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MALARIADr Aslesh OP
MBBS, MDAssistant professor, community medicine
Pariyaram Medical College
Content
History Burden Agent vector Epidemiology Clinical features control
Malaria- Mal air
Malaria in History Ancient references
China, Assyria, India 500 BC Hippocrates gives first clinical
description
Malaria in History Ancient references
China, Assyria, India 500 BC Hippocrates gives first clinical description
Historical Impacts 413 BC Fall of Greek empire 323 BC Alexander the Great died of
malaria The Roman Empire: Malaria is generally
considered to have played a role in the decline of Rome, a city located in marshland, where malaria is transmitted
In world war 2, more people died due to malaria than in war
Burden of malaria
Globally 150 to 300 million cases annually 81% in African region 13% South east Asian region 5% eastern Mediterranean
Burden in India
In India 27% of the population live in malaria high transmission area
58% in low transmission area
Burden in kerala
Agent
Plasmodium –4 species P falciparum P vivax P ovale P malaria
Vector –Anopheles mosquito
Breeding place of anopheles
Reservoir of infection
Only human reservoir
Host factors favoring malaria infection
Age Sex Genetic- sickle cell anemia, duffy
negative blood type Low socio economic status Poor housing standards Migration Occupation- agriculture
Environmental factors
Season-Rainy season Temperature – 16-30 degree High humidity- above 60% Altitude- less than 2500 metes
Incubation period
Length of time between infective mosquito bite and first appearance of fever P Falciparum malaria- 12 days P Vivax -14 days P malaria- 28 days P ovale -17 days
Clinical features
Typical fever- 3 stages
Cold stage Chills and rigor Last for 1/4th to 1 hour
Hot stage Hot and dry Last for 2-6 hour
Sweating stage Fever comes down
with profuse sweating
Complication
Cerebral malaria Renal failure Liver damage Dehydration Anemia
Diagnosis
Microscopy-Blood smear examination for parasite
Serological test- fluorescent antibody test Rapid diagnostic test
Treatment
For falciparum Artisunate combination therapy
For vivax Chloroquine along with primaquine
Epidemiological Models
Infected People
MosquitoesUninfected
People
contact contact
Habitat
Climate
Food
Source of Plasmodium
Source of New Hosts
Habitat
Behavior
Breaking the Chain
Infected People
MosquitoesUninfected
People
contact contact
Habitat
Climate
Food
Source of Plasmodium
Source of New Hosts
Habitat
Behavior
Eliminating Mosquitoes
Destroy habitat Insecticides Biological control
Indoor residual spraying
Pesticide Resistance
Rapid Reproduction Natural selection
Anti larval method-Source reduction
Biological method- larvicidal fish
Getting rid of the source of Plasmodium
Getting rid of the source of Plasmodium
Drug treatment Transgenic mosquitoes
Getting rid of the source of Plasmodium
Drug treatment Transgenic mosquitoes Why don’t these work?
Getting rid of the source of Plasmodium
Drug treatment Transgenic mosquitoes Why don’t these work?
Availability of drugs Money Medical staff
Recrudescense Drug resistance Reservoir hosts? Transgenic mosquitoes not a reality Expensive
How can we protect the uninfected population?
Vaccines Prophylactic drugs
How can we protect the uninfected population?
Vaccines Prophylactic drugs Why don’t these work?
How can we protect the uninfected population?
Vaccines Prophylactic drugs Why don’t these work?
Vaccines unsuccessful Prophylactic drugs expensive Prophylactic drugs unpleasant
How can we prevent contact between people and mosquitoes?
Insecticides Mosquito nets Long clothing Behavior Avoid mosquito
habitat Screens on
houses
How can we prevent contact between people and mosquitoes?
Insecticides Mosquito nets Long clothing
Behavior Avoid mosquito
habitat Screens on
houses
Why don’t these work?
How can we prevent contact between people and mosquitoes?
Insecticides Mosquito nets Long clothing Behavior Avoid mosquito
habitat Screens on
houses
Why don’t these work? Money Availability of
materials Human
behavior difficult to change
Other diseases caused by mosquito
Dengue Chikenguniya Filariasis Japanese encephalitis
AedesDengue feverChikunguniya Yellow fever in African countries
Filariasis
Culex mosquito Filarial scrotum Filarial leg 120 millions in 73 countriesSEAR countries 31 millions clinical cases, 60 millions mf carriersIndia 45 prevalence millions , incidence 6 millions per year
What you can do to prevent
Observe dry day once a week
Thank you
