PREVENTION OF MALARIA

Malaria is a mosquito-borne disease that affects humans and animals. It is caused by the plasmodium bacteria when an infected mosquito injects malaria parasites into the bloodstream.

Disease Burden

According to the latest World malaria report, there were 247 million cases of malaria in 2021 compared to 245 million cases in 2020. The estimated number of malaria deaths stood at 619 000 in 2021 compared to 625 000 in 2020.

The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2021 the Region was home to about 95% of all malaria cases and 96% of deaths. Children under 5 years of age accounted for about 80% of all malaria deaths in the Region.

Four African countries accounted for just over half of all malaria deaths worldwide: Nigeria (31.3%), the Democratic Republic of the Congo (12.6%), United Republic of Tanzania (4.1%) and Niger (3.9%).

Symptoms of Malaria are similar to flu symptoms and they include

• fever and sweating,
• chills that shake your whole body,
• headache and muscle aches,
• fatigue,
• chest pain,
• nausea and vomiting.

Severe cases of malaria occur when malaria has progressed to affect vital body organs. At this point, the malaria parasites have affected over 5% of the red blood cells. Its symptoms include severe anemia, jaundice, coma, enlarged liver, blood in the urine, changes in blood clotting, impaired consciousness, changes in behavior, high acidity in the blood and body fluids and seizures. Severe malaria is a life threatening medical emergency as it may lead to death.

Prevention of Malaria

Prevention of malaria is currently based on two complementary methods:

• chemo prophylaxis (Use of drugs and medication for prevention)
• protection against mosquito bites.

Protection against Mosquito bite.

If you are located or traveling to places where malaria is common, make sure to stay safe from mosquito bites. Also, the chances of severity vary from individual to individual depending on their physical condition and health records. Here are some of the preventive measures you can take to control malaria and stop it from spreading further.

• Wear full sleeve protective clothing.
• Spray insect repellants on your exposed skin. The recommended repellent contains 20-35% N N, N-Diethyl-meta-toluamide (DEET).
• Use a mosquito net over the bed if your bedroom isn’t air-conditioned or screened. For additional safety, you can treat the mosquito net with the insecticide permethrin.
• When you go out, in addition to spraying insect repellants on your exposed skin, you can also spray on your clothing. Mosquitoes find it easy to bite through thin clothing.
• Keep your home and surroundings clean without any junks or wastes.
• When it comes to controlling the disease, keep an eye out for the symptoms like fever with high temperature. As soon as you find any possible signs of malaria, consult your doctor immediately.
• Make sure you don’t keep your windows and doors open at night as mosquitoes get active during the night and pose a higher risk. You can either use a mosquito or any net to seal your window and then open for the whole day.

MALARIA IN PREGNANT WOMEN

Malaria is a major threat to the lives of mothers, fetuses, and infants because pregnancy causes women to lose some of their immunity to malaria. The infection can cause anemia in the mother and lead to miscarriage, stillbirth, prematurity and low birth weight, a leading cause for infant death. . Therefore, implementing effective prevention measures is crucial for the health and well-being of pregnant women and their unborn babies. These measures include:

1. Use of Insecticide-Treated Bed Nets: this is a highly effective method of preventing malaria transmission in pregnant women. It is recommended that pregnant women sleep under Insecticide-treated bed nets every night to reduce risk of infection.
2. Indoor Residual Spraying: this is an effective way of preventing malaria transmission in pregnant women. It involves spraying insecticides on the interior walls and ceilings of the house to kill mosquitoes. However, pregnant women should be given alternative sleeping arrangement during the spraying activities.
3. Environmental Management: Environmental management strategies, such as eliminating stagnant water sources, are essential for preventing malaria transmission in pregnant women. Pregnant women should avoid traveling to areas with high malaria transmission rates and should take preventive measures as described earlier.
4. Chemo prophylaxis : Use of Intermittent Preventive Treatment in Pregnancy involves administering antimalarial medication to pregnant women at regular intervals. This helps to reduce the risk of contracting malaria during pregnancy, and improve birth outcomes. The World Health Organization recommends at least three doses of IPTp(Intermittent Preventive treatment for malaria in pregnancy) from the second trimester.

MALARIA IN SICKLE CELL PATIENTS

Malaria is a serious health threat, particularly for people with sickle cell disease because they have weakened immune systems, making them more vulnerable to severe malaria infections. Sickle cell patients face an increased risk of severe malaria infections compared to the general population. Several factors contribute to the heightened susceptibility of sickle cell patients to malaria. These include:

1. Sickle Cell Hemoglobin: Sickle cell disease is an inherited blood disorder characterized by the presence of abnormal hemoglobin in red blood cells. The sickle hemoglobin (HbS) causes red blood cells to become stiff and take on a crescent or sickle shape. These abnormal cells have a shorter lifespan, leading to chronic anemia and impaired immune function, making sickle cell patients more susceptible to infections, including malaria.

2. Impaired Immune Response: Sickle cell disease affects the immune system, leading to immune dysfunction. This compromises the ability to control malaria infection leading to more severe outcomes.

3. Altered Red Blood Cell Function: Sickle cell disease alters the function and characteristics of red blood cells. Sickle-shaped red blood cells are more prone to being infected by Plasmodium parasites resulting to increased susceptibility to parasite invasion, thus higher malaria infection.
4. Chronic Anemia: Sickle cell patients commonly experience chronic anemia due to the reduced lifespan of their red blood cells. Anemia weakens the body’s overall capacity to combat infections, including malaria. Decrease in the oxygen-carrying capacity of the blood resulting from anemia compromises organ function and increase the severity of malaria.
5. The measures of protection against mosquito bite can be adopted for sickle cell patients.
6. Chemo prophylaxis : Daily use of Proguanil is also recommended.
7. Prompt diagnosis and treatment of malaria infections is essential for sickle cell patients as they are more susceptible to malaria which can lead to life-threatening complications like acute chest syndrome. Therefore, any symptoms of malaria should be promptly reported to a healthcare provider for diagnosis and treatment.

MALARIA IN CHILDREN.

Children are more susceptible to severe cases of  Malaria due to their weaker immune system (compared to adults), their limited exposure to previous Malaria infection causing reduced immunity in them and their frequent exposure to Malaria prone environment. Among other preventive measures highlighted, the following can also be done :

1. Skin should be covered with clothing (lightweight for comfort and light-colored to be less attractive to insects).
2. Clothes and bed nets can be impregnated with an insecticide to increase their effectiveness in protecting children. Products such as 0.5% permethrin can be sprayed on clothes and nets to moisten them; the material should then be allowed to air dry for at least 6 h before use.
3. Prompt diagnosis and treatment of malaria infections is also essential.

References

1. Bardají, Q. Bassat, P. L. Alonso, and C. Menéndez, “Intermittent preventive treatment of malaria in pregnant women and infants: making best use of the available evidence,” Expert Opinion on Pharmacotherapy, vol. 13, no. 12, pp. 1719–1736, 2012.
2. Menendez, “Malaria during pregnancy,” Current Molecular Medicine, vol. 6, no. 2, pp. 269–273, 2006.
3. Eleonore NLE, Cumber SN, Charlotte EE, Lucas EE, Edgar MML, Nkfusai CN, Geh MM, Ngenge BM, Bede F, Fomukong NH, Kamga HLF, Mbanya D. Malaria in patients with sickle cell anaemia: burden, risk factors and outcome at the Laquintinie hospital, Cameroon. BMC Infect Dis. 2020 Jan 14;20(1):40. doi: 10.1186/s12879-019-4757-x. PMID: 31937250; PMCID: PMC6961385.
4. Cot and P. Deloron, “Malaria during pregnancy: consequences and interventional perspectives,” Medecine Tropicale, vol. 63, no. 4-5, pp. 369–380, 2003.
5. E. Duffy and M. Fried, “Malaria in the pregnant woman,” Current Topics in Microbiology and Immunology, vol. 295, pp. 169–200, 2005.
6. Updated WHO recommendations for malaria chemoprevention among children and pregnant women
7. Malaria, World Health Organization. https://www.who.int/news-room/fact-sheets/detail/malaria.