Structure

17.1 Introduction
17.2 Malaria
17.2.1 The Diseas-What Causes it? Who gets it? How and when does it spread?

t 17.2.2 Symptoms and Complications

17.2.3 Prevention and Management
17.3 Let Us Sum Up
B
17.4 Glossary
17.5 Answers to Check Your Progress Exercises

17.1 INTRODUCTION

In the previous two units of Block 5, you have learnt some of the commonly
prevailing infectious diseases, such as measles, tuberculosis, poliomyelitis, whooping

1
infectious disease transmitted by a kosauito. What are the conseuuences of malaria?

prevent malaria in the communities. So how to control/manage malaria? Read this

unit to find out.

Objectives
After studying this unit, you will be able to
e identify the cause and mode of spread of malaria
e enumerate the symptoms and complications of malaria, and
e discuss steps to manage and prevent malaria.

17.2 MALARIA

Malaria has been in the limelight ever since about 90 years ago when Sir Ronald
Ross showed how it was transmitted. Malaria, you might be aware is an infectious
disease caused by the presence of a parasitic protozoa of the genus plasmodium
within the red blood cells. The disease is transmitted by a type of female mosquito
called Anopheles. The disease is mainly confined to tropical and subtropical areas.
In India, concerted attempts have been made since 1950 to control the problem of
malaria. There have been major setback to the early success achieved in the sixties in
the control of malaria. In India the number of cases of malaria dropped down from
b
about 75 million to about 2 million in 1958. However, in the year 1976. 6.5 million
, cases of malaria were detected in the country. In view of this upsurge in the disease
malaria is receiving the attention of the health administrators and policy makers.

17.2.1 The Disease-What Causes it? Who gets it? How and when
I
I does it spread?
The disease is caused by the plasmodium parasite and is transmitted by the anopheles
mosquito.
I
Who gets the disease?
I
The discussion below (under different headings) prevent a clear picture of who are
susceptible to malaria.
Common Infectlous D l s e ~ ~ e s Age : Malaria affects all ages, though new born infants have considerable resistance to
infection with malaria.
Sex : Males are more affected than females mainly because they lead more outdoor
life and are likely to frequent areas where infected mosquitoes thrive. Also females in
India are better covered with clothes.
Socw-economic conditions : Where economic conditions are poor, malaria is more
prevalent. Houses which are ill-ventilated and poorly lighted provide ideal resting
places for mosquitoes. Malaria is commonly acquired by mosquito bites within the
house. Malaria is widely prevalent in tribal areas. This is because the conditions in
tribal areas, usually surrounded by forests, provide favourable grounds for mosquito
breeding. In addition, in view of their inaccessibility, malaria control in these areas
is often difficult.
Migrant labourers working on dams : Engineering sites and migrant agricultural
labour may import malaria and reintroduce malaria into areas where it has been under
control.
Environmental factors : Discussed below are environmental factors.
Season - In India, malaria is most prevalent during the months of July to November.
High Temperatures are detrimental to parasite development.
Rainfall - Rain in general increases mosquito breeding. However, heavy rains may
flush out breeding places.
Man-made Malaria - Man-made alterations to the environment like extensive
irrigation systems can introduce malaria into areas where mosquito activity would
have reduced during dry season. Garden pools and stagnant cess pools of water and
sewage can increase mosquito breeding and lead to malaria.

How does it spread?

Malaria is transmitted by the bites of certain species of infected female anopheles
mosquitoes. In India, the mosquito vectors of importance are Anopheles culicifacies
and Anopheles jluviatilis. Anopheles stephensi is considered an important vector
(carrier of infective agent from one host to another) of malaria in the urban areas.
These female anopheles mosquitoes ingest human blood containing malarial parasites.
The male and female unite in the stomach of the mosquito and multiply and then
invade the salivary glands. When the mosquito bites the man and takes blood meals
the parasites are injected into the blood srream and migrate to the liver and other
organs where they multiply. (In the liver the parasites penetrate into a liver cell and
after considerable development the original single infective form sub-divides into as
many as several thousands of new individual forms). The liver cell ruptures liberating
the new individuals into the blood stream. Some of these enter cells and undergo a
process of multiplication and development. Rapid multiplication of the parasite results
in destruction of the red cell and the new forms are free in the blood stream and
enter fresh red cells. Red cell destruction results in anaemia and at this stage of the
life cycle of parasite the patient experiences periodic bouts of shivering, fever and
sweating. From this stage, sexual forms (gametocytes) of the parasite develop which
on ingestion in a blood feed by an anopheles mosquito to carry on the life cycle of
the parasite in that insect.
In the susceptible individuals, after undergoing cycle, parasites usually appear in b l d
within 3 to 14 days after onset of symptoms.
Malaria is also transmitted by blood transfusion.
Incubation period : The length of time between the bite of an infected mosquito and
the first attack of fever is usually not less than 10 days.
There are four types of plasmodium species. The incubation period varies according to
the species. In the case of P. falciparwn it is 12 days and in P. vivax and P. ovale 14
to 15 days. It is about one month in the case of P. malariae.
Perwd of communicability : As long as the parasite are present in the blood of
patients mosquitos can be infected.
 Susceptibility : Susceptibility is 'universal'. In those who were frequently infected, the
degree of susceptibility is sometimes lessened. In highly endemic areas, adults may be
more tolerant to developing malaria. Individuals with sickle cell trait are relatively
immune to malaria.
f Check Your Progress Exercise 1
1) Draw the life cycle of the malaria parasite in mosquito and man.

2) How long does it take from the time the mosquito bites to the onset of fever ?
.......................................................................................................
3) Prepare a list of the factors that facilitate high prevalence of malaria Circle all
those factors which are relevant in your neighbourhood or a slum area near your
place of residence.
a) .................................................................................................
b) ........................... - ....................................................................
c) .................................................................................................
d) .................................................................................................
e) .................................................................................................
f) .................................................................................................
17.2.2 Symptoms and Complications
Malaria is characterised clinically by 3 stages :
1) Cold Stage : The patient will have fever of sudden onset with rigor (shaking
chills) and a feeling of extreme cold which is accompanied by shivering.
2) Hot Stage : The patient complains of sensation of burning and tries to take off all
the clothes on him. The patient will have splitting headache.
3) Sweating Stage : The fever subsides accompanied by profuse sweating.
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After an interval £tee of fever, the cycle of chills followed by fever and sweating is
repeated either daily, alternate day or every third day. If untreated, the primary attack
may last from a week to more than a month. Relapses occur at irregular intervals for
several years. Enlargement of spleen is common in areas where malaria is persistent.
The patients may also have anaemia (reduction of haemoglobin in blood).
Actually there are 4 types of malaria. They are quite similar in their symptoms and
often it is difficult to differentiate them without laboratory studies. The most serious is
malignant tertian malaria or falciparum malaria. Apart from the symptoms mentioned
above, it can affect central nervous system leading to loss of orientation, delirium and
may even lead to coma.
The other human malaria-benign tertian or vivcls, quartan and o v a l e a r e not
dangerous as to lead to death, except perhaps in very young children.
Complications of malaria
Cerebral malaria is an extremely dangerous complication of falciparum malaria The
patients may have convulsions (fits) and end up in coma. Fatality is very high in such
Common Infectlous D k a u s Diarrhoea and malnutrition are also considered to be common complications of
malaria. Chronic anaemia also is common in children with malaria.

17.2.3 Prevention and Management

Prevention/Management of malaria is discussed below. We begin with preventive/
control measures.
Prevention/Control of malaria :Prevention and control of malaria mainly depend
on- (a) control of mosquitos through spraying of insecticides like DDT or malathion
(b) active and passive surveillance of the areas where annual parasite incidence is
more than 2 and (c) presumptive and radical treatment of cases of malaria. Let us
learn about these measures.
A) Spraying of Pesticides : The spraying of insecticides like DDT or malathion is
done twice or thrice in an year wherever the annual parasite incidence (number of
confirmed cases of malaria during one year per 1000 population) is more than 2.
B ) Active Surveillance : Under active surveillance one health worker will visit each
house in his area, consisting of 1000 households, once every fortnight. He will
enquire whether anyone in the house had fever during the previous fortnight or at the
time of the visit. In both the instances, blood film is collected. He then distributes a
single dose of four tablets of chloroquin (drug used for malaria treatment). This is
known as presumptive treatment.
C) Radical Treatment : I f the blood film is positive, appropriate radical treatment is
given. l l i s consists of giving chloroquin along with primquin to kill the parasite.
In addition to the above measures other methods of prevention/conml include :
D) Protection against mosquitos : Protection against mosquitoes can be done by
adopting the following four measures:
a to do away with the conditions which render possible the breeding of
mosquitoes.
a to destroy mosquitoes at some period of their life. This can be done by spraying
DDT or spraying kerosene oil, diesel or fuel oil on the surface of stagnant water
(this suffocates the law=. as they cannot breathe) or by introducing larvicidal
fish into pools of water where mosqiitoes breed.
a to prevent the mosquito from biting the man. In endemic areas, the person must
be advised to sleep under mosquito nets to prevent mosquito bites. Insect
repellents (such as odomos) which are applied to the skin may also help.
a to attack the parasite as it circulates in the blood of man. Anti-malarial drugs
(chloroquin. pyrimethamine) can be used for the purpose.
E) Environmental Sanitation : Improvement of environmental sanitation through
filling of drains and stagnant pools is one of the permanent ways of reducing
mosquito breeding. In the rural areas, the household drain water should be let into
soak pits instead of letting out into open drains.
You can also help in the control of malaria to a certain extent. In areas, where
malaria is endemic, assume that all cases of fever are malaria. In such cases, arrange
for presumptive treatment after a blood film is collected from them. Simultaneously,
ensure that the health authorities carry out spraying operations to control the
mosquitos. If the slide was positive for malaria the patient should be educated to take
radical treatment. You can also educate the community to remove mosquito breeding
places such as stagnant pools, cess pools etc.
Management of malaria : Treatment of confirmed cases of malaria with oral
Chloroquin and himaquin is recommended. In wute cases intramuscular chloroquin
can be given.
Points to remember given below presents an overview of malaria. Read them
carefully.

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Anaemia : Reduction of haemoglobin in blood
Annual Parasite : Number of confirmed cases of malaria in one
Incidence (APT) year per 1000 population.
Benign Tertian : Malaria caused by vivax type of malarial
parasite u
: Sexual forms of malarial parasites. These
develop in man.
Malignant tertian Malaria : Malaria caused by falciparum type of malarial 4
parasite
Presumptive Treatment of : Treatment of all fever cases assuming them to
Malaria be as malarial fevers
Prophylactic Treatment : Treatment taken to prevent a disease
Radical Treatment of Malaria : Treatment for malaria aimed at killing
gaemetocyt. of malarial parasite
Rigor : Feeling of cold with body shaking vigorously
Salivary Gland : A gland that produces saliva
Vector : Carrier of infective agent from one host to
another e.g. mosquitoes-in malaria

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17.5 ANSWERS TO CHECK YOUR PROGRESS
EXERCISE

Check Your Progress Exercise 1

,
1) Skin

bF~--'
Mosquito inject
Mosquito
human blood
containing parasite
1
New form free bites human
in the blood
'r
Rupture
I
*.
through the
blood cell

blood cell reach liver cells i

multiply
'r I
Parasite I

2) About 10 days
3) a) Poor economic conditions
b) The ventilated and poorly lighted houses
c) Migrant agricultural labour
 d) Months of July to November
e) Rainfall
f) Stagnant pools of water and sewage
\
Check Your Progress Exercise 2
1) Look for cases of fever actively
Take blood film on.a slide
Administer tables of chloroquine
If the slide is positive for malarial parasite administer radical treatment with
primaquine and chloroquine
Arrange for spraying operation
Ensure that breeding places are closed
Educate the community to keep the surroundings dry and clean
Educate them to sleep under mosquito nets
2) Diarrhoea and Anaemia.