malaria in Papua New Guinea

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3. Malaria
• Is an infectious disease caused by a parasite,
Plasmodium which infects red blood cells.
• It is characterized by cycles of chills, fever, pain and
sweating.
• It is caused and spread by a female anopheles
mosquito
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4. HISTORICAL BRIEF
Has infected humans since beginning of mankind.
The name “mal aria” (meaning “bad air” in Italian)
First used in English in 1740 by H. Walpole
The term was shortened to “malaria” in the 20th
century. C. Laveran in 1880 was the first to identify the
parasite in human blood
In 1889, R. Ross discovered that mosquitoes
transmitted malaria
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5. Four common species - Parasites
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale
Plasmodium falciparum – the most serious type. It can
be life-threatening.
However, another relatively new species, Plasmodium
knowlesi, is also a dangerous species that is typically
found only in long-tailed and pigtail macaque
monkeys
Like P. Falciparum, P. Knowlesi may be deadly to anyone
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6. •Characterized by flulike illness with:
• Fever
• Chills
• Muscle aches
• Headaches
• Nausea/vomiting
• Cough
• diarrhea
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8. How is malaria transmitted?
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10. Where is malaria a particular
problem?
Is a particular problem and a major one in areas of
Asia, Africa, and Central and South America.
Anyone living in or traveling to a country where
malaria is present can get the disease
Occurs in about 100 countries; approximately 40% of
the world population is at risk for contracting malaria
(http://www.cdc.gov/malaria/travelers/country_table/a.
html)
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11. Incubation period for malaria?
Period between the mosquito bite and the onset of the malarial
illness is usually one to three weeks (7 – 21 days)
Initial time period is highly variable as reports suggest that the
range of incubation periods may range from 4 days to 1 year
Certain types of malaria (P. Vivax and P. Ovale) parasites can also
take much longer, as long as 8 – 10 months to cause symptoms
These parasites remain dormant (inactive or hibernating)in the
liver cells during this time
Some of these dormant parasites can remain even after a patient
recovers from malaria, so the patient can get sick again. This
situation is termed relapsing malaria
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13. Malaria Diagnosis
Clinical symptoms associated with travel to areas that
have malaria risk (travel history is essential)
Many diseases can mimic symptoms of malaria (e.g.
yellow fever, dengue fever, typhoid fever, cholera,
filariasis and even measles and tuberculosis )
Blood smear on microscope slide that is stained
(Giemsa stain) to show parasites inside red blood cells
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14. MALARIA DIGNOSIS - PMGH
Malaria Laboratory
PMGH 2011
0…0
100
200
300
400
500
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
No. of slides examined - MALE 0 - 4 yrs
5 - 14 yrs
15 + yrs

15. MALARIA DIGNOSIS - PMGH
0
100
200
300
400
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
No. of slides examined - FEMALE
0 - 4 YRS
5 - 14 YRS
15 + Yrs
Malaria Laboratory
PMGH 2011

16. Malaria Admissions – Emergency
Department (PMGH 2011)
10, 12% 4, 5%
8, 10%
8, 10%
18, 22%
5, 6%
2, 2%
13, 16%
5, 6% 3, 4% 5, 6% 1, 1%
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Emergency Daily Attendance 2011

17. Diagnosis at Emergency - 2011
124
127
100
320
157
98
45
78
126
48
5275
8229
391
164
182
90
144
73
54
67
52
30
323
18
104 8 49 57
Common diseases seen in Emergency
Head Injury
CVA/Stroke
Pneumonia
PTB
Extra PTB
Cancer
Resp. Diseases
HIV/AIDS
Diabetes
Hypertension
AMI
Heart diseases
Malaria
Burns
Fractures
Emergency Daily Attendance 2011

18. Malaria Admissions – Medical
Ward - 2010
0
20
40
60
Ward 4A Ward 4B
45
12
39
7
6 5
No: of Malaria cases - 2010
Admissions
Discharges
Deaths
Medical Ward Data Reports - 2010

19. Malaria Admissions – Medical
Ward - 2011
0
10
20
30
Ward 4A
Ward 4B
21
9
18
7
3
2
Admissions Discharges Deaths
Medical Ward Data Reports - 2010

20. Treatment for Malaria
Three main factors determine treatments:
The infecting species of plasmodium parasite,
The clinical situation of the patient (e.g. adult,
child, pregnant female with either mild or
severe malaria)
The drug susceptibility of the infecting
parasites – drug susceptibility is determine by
the geographic area where the infection was
acquired.
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21. Cont’ treatment
Drug treatment of malaria is not always easy.
Chloroquine phosphate (Aralen)is the drug of choice for all
malaria parasites except for chloroquine-resistant
plasmodium strain
Unfortunately, resistance is usually noted by drug-
treatment failure in the individual patient.
However, multiple drug-treatment protocols for treatment
of drug-resistant plasmodium strains (quinine sulfate +
doxycycline), Sulphadoxine with Pyrimethamine
(Fansidar) or tetracycline (Achromycin), or clindamycin
(Cleocin), or atovaquone-proguani (Malarone)
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22. Con’t treatment
The WHO’s treatment policy recently established in
2006, is to treat all cases of uncomplicated P.
falciparum malaria with artemisinin derived
combination therapy (ACTs).
ACTs are drug combinations
artesunate-amodiaquine,
artesunate-mefloquine,
artesunate-pyronaridine,
etc used to treat drug-resistant P. falciparum.)
• One promising drug class under investigation is the
spiroindolones, which have been effective in stopping P.
falciparum experimental infections.
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23. Is malaria a particular problem
during pregnancy
Infants, children and pregnant women, along with
immuno-depressed patients are at higher risk for
worse outcomes when infected with malaria parasites
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24. How do people avoid getting
malaria
To reduce chance of getting malaria,
people should avoid malaria-endemic areas of the world,
use mosquito repellents,
cover exposed skin,
and used treated mosquito netting covered areas when
sleeping
Regular health checks to know your status
Prophylaxis
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25. PNG reports on successes
Health and HIV/AIDS Minister Jamie Maxton-Graham
said the country had the highest case of malaria in the
Western Pacific region
About 1.7 million malaria cases and 600 deaths caused
by malaria were recorded annually in health facilities
Mr. Maxton-Graham emphasized the importance of
prevention saying malaria would not be an issue in this
country if we all practiced prevention
(By Shirlyn Belden, April 25th 2012 - The National)
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26. What is the prognosis (outcome)
for people with malaria
Majority of people do well and the fevers abate after 96
hours (4 days)
Malaria caused by P. falciparum or P. knowlesi, even
when treated have outcomes ranging from fair to poor,
depending on how the parasites react to treatment
Untreated people die from infection
In general – infants, children under 5yrs, depressed
immune system (AIDS or cancer patient) have a more
guarded prognosis
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27. Researchers cite drop in malaria cases
The PNGMRI has reported a significant reduction in the prevalence of
malaria infections in the country in the past three years
This was due to efforts by the national government and international
partners to conduct awareness, distribute treated nets and effective
malaria treatments in hospitals under malaria programmes and other
supportive initiatives.
Studies & Surveys conducted by MRI revealed that malaria prevalence
had dramatically dropped from 12% in 2009 to below 8% in 2011
50% of PNGean are now sleeping under treated mosquito nets and are
seeking treatment when sick
Over 160 villages and 5,000 households had been reached by awareness
and distribution of treated nets since 2004 (DR. Manuel Hetzel, MRI’s
population & demography unit)
Insecticides-treated bed nets have distributed widely in communities
since 2004 by RAM PNG and NDOH with 80% of household across
PNG now owning at least one treated net, up from about 10% before
the widespread distributions began
(by Shirlyn Belden, The National April 2012)
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28. Where can people get more
information about malaria
CDC – Center for disease control and prevention
PNG – Health Department
Hospitals
Health centers
Local Health post
Health workers
And NGOs & partners
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29. THANK YOU ALL…
TENKIU TRU…
WUROH!..
ANY QUESTIONS?
SAMPLA ASKIM?
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30. References
D’Acremont, V., C. Lengeler, and B. GENTON.
“Reduction in the Proportion of fevers Associated with
Plasmodium falciparum Parasitaemia in Africa: A
systemic Review.” Malaria journal 9.240 Aug. 22, 2010
doi: 10.1186/1475-2875-9-240.
Rottmann, M., C. McNamara, B. Yeung, et al.
“Spiroindolones, a Potent compound Class for the
treatment of Malaria.” Science 329 (2010): 1175-1180.
The National, April 2012 (World Malaria day)
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