malaria epideological triad,clinical feaATURES

1. MALARIA

2. INTRODUCTION-
MALA - BAD
ARIA – AIR
In ancient Italy , people associated this with bad air . Hence
,the name MALARIA. It’s a communicable disease caused
by protozoal parasite, of the genius plasmodium
transmitted from person to person by the bite of infected
female Anopheles mosquito.
The mortality is not high but it produces incapacitation
affecting the human resources of the country which
ultimately affects the progress of the nation, socially &
economically.

3. HISTORY-
•Hippocrates in 5th century BC was the first person to
describe features of malaria.
•Charak And Sushruta also gave the description of the
disease & associated the disease with the bites of
mosquitoes.
•1880-Laveron, a French army surgeon, discovered
malarial parasites in human RBCs & got Nobel prize.
•1894-Mason hypothesized that mosquitoes transmit the
disease.

4. •1897-Ronald Ross confirmed the same & studied
the development of parasite in the body of the
female anopheline mosquito
•1898-3 Italian scientist namely Bignami,
Bastianelli & Grassi demonstrated the sporozoites
in the salivary glands of Anophelin mosquitoes.
•1939- Paul Muller discovered insecticidal property
of DDT, which opened a new avenue in control of
malaria
•1953- Govt. Of India launched National malaria
Control Program(NMCP)

5. •1958-NMCP was converted into National malaria
Eradication Program(NMEP)
•197-NMEP was revised and upgraded & was called as
Modified Plan Of Operation Of malaria Control(MPO)
•1995-accelerated malaria action program was taken up
in high risk areas.
•1999-national Program was renamed as “National Anti
Malaria Program”
•Since 2003-04, the National program against malaria is
included under national Vector Borne Disease Control
Program(NVBDCP)

6. MAGNITUDE-
Malaria is a global problem, about 100 countries are
malarious
According to the latest estimates, there were about 198
million (124-283 million) cases of malaria in the year
2013 and an estimated 584,000 deaths (367,000-
755,000). Malaria mortality rates have fallen by 4 7 per
cent globally since year 2000, and by 54 per cent in the
WHO African Region. Most deaths occur among
children living in Africa, where a child dies every minute
from malaria (lA

7.  INDIA
 Malaria continues to pose a major public health threat
in India, particularly due to Plasmodium falciparum
which is prone to complications. In India about 21.98 per
cent population lives in malaria high transmission areas.
 (More than1 case/1000 population) areas and about 67
per cent in low transmission (0-1 case/1000 population)
areas (2). About 92 per cent of malaria cases and 97 per
cent of deaths due to malaria is reported from North-
eastern states.

8. AGENT FACTOR-
 Malaria is caused by four species of protozoal parasite
of genus “Plasmodium”.
They are
 PL. vivax
 PL. falciparum
 PL. malarie
 PL. ovale
PL. vivax is responsible for about 70% of the case
PL. falciparum for 25-30%
4-8% due to mixed infection
PL. malarie for less than 1% infection in India.

9. LIFE HISTORY-
 The malaria parasite undergoes 2 cycles of
development the human cycle (asexual cycle) and the
mosquito cycle (sexual cycle). Man is the intermediate
host and mosquito the definitive host.
human being= sporozoites- hepatic phase- erythrocytic
phase- gamates
mosquito- gamets- ookinet- ocyst- sporozoites which
are stored in salivary gland of mosquito. infective form.

10. RESERVOIR OF INFECTION-
There is only human resevoir & no animal reservior
except chimpanzees in Africa, which carry PL. malarie.
A reservoir may be a case or carrier. A carrier is one who
is having gametocytes circulating in the blood.
Children are more likely to be gametocyte carriers than
adults.
T he criteria to call a person as malaria carrier are:
• He/she should have both the sexes of the gametocytes in
the blood
• The gametocytes must be matured
• They must be viable
• They must be present in sufficient numbers (density)
(at least 12 per Cu mm of blood).

11. HOST FACTORS-
 AGE INCIDENCE- No age is bar form malaria.
Newborns are resistant to Pl. falciparum because of
high concentration of fetal hemoglobin.
Young children are high risk group.
 SEX- Men are more prone because of outdoor life and
less clothed than women.
 PREGNANCY- Pregnancy increase the risk &
severity of malaria. It may result in abortion or still
birth or premature delivery.
 Occupation- It is more among rural people, because of
agricultural occupation.

12.  HOUSING: Housing plays an important role in the
epidemiology of malaria. The ill-ventilated and ill-
lighted houses provide ideal indoor resting places for
mosquitoes. Malaria is acquired in most instances by
mosquito-bites within the houses.
 POPULATION MOBILITY : People migrate for one
reason or other from one country to another or from
one part of a country to another.Some of them may
import malaria parasites in their blood and
reintroduce malaria into areas where malaria has been
controlled or eliminated.

13.  HUMAN HABITS : Habits such as sleeping out of
doors, nomadism, refusal to accept spraying of houses,
replastering of walls after spraying and not using
measures of personal protection (e.g. bed nets)
influence man-vector contact, and obviously the
choice of control measures.
 IMMUNITY-Active immunity is species-specific, that
is, immunity against one strain does not protect
against another. People living in endemic areas
exposed continually to malaria develop considerable
degree of resistance to clinical disease

14. PRE-DISPOSING FACTOR-
 Poor- standard of housing with ill- lighting & ill –
ventilation
 Human activities like
*industrialization
*urbanisation
*irrigation
*agricultural activities
*deforestation
Therefore malaria due to such is called “Man – Made
” Malaria.

15. ENVIRONMENTAL FACTOR-
 SEASON-Incidence high between July to November.
 Atmospheric temp.- Favorable temp. for the
development of parasite is between 20*-30* C.
 Rainfall- it provides breeding places for mosquitoes.
 Altitude- Altitude above 2500 meters is unfavorable so,
malaria is rare in Nepal.
 MAN-MADE MALARIA: Burrow pits, garden pools,
irrigation channels and engineering projects like
construction of hydroelectric dams, roads, bridges
have led to the breeding of mosquitoes and an
increase in malaria. Malaria consequent on such
human undertakings is called "man-made malaria".

16.  Vectors of malaria- Female anophelin are chief
vectors.
Others are- CULCIFACIES, FLUVIATILIS,
STEPENIS, MINIMUS, PHILLIPPINENISIS,
SUDAICUS, MACULATUS
 Breeding habits: Anopheline female mosquito breeds
in fresh water as in ponds, cisterns, wells, over-head
tanks, pools, etc. anti-larval measures have to be
carried out only in such breeding places.

17.  Feeding habits: Anopheline female mosquitoes feed
on human blood (anthrophilic). Blood meal is a must
for laying eggs. Male mosquitoes do not transmit the
disease because they do not bite. They feed on plant and
fruit juice. Female mosquitoes bite during night times.
 Resting habits: Most of these vectors rest indoors, after
blood meal (endophily). Few rest outdoors (exophily).
Therefore anti-adult measures are carried out indoors.
 Density: Mosquitoes should be present in adequate
density (above the critical level) for active transmission
of the disease. T his varies from species to species.

18. MODE OF TRANSMISSION-
 Malaria is transmitted usually form person to person
by the bite of infected female anophelin mosquito.
 It is also transmitted accidentally through
contaminated syringes & needles.
 Vertical transmission form infected pregnant mothers
to the fetus can occur but very rare.

19. INCUBATION PERIOD-
 It is the period between the bite of the infected
mosquito and the onset of first symptom i.e. fever.
The period varies as follows-
*PL. vivax-14 days
*PL. falciparum-12 days
*PL. malariae-28days
*PL. Ovale- 17 days

20. CLINICAL FEATURES-
 Benign Tertian Malaria (Vivax Malaria)
There are three stages-
 (1) Cold Stage-
*Sudden onset of fever with rigors
*Sensation of extreme cold
*Teeth chatter
*Desire to cover with several blankets
*Severe headache
* Vomiting
 (2) Hot Stage-
*High fever 103*- 104* F
*Burning hot sensation, remove blanket & his/her
clothes.

21. *Headache
This stages last for 2-6 hours.
• (3) Sweating Stage-(Stage of diaphoretica)
*Fever comes down associated with profuse
sweating.
*Followed by deep sleep due to exhaustion
*this stage lasts for 2-4 hours.
•In vivax malaria, fever reappears every third day.
Rupture of RBC & release of merozoites in associate
with rigors. Repeated episodes result in splenomegaly
& secondary anaemia.

22. •Malignant Tertian Malaria (Falciparum Malaria)-
*Gradual rise of temp, increase daily becomes high
& almost continuous.
*Cold, hot & sweating stage rarely occur.
*Vomiting & headache persist.
COMPLICATION-
•Cerebral malaria -
*High fever *Death
*Convulsion *Coma
*Paralysis
*Delirium
*Stupor

23. •Black Water Fever
*Fever
*Black- coloured urine due to hemolysis of RBCs &
hemoglobinuria.
•Algid Malaria
*Features of shock
•Septicemic Malaria
*Features of septicemia & circulatory failure
• Quartun Malaria : This is caused by Pl. malariae.
Fever appears once in 4 days. d.
• Ovale Malaria: This is cause by Pl. ovale, common
only in Africa.