Basics of Malaria
Background: Malaria is a very old disease in the world. Charaka, Susrata, Hipocratas, everybody has written about it. In some places it is known as Pali Jara. The word malaria has been derived from the Italian word ‘Mal’ which means Bad and “Aria” which means Air. So it was presumed that malaria occurs due to bad air. Similarly most of the people have wrong conception that due waste water, due to bath in waste/bad water, due to drink unclean/unsafe water it happens.
In 1600 some Missionaries from Spain visited Peru, there they found some people are using bark of a tree to get cure from the fever and this is the first known treatment of malaria. This tree is the CINCHONA. We are preparing Quinine (injection) from it. So the tribals of Peru are the first medicine men for malaria. This plant was planted in India in Nilagiri Hills in the year 1872. In the year 1880 one French Scientist discovered the malaria parasite. But all were not sure from which source this parasite is affecting. One UK scientist Patrick Manson told that it is probably from mosquito the men are getting. All over the world there was researches to know the where about of the parasite. But the credit went to India, where the British Military doctor Ronald Ross, placed at Secunderabad discovered the parasite in the mosquito’s stomach. Since that day it became pretty clear that the mosquito spreads malaria. But his message did not reach the common people till now, as we can control malaria, if we can control mosquito. In 1934 the mostly used chloroquine tablet was invented. Similarly during 2nd World War one German Soldier started the use of DDT to get relief from mosquito. And this was treated as the first preventive method of controlling mosquito.
Malaria was a very big problem in India. After Independence different programs were launched to control as well as to eradicate malaria. These programs are, National Malaria Control Program (NMCP), National Malaria Eradication Program (NMEP), Enhanced Malaria Control Program (EMCP), National Anti Malaria Program (NAMP) and in 2003 National Vector Borne Diseases Control Program (NVBCP). In 1953 there was 750 lakh malaria affected people in India but due to the implementation of NMCP & NMEP it reduced to 50000 only and the govt. thought that it can eradicate malaria. But later on it is learnt that it is impossible to eradicate malaria as each year the numbers of affected people are varying and increasing considerably.
a) What is Malaria: Malaria is one type of fever among different types of fevers, which occurs due to the bite of female anopheles Mosquito. Malaria can be divided into two groups such as Simple and Severe malaria. The symptoms of malaria are;
Simple Malaria: Cold?Hot?Sweating?Break?Cold? Hot?SweatingSome get pain & vomitFeeling weak, Anemia,Enlargement of Spleen.
Severe malaria / complicated malaria: This leads to the following diseases:
Acute Renal Failure
Vomiting and Diarrhea
Hemoglobinuria – Black water fever
Disseminated Intravascular coagulation
Associated Bacterial Infections – LRI, UTS
Malaria is a fever caused by a parasite. The parasite is known as plasmodium. There are four types of plasmodium, which can create fever in human being. They are as follows.
1. P.v– Plasmodium Vivax
2. P.f – Plasmodium Facliparum
3. P.m – Plasmodium malaria
4. P.o – Plasmodium Ovale
The first two types are mainly found in India while the P.o is not found in India. In Rayagada and Koraput districts of Orissa there is 96% & 98% P.f cases, respectively. The P.f type causes death while death cannot be caused in P.v cases. The P.v causes the simple malaria only while the P.f can cause both simple and complicated malaria.
What to do when there is Malaria: It is better to go for blood test for malaria cases, if there is facility for blood test. It is told that there is 4 line / level for medicines. But for the field level staff it is wiser to go up to 2nd level, as they do not have essential qualification to go for next levels. In first line it is always better to go for chlorquine tablets. There is risk in injection particularly for children. The first doze must be 4 tablets. WHO prescribes 4+4+2 chlorquine doze (250mg) is ideal for adults.
Chlorquine dosage according to Age/WeightEach tab contains CQ phosphate – 250mg that is equivalent to – 150mg base.
Age group in years Probable weight NO OF TABLETSDay –1 10mg base /kg Day –2 10 mg base / kg Day – 3 5mg base / kg0-1 6 kg ½ ¼ ¼1-4 15 kg 1 1 ½5-8 30 kg 2 2 19-14 45 kg 3 3 11/215 above 60 kg 4 4 2The tablets should be taken after food and a 3 days course is idle. If chloroquine does not work then pyralafin can be given, which is the 2nd line for medicine. It consists of solfa and pyramithimin. Its prescribed dosages are:
Weight Tablets20kg 1 tab40 kg 2 tabs60 kg 3 tabs
If chlorquine does not work within three days then one should go for 2nd line. If a patient does not recovers in 2nd line, its better to refer him/her to the nearest health centre, which is the third line of medicine in malaria program.