MALARIA

GEOFFERY JACOB
X¿mdm¡nbXv : Health Inspector
Primary Health Centre
Karuvatta
9946156855
geofferyjacob@gmail.com
ae¼\
ae¼ \n
 Ncn{{Xw
Ncn

• 1880
1880-- ¹mkvtamUnbw F¶ tcmKméhns
tcmKméhns\
\ Is−¯n
eqbnkv Aevt^m¬kv emshd³
Louis Alphonsse Laveran
1907 Â Ct±
Ct±l¯në s s\
\mt_Â k½m\
k½m\w e`n¨
e`n¨p
 am³k¬
Manson
1894 tcmK¸IÀ¨¡v ImcW¡mÀ
sImXpImsW¶v Is−¯n
1897 - sImXpInse tcmKméhnsâ
PohnX N{Iw Is−¯n

tdmWmÄUv tdmkv
Sir. Ronald Ross
 1939 – PAUL HERMAN MULLER

1939 Â t]mÄ slÀa³ apsÅÀ Uo.Un.Sn I−p]nSn¨p

 tcmK hnXcWw
• temI hym
hym]]Iw
• temI P\kwJybpsS 40% tcmK `ojWnbpsS
\ngenÂ
• 1947Â 300 Zie£w BfpIÄ¡v ae¼\ ae¼\n
_m[n¨
_m[n ¨p þ 3 Zie£w t]À ae¼\
ae¼\n _m[n¨
_m[n¨v
acn¨
acn ¨p
• 1989  aUKmkvIdn D−mb Hu«v t{_¡
t{_¡nÂ
nÂ
2500 acWw
• Ct¸mÄ 120 Zie£w t]À¡vt]À¡v tcmK_m
tcmK_m[[
• 800,000 <5 acWw / {]
{]XnhÀjw
XnhÀjw
 ae¼\n _m[
ae¼\
C´ybnÂ
1947
75 Zie£w ae¼\n _m[nXÀ
0.8 Zie£w ae¼\n acWw
 C´y þ ae¼
ae¼\\n _m[
2500

2000

1500
CASES*1000
1000

500

0
200 200 200 200 200 200 200 200
0 1 2 3 4 5 6 7
CASES*1000 2032 2085 1841 1869 1915 1817 1785 1480
 ae¼\
ae¼ \n acWw C´ybnÂ
1800
1600
1400
1200
1000
800
600
400
200
0
2000 2001 2002 2003 2004 2005 2006 2007
C´y þ hmÀjnI ]cmZ kqNIw (API)

2.5

1.5

0.5

0
'00 '01 '02 '03 '04 '05 '06 ,07
 INDIA PF %
52

50

48

46

44

42

40
'00 '01 '02 '03 '04 '05 '06 '07
 tIcfw

35
30
25
20
CASES*10
15 DEATH
10
5

0
2000 2002 2004 2006
tIcfw þ hmÀjnI ]cmZ kqNIw (API)

0.12

0.1

0.08

0.06 API

0.04

0.02

0
'00 '01 '02 '03 '04 '05 '06
Year Total P.falciparu Pf % API Deaths
Malaria m due to
Cases ( in cases (in malaria
million) million)
1995 3.03 1.14 38.84 3.29 1134
1996 3.04 1.18 38.86 3.48 1010
1997 2.66 46.35 37.87 2.86 879
1998 2.22 1.03 46.35 2.44 695
1999 2.28 1.14 49.96 2.41 1079
2000 2.03 1.05 51.05 2.09 959
2001 2.09 1.01 48.20 2.06 1005
2002 1.84 0.89 48.72 1.80 973
2003 1.87 0.85 45.85 1.82 1006
2004 1.92 0.89 46.47 1.84 949
2005 1.82 0.81 44.32 1.68 966
2006 1.79 0.84 46.98 1.65 1708
2007 1.48 0.73 49.13 1.35 1173
Slide 17

A1 Akber, 6/30/2010
 tcmKImcI ]cmZw
¹mkvtamUnbw (t{]mt«mtkmh)

¹mkvtamUnbw ¹mkvtamUobw ¹mkvtamUnbw ¹mkvtamUobw

sshhmIvkv ^mÂkn]mcw atecnb HmthbvÂ
¹mkvtamUnbw sshhmIvkv
¹mkvtamUobw ^mÂkn]mcw
 ¹mkvtamUobw ^mÂkn]mcw
aëjy cà¯n (Kantämsskäv)
¹mkvtamUnbw atecnb
¹mkvtamUobw HmthbvÂ
]cmZ¯nsâ PohnX N{Iw
aëjy\nÂ

AssewKnI N{Iw (SCHIZOGONY )

sImXpInÂ

ssewKnI N{Iw (SPOROGONY)

¹mkvtamUnbw þ PohnX N{Iw
 AssewKnI N{Iw
(SCHIZOGONY)

