in 2010 and 217 million cases in 2016. Fifteen countries in sub-Saharan Africa and India carried almost 80 percent of the global malaria burden. India reported three million lesser cases in the same period, a 24 percent decrease compared with 2016. In India, P. falciparum and P. vivax are the most common species causing malaria,” says Dr. Pankaj Singhai, senior consultant physician, Department of Internal Medicine at Manipal Hospital in Bangalore.
“However the good thing is that there have been significant fall in malaria deaths found between 2010 to 2017 from 6.07 to 4.35 lakhs. Children below five years have been and are most vulnerable to malaria death. In 2017, they have accounted for 61 percent of total malaria deaths worldwide,” says Dr. Mahamood Shariff, research officer, National Vector Born Disease Control Program, Directorate of Health Services, Bangalore.
Malaria is caused by the Plasmodium parasite and is transmitted by female Anopheles mosquitoes between 9 pm to 5 am. The symptoms of this disease manifest between ten days and four weeks of a mosquito bite. The parasites travel to the liver, develop, grow in number and then infect the red blood cells. Symptoms usually appear between 10 and 15 days after the mosquito bite. More commonly, the patient presents with a combination of symptoms like fever, chills, sweats, headaches, nausea, vomiting, body aches and general malaise.
If malaria is not treated, it can be fatal. In complicated cases, it can cause breathing problems, organ failure, anaemia, and low blood sugar levels. Persons residing in malaria prone zones/areas near clean stagnant water, small children, pregnant woman, or immune compromised persons (HIV), travellers from non-malaria endemic regions are at the higher risk of being infected.
“To prevent this condition, one should use proper air conditioning and nets on doors and windows. If this is not possible, the doors and windows should be closed properly, mosquito nets should be treated with insecticides, and insect repellents on the skin should be used. Light, loose-fitting trousers rather than shorts, and shirts with long sleeves should be worn. This is particularly important during early evenings and nights, when mosquitoes prefer to feed. Chemoprophylaxis with antimalarial drugs is recommended for travellers in malaria endemic areas,” explains Dr. Singhai.
The WHO African region continues to shoulder more than 90 percent of the global malaria burden. In the ten African countries hit very much by malaria, there were an estimated 3.5 million more cases of the disease in 2017 over the previous year. In a major advancement in the medicines, Africa recently began the world’s biggest anti-malaria vaccine campaign. Malawi has become the first country to begin the use of the mosquirix vaccine for childhood immunization programs. Ghana and Kenya are expected to begin shortly. Mosquirix is said to trigger the immune system to defend against the first stages of the infectious disease shortly after the malaria parasite enters the bloodstream through a mosquito bite.
“Malaria occurs due to three factors — agents-malarial parasite, host (human) and environment factors like rainfall, temperature and humidity. Urbanisation has led to lack of proper drainage and usage of unprotected water reservoirs that favour vector breeding. Also the malaria control in such areas is problematic because of rapid construction, migration, and mushrooming of slums,” says Dr. Singhai
In the rural areas of our country there was a time when medicines and treatments were not available for malaria. And pregnant women and old people infected with the disease had to travel to the cities for expensive treatment. However the things today in most rural areas are far better. Dr. Shariff adds “With the primary healthcare centres, we make all possible attempts to treat people who are infected with malaria. We also make sure that they are given good treatment, care and medicine. With these continuous efforts, we have noticed a steady decline in the malaria cases every year which is by 30 percent from the previous year. This is a great positive outcome.”
The initiatives of the government include “the National Malaria Eradication Program (NMEP), Drug Distribution Centres and Fever Treatment Depots in rural areas for providing easy access to anti-malaria drugs to the community. The Indian government has also released a National Strategic Plan (NSP) for malaria elimination for years 2017-2022, targeting the eradication,” concludes Dr. Singhai.
According to Dr. Singhai severe malaria manifestations can develop in P. falciparum infection over a span of time as short as 12–24 hours and may lead to death, if not treated promptly and adequately. Severe malaria is characterised by one or more of the following symptoms:
- Impaired consciousness/coma
- Repeated generalised convulsions
- Renal failure
- Severe anaemia
- Pulmonary oedema/acute respiratory distress syndrome
- Metabolic acidosis
- Circulatory collapse/shock
- Abnormal bleeding and disseminated intravascular coagulation (DIC)