dr aslesh op mbbs, md assistant professor, community medicine pariyaram medical college

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