World Malaria Day

I have come to realize that whenever malaria in mentioned anywhere outside Africa, it’s seen as a very deadly disease and I can’t help but laugh at this notion for if this is really true all Africans would have been long gone and there wouldn’t be any continent like African continent.

I remember the day we watched documentary on malaria, the laugh and smiles on my African group mates faces said it all. We sure were like it’s not that serious.

Hence I would be writing this blog post as a Nigerian who has suffered or come down with or been diagnosed malaria even when I feel it wasn’t the reason for me being down at some point, it could have been stress anyway.

Every year on the 25th of April, WHO and UN alongside the world at large observe whichever day it falls on as World Malaria Day.

This is done with different yearly captions to create awareness, raise funds for the treatment and prevention of malaria.

What’s Malaria?

It is a tropical disease spread by infected female anopheles mosquitoes and there are basically two types uncomplicated and severe(complicated) malaria.

On being bitten by infected female anopheles mosquito it takes an incubation period of 7-30 days for first symptom to appear although sometimes shorter periods of incubation are observed most frequently with P. falciparum and the longer ones with P. malariae which Nigeria has more of P. falciparum.

Life Cycle of Malaria Parasite

The parasite life cycle culled from CDC involves two hosts. During a blood meal, a malaria-infected female Anopheles mosquito inoculates sporozoites into the human host . Sporozoites infect liver cells and mature into schizonts, which rupture and release merozoites . (Of note, in P. vivax and P. ovale a dormant stage [hypnozoites] can persist in the liver (if untreated) and cause relapses by invading the bloodstream weeks, or even years later.)

After this initial replication in the liver (exo-erythrocytic schizogony ), the parasites undergo asexual multiplication in the erythrocytes (erythrocytic schizogony ). Merozoites infect red blood cells . The ring stage trophozoites mature into schizonts, which rupture releasing merozoites . Some parasites differentiate into sexual erythrocytic stages (gametocytes) .

Blood stage parasites are responsible for the clinical manifestations of the disease. The gametocytes, male (microgametocytes) and female (macrogametocytes), are ingested by an Anopheles mosquito during a blood meal . The parasites’ multiplication in the mosquito is known as the sporogonic cycle .

While in the mosquito’s stomach, the microgametes penetrate the macrogametes generating zygotes. The zygotes in turn become motile and elongated (ookinetes)  which invade the midgut wall of the mosquito where they develop into oocysts .

The oocysts grow, rupture, and release sporozoites, which make their way to the mosquito’s salivary glands. Inoculation of the sporozoites  into a new human host perpetuates the malaria life cycle.

Signs and Symptoms 

Getting infected presents with a wide range of symptoms while depending on the type and individual suffering from it.

For uncomplicated malaria which is common, the following are observed and to be honest once someone starts feeling feverish with chills and body aches in my country, best believe the individual will be diagnosed with malaria so they just walk down to the pharmacy to buy drugs for treatment.

• Fever
• Chills
• Sweats
• Headaches
• Nausea and vomiting
• Body aches
• General malaise

Diagnosis

Physical findings which are observed by doctors that gives a pointer are:

• Elevated temperatures
• Perspiration
• Weakness
• Enlarged spleen
• Mild jaundice
• Enlargement of the liver
• Increased respiratory rate

However, for confirmatory purposes it is diagnosed by demonstration of parasites in the blood, which is usually by microscopy.

Additional laboratory findings may include mild anemia, mild decrease in blood platelets (thrombocytopenia), elevation of bilirubin, and elevation of aminotransferase.

An individual is said to have complicated (severe) malaria when there are serious organ failures or abnormalities in the patient’s blood or metabolism and the manifestations are:

• Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities
• Severe anemia due to hemolysis (destruction of the red blood cells)
• Hemoglobinuria (hemoglobin in the urine) due to hemolysis
• Acute respiratory distress syndrome (ARDS), an inflammatory reaction in the lungs that inhibits oxygen exchange, which may occur even after the parasite counts have decreased in response to treatment
• Abnormalities in blood coagulation
• Low blood pressure caused by cardiovascular collapse
• Acute kidney injury
• 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
• Hypoglycemia (low blood glucose). Hypoglycemia may also occur in pregnant women with uncomplicated malaria, or after treatment with quinine.

Treatment

The World Health Organization recommends that patients in malaria-endemic areas be treated within 24 hours after their first symptoms appear.

Treatment of a patient depends on the country’s national guidelines, which typically take the following into consideration:

• Type (species) of the infecting parasite
• Clinical status of the patient
• Any accompanying illness(es) or condition(s)
• Pregnancy
• Drug allergies, or other medications taken by the patient
• Where the infection was acquired and the presence of antimalarial drug resistance there.

Uncomplicated Malaria

Patients who have uncomplicated malaria can be treated on an outpatient basis; however, patients with severe/complicated malaria is a medical emergency and should be treated urgently and aggressively..

Most drugs recommended for treatment of uncomplicated cases in the malaria-endemic world are active against the parasite forms in the blood (the form that causes disease). Listed below are some of the drugs approved by the World Health Organization and those most commonly recommended by national malaria control programs in the malaria-endemic world:

• Artemesinin-based combination treatments, (e.g, artemether-lumefantrine, artesunate-amodiaquine)
• Chloroquine*
• Doxycycline
• Mefloquine*
• Quinine

*Two of these drugs, chloroquine and mefloquine, are no longer effective in some or many parts of the world.

Don’t get scared yet assuming you have interest in visiting my beautiful country Nigeria for it definitely is preventable .

Prevention

Prevention is mainly by use of or sleeping in insecticides treated nets, taking anti malaria drugs, applying insecticide ointment/cream, avoid leaving house in the evening wearing clothes that expose the skin especially the lower extremities (legs) and upper extremities ( hands).

Is there Malaria Vaccine?

The good and awesome news is that after series of trials and much effort by health researchers, there’s vaccine against it called RTS,S/AS01 (RTS,S).

Being an African, I am looking for the vaccine for myself because it’s not yet available in Nigeria but available in countries like Ghana, Malawi and Kenya and I have this belief that it might be available in the states and in western countries because they react badly against mosquito bite.

To my country men:

Let’s Keep our environment water logged free and breeding ground free for these mosquitoes.

Sleep under insecticide treated mosquitoes and treat malaria immediately noticed having gone through proper test for diagnosis.

Let’s go for proper diagnosis whenever we feel sick for not all body aches or headaches are due to malaria, some can be from stress.

Malaria is 100% treatable, 100% preventable and on this day, I join the health bodies: WHO, UN and others to create awareness on this disease, aiding to fight against the multiplication of these mosquitoes.

I look forward to the day the World especially Nigeria (the most beautiful country) will be malaria free.

Till next post Stay Healthy!