1.Hepatic Phase 2.Erithrocytic phase

(Pre erythrocytic Phase) AêW càmé¡fnÂ
IcfnÂ
 BXntYb LSI§
LSI§Ä
(Host Factors)
• hbÊv þ FÃm {]mb¡mêw, æ«nIfpw
• enwKw þ ]pêj·mêw kv{XoIfpw
(]pêj·mcn IqSpXÂ)
• hwiw þ B{^n¡³ hwiPcn sshhmIvkv
CÃ
kn¡nÄ sk þ ^mÂkn]mc¯në
C½}Wnän
• kmaqly km¼¯nI LSIw þ tem ¢mÊnÂ
IqSpXÂ
• tZim´c Ka\w \S¯p¶hcn IqSpXÂ
 tcmKmé hmlIÀ
CARRIER
1.M+F Kmantämsskävkv
2. {]mb]qÀ¯nbmb Kmansämsskävkv
3. kPohambncnçw (4AQ \nÀÖohamçw)
4. km{µX -12 No.s/1Cu.mm càw
 ]cnØnXn LSI§
LSI§Ä
• Imew þ ag¡mew Pqembv þ
\hw_À
hw_À..
• Xm
Xm] ne..-
]\ne 20
20˚c
˚c to 30
30˚c
˚c
• Anco£ CuÀ¸w þ Bt]£nI
Bt]£nI
CuÀ¸w 60%
60% þ sImXpæIÄ¡v
AëtbmPyambXv
• Dbcw þ 6000 ASnç apIfnÂ
At\
At\m^nenkv sImXpæIÄ CÃ
 tcmK hmlIÀ
At\m^nekv sImXpæIÄ
380 PmXnIÄ
60 PmXnIÄ C´ybnÂ
At\m^nekv Ìos^³kn
At\m^nekv Aev_nam\kv
At\m^nekv I|enknt^jokv
At\m^nekv sshjvWqbn
At\m^nekv an\nakv
At\m^nekv ^nenss¸³knkv
At\m^nekv ^veqhnbmänenkv
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ap«
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(ssk^¬ S}_v CÃ)
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]}¸
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At \m^nekv AÂ_na
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At \m^nekv Ìo^³kn
ap«bnSp¶ Øe§Ä
ap«bnSp¶ Øe§Ä
 tcmK
e£W§
e£W §Ä
 SIGNS & SYMPTOMS
km[mcW
km[ mcW e£W
e£W§
§Ä

COLD STAGE HOT STAGE

SWEAT STAGE
1. ioX L«w :
XethZ\
XethZ\
Hm¡m\
Hm¡m \w
O˱
OÀ ±n
ISp¯
ISp ¯ ]\
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hndbÂ
15 anë«v apXÂ 1 1/2 aWn¡qÀ hsc
Xm
Xm]
] L«w:
L«w:
]Äkv \nc¡v IqSpì

izk\ \nc¡v IqSpì

izk\
tcmKn¡v ITn
ITn\\amb NqSv Aë`hs¸Spì

30 anë«v apXÂ 1 aWn¡qÀ hsc

\o−p\
o−p\ne¡mw
hnbÀ¸v L«w
tcmKn [mcmfambn hnbÀçì
FÃm e£W
e£W§ §fpw A{]Xy£amhpIbpw
A{]Xy£amhpIbpw
tcmKn km[
km[mcW
mcW \nebnte¡v aS§
aS§pIbpw
sN¿pì..
sN¿pì

tcmKe£W§fpsS Cu N{
tcmKe£W§ N{Iw
Iw BhÀ¯n¨
BhÀ¯n¨p
sIm−ncnçw
tcmK k¦oÀ®X
• hnfÀ¨
• A]kvamcw
• hr¡ XIcmdpIÄ
• ¹ol ho¡w
• IcÄ ho¡w
• \|tamWnb
• ssls]m ss¥koanb
 tcmK\
tcmK\n˨bw
• ae¼
ae¼\\nçÅ càcà]Se
]Se ]cntim
]cntim[
[\
• BânP³ sSÌv þ ImÀUv sSÌv
• tamenI|emÀ satXUv þ PCR
 NnInÂk
tZiob NnInÂkm \bw þ 2008

• pf (Confirmed) - CQ (3 d) + PQ (1 d)
• Pf (CQ Resistent ) - ACT (A 3 d + SP 1 d)
• Pv (Confirmed) - CQ (3 d) + PQ (14 d)
• Clinical (HR) - CQ (3 d) + PQ (1 d)
• Clinical (LR) - CQ (3 d)
 NnInÂk
^vtfm NmÀ«v
ssat{Im kvtIm]n ^ew

^mÂkn]mcw sshhmIvkv s\Käohv

NnInÂk 1 NnInÂk 2 Aân atecnb aêì
th−
 NnInÂk
^vtfm NmÀ«v
dm]nUv UbKtWmÌnIv Inäv

^mÂkn]mcw e`yaÃ/
NnInÂk 1 s\Käohv
NnInÂk 3
 TREATMENT

• Treatment 1(pf
1(pf))
Chloroquine 25mg/kg over 3 days+
Primaquine 0.75mg/kg Single Dose
Or
(ACT QUALIFED AREAS)
Artesunate 4mg/kg – 3 days +
Sulpha pyrimethamine 25/1.25mg/kg
single dose +
Primaquine 0.75mg/kg single dose
 Treatment (pv)
pv)
Chloroquine 25mg/kg over 3 days+
Primaquine 0.25mg/kg – 14 Days
Treatment 3
Chloroquine 25mg/kg over 3 days
 TREATMENT
CHLOROQUINE
Age Day 1 Day 2 Day 3

No.Of mg No.Of mg No.O mg

tab. tab. f tab.
<1 1/2 75 1/2 75 1/4 37.5
1-4 1 150 1 150 1/2 75
5–8 2 300 2 300 1 150
9 – 14 3 450 3 450 1½ 225
15 & > 4 600 4 600 2 300
 TREATMENT
PRIMAQUINE for
p.Falciparum
Age PRIMAQUINE ON DAY 1

Mg base No.Of tab. No.Of tab.

( 2.5mg base ( 7.5mg
base
<1 Nil
1-4 7.5 3 1
5–8 15 6 2
9 – 14 30 12 4
15 & > 45 18 6
 TREATMENT
PRIMAQUINE for p.vivax
Age PRIMAQUINE DAILY DOSE FOR 14 DAYS

Mg base No.Of tab. No.Of tab.

( 2.5mg base ( 7.5mg base

<1 Nil Nil Nil

1-4 2.5 1 1/3
5–8 5.0 2 2/3
9 – 14 10.0 4 1+1/3
15 & > 15.0 6 2
 TREATMENT
ACT Combination
AS -50mg
SP -500mg+2.5mg
Age Day 1 Day 2 Day3
(No. of Tab) (No. of (No.
Tab) of
Tab)
<1 AS ½ ½ ½
SP ¼ Nil Nil
1-4 AS 1 1 1
SP 1 Nil Nil
5–8 AS 2 2 2
SP 1 +1/2 Nil Nil
9 – 14 AS 3 3 3
SP 2 Nil Nil
15 & > AS 4 4 4
SP 3 Nil Nil
 tcmK {]
{]Xntcm
Xntcm[
[ tijn

• BhÀ¯n
BhÀ¯n¨¨v
tcmK_m[
tcmK_m[bp−mImw
 hmIvkn³

• KthjW¯nÂ
• Is−¯nbncnçì
• ]co£W¯nÂ
• {]tbmK¯nembn«nÃ
 {]Xntcm[ þ \nb{´
nb{´W X{
X{´
´w

• tcmKw t\cs¯ Is−¯epw icnbmb NnInÂkbpw

• kwtbmPnX sImXpæ \nb{´W {]hÀ¯\w
sF.BÀ.Fkv
ssPh \nb{´Ww (Iq¯mSn t`mPy aÂky§Ä)
IoS\min\n D]tbmKn¨ sImXpæ heIÄ
• tcmK¸IÀ¨ \nb{´Whpw XSbepw
• sF.C.kn þ hyànKXhpw kaqlnIhpw
• Øm]\ amt\Pvsaâpw hZKv[y t]mjWhpw
• ]mÊohv & BÎohv »Uv kvanbÀ

• NnInÂk
kwtbmPnX sImXpæ \nb
nb{{´Ww

• Anti Larval
• Anti Adult – IRS
• Personal Protection - ITN
IEC
 PERFORMANCE INDICATORS
1. ABER ( Annual Blood Smear Examination
Rate ) : No. of BS Examined / Total
Population × 100
2. API (Annual Parasite Incidence) Rate : No. of
Malaria +ve
+ve Slide /Total Population under
Observation × 1000
3. AFI ( Annual Falciparum Incidence ) Rate :
No. of Falciparum Smears / Total Population
× 1000
 PERFORMANCE
INDICATORS

4. SPR (Slide Positivity Rate ) : No.of +ve Slide /

Total no. of Slide × 100
5. SFR ( Slide Falciparum Rate) : No. of
Falciparum Slides / Total Slides × 100
6. Pf % : pf + ve slide / Total +ve
+ve slide × 100
 NATIONAL PROGRAMME
• 1947 – 75 million cases/0.8 million death
• 1953 - NMCP
• 1958 – 0.1 million cases/ no death -NMEP
• 1964 – 76 – 6.47 Million cases
• 1977 – MPO
• 1994 – IMCS
• 2008 – NATIONAL DRUG POLICY
 FIGHT
FOR
MALARIA FREE COUNTRY
Small Bite – Big Threat
THANK YOU