Community Control of Malaria

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QUESTION

how can the community can control malaria through personal protection?

ANSWER

That’s a very good question. One of the most effective known ways for reducing infection with malaria is through the use of long-lastong insecticide treated bednets. Sleeping underneath one at night drastically reduces the chance of being bitten by the Anopheles mosquitoes that transmit malaria.

Other personal protection measures include indoor residual spraying (IRS) with insecticides, which reduces the number of mosquitoes inside houses and also prevents infection. These protection methods protect individuals and families from malaria, but they also can assist in interrupting transmission—that is, if enough families use bednets and do IRS, the whole community may benefit from reduced numbers of mosquitoes that are carrying malaria.

Estimates of the level of bednet or IRS coverage required for community benefits to occur vary based on the region and the local strength of transmission (Killeen et al. reported coverage ranging from 35%-65% as adequate for detecting community-level benefits. This was published in the journal PLoS Medicine in 2007). However, most organisations are advocating attempting 80% coverage of bednet use—therefore, large efforts are being made to increase current bednet coverage and IRS efforts, especially in sub-Saharan Africa where the highest number of cases and the highest mortality rates are observed.

Treating Headache Pain

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QUESTION

Is it ok to treat with NSAIDs or aspirin, or is paracetamol preferred?

ANSWER

If the question relates to headaches caused by malaria, then yes, most over the counter analgesics (pain relievers) can be used to treat the headaches and joint pain associated with malaria. Paracetamol may also assist in reducing fever.

Blood Test for Malaria

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QUESTION

I would like to know whether the malaria prevention medicine could impact the blood test result for malaria?
For example, if we did a blood test after taking the malaria prevention medicine, will the blood test result could be positive because of that and we are actually not having malaria parasite inside our body?

ANSWER

Malaria preventative medication should not give you a false positive test result – in other words, if you are on malaria medication and take a malaria blood test, if it says you are positive, then you probably have malaria! Anti-malaria medication prevents malaria from establishing in your blood, and it is very effective if taken correctly, but there are instances in which someone taking anti-malarials still gets malaria. In these cases, the anti-malarials will often ensure than the severity of the infection is greatly reduced – it can also delay the onset of symptoms.

If you have taken medications for malaria, please help Malaria.com by taking our Malaria Medication Side-effects Survey: Treatment and Prophylaxis. Thank you!

How Many People Have Died from Malaria?

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QUESTION

How many people have died from this disease today? (2011)

ANSWER

Estimates for the number of annual deaths from malaria vary, and are not very accurate since they depend heavily on the quality of reporting. Since the majority of people who die from malaria are in sub-Saharan Africa, and often far from decent health facilities, it can sometimes be difficult to determine whether someone died of malaria or some other cause. The latest data available are for 2010 (2011’s statistics will be published some time in 2012): World Health Organisation estimated that last year approximately 655,000 people died from malaria, which was a decrease of 39,000 from 2009 and a drop of 25% from 2000. It is expected that the number of deaths will continue to fall in 2011. Organisations such as Malaria No More are dedicated to ending all deaths from malaria by the year 2015.

If you have ever taken anti-malaria medication, please take Malaria.com’s brief Malaria Medication Side-effects Survey: Treatment and Prophylaxis.

Malaria Prevention

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QