Malaria

Malaria
Introduction
• Malaria is an acute febrile illness caused by Plasmodium
parasites, which are spread to people through the bites of
infected female Anopheles mosquitoes. It is preventable and
curable – WHO.
• It is a mosquito borne disease, transmitted through bites of
infected Anpoheles mosquitoes.
Agent factor
• Causative agent- Plasmodium Species
i. Plasmodium falciparum – most dangerous
ii. Plasmodium vivax – most common
iii. Plasmodium ovale
iv. Plasmodium malaria
Mode of transmission
• Primary host / vector – Female Anopheles mosquitoes.
• Secondary host – Human body
Mode of transmission
Incubation
Features Plasmodium falciparum Plasmodium Plasmodium malariae
vivax ,orale
Incubation 8-25 days 8-25 days 15-30 days
Asexual cycle < 48 hours 48 hours 72 hours
Fever periodicity No particular pattern Alternate days Every third days

Symptoms
• Fever
• Chills
• Headache
• Nausea vomiting
• Jaundice
Magnitude of the problem
• Magnitude of Malaria Globally
• Malaria remains a significant global health concern, especially in tropical and subtropical regions:
• Global Burden:
• In 2021, there were an estimated 247 million malaria cases worldwide and approximately 619,000 deaths,
according to the WHO.
• Sub-Saharan Africa bears the highest burden, accounting for about 95% of cases and deaths, with children
under 5 being the most vulnerable.
• Geographic Distribution:
• Malaria is endemic in 91 countries, with regions in Africa, Southeast Asia, and the Eastern Mediterranean
being the hardest hit.
• Economic and Social Impact:
• Annual global losses exceed $12 billion in direct healthcare costs and lost productivity.
• Malaria contributes to poverty by straining healthcare systems and reducing economic output.
• Progress and Challenges:
• Global efforts have reduced malaria incidence by 27% and mortality by 51% since 2000.
• Challenges include drug resistance, insecticide resistance, and climate change expanding mosquito habitats.
Magnitude of the problem
•Malaria cases have significantly declined, but it remains endemic in certain regions, primarily in the
Terai belt and parts of the hilly and mountainous areas.
•According to Nepal's Ministry of Health, malaria cases were reduced to 1,244 cases in 2022, with no
reported deaths.
•Geographic Focus:
•High-risk areas are concentrated in Sudurpaschim and Karnali Provinces, with moderate risk regions
in Lumbini Province.
•Upper hilly river valleys, previously considered non-endemic, are now reporting increased cases due to
climate change and human mobility.
•Seasonality:
•Transmission peaks occur before and after the monsoon season, as the climatic conditions favor
mosquito breeding.
•Progress and Interventions:
•Nepal has adopted a micro-stratification approach, categorizing wards into high, moderate, low, and
no-risk zones.
•The country aims for malaria elimination by 2026, with a focus on strengthening surveillance, vector
control, and community-level interventions.
Diagnosis
• Clinical diagnosis – high fever, headache, nausea and vomiting,
muscles pain, fatigue
• Laboratory diagnosis- malaria blood smear

i. thick smear: presences of parasite
ii. Thin smear: can determine species..
Diagnosis
• Anti gen test : RDT (Rapid Diagnostic Test)
i. particularly in resource-limited settings
ii. Rapid screening in outbreaks or emergencies.
• Molecular diagnostic test: PCR ( Polymerase Chain Reaction)
i. Highly sensitive and specific
ii. Used to detect and differentiate between Plasmodium
species, especially in low-level parasitemia.
Medication
• The treatment depends on the species of plasmodium.
i. Traditional medication- Chloroquine which is plant based
medication widely used for all kinds of malaria
ii. Current gold standard - Artemisinin-Based Combination
Therapies (ACTs) recommended by WHO this medications
aims to eliminate the parasite from the bloodstream and
prevent relapse.
Treatment
• Artemisinin-Based Combination Therapies (ACTs) in which the
combination of artemisinin with another antimalarial is used in
an iv formulation.
• This combination will work for acute malaria in case of vivax
and orale.
• But the malaria hide in liver which is called hyponozoid phase
is not affected by Armtemisin.
• So this has to be followed by the Parimaquin which helps to
prevent relapse of malaria.
Treatment
• In case of falciparum, a single dose of Parimaquin is essential
to prevent transmission of disease.
• It is important to treat not only acute phase but also have to
follow prevent relapse or transmission of disease.
Vaccine
• Recently approved vaccine available for malaria which is
available by the brand (Mosquirix) approved in Oct, 2021 by
WHO.
• This is a critical for protecting children in high-risk areas,
complementing other malaria control interventions.
Why malaria vaccines are not used in
Nepal?
• Low malaria burden causing significant progress in reducing
malaria.
• According to the National Malaria Strategic Plan 2021–2025,
the number of reported cases is relatively low, with most cases
being Plasmodium vivax.
Prevention
• Use long-lasting insecticidal nets (LLINs) to protect against
mosquito bites while sleeping.
• Spraying long-lasting insecticides on walls and surfaces to kill
mosquitoes that rest indoors.
• Eliminate standing water (breeding sites for mosquitoes).
• Wear long-sleeved shirts and pants, especially during dawn and
dusk when mosquitoes are most active.
• Promote awareness of personal and household protective
measures.
Conclusion
• Malaria is preventable and curable but remains a significant
global health challenges.
• Progress has reduced cases and mortality.
• Strengthened surveillance, vector control, and community
interventions are key to elimination.
• Advancements in diagnostic, treatments, and vaccines support
eradicating efforts,.
• Reducing malaria will alleviate its socio economic impact
worldwide.
Thank you

Malaria

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Malaria

Asexual cycle < 48 hours 48 hours 72 hours

Fever periodicity No particular pattern Alternate days Every third days

• Laboratory diagnosis- malaria blood smear

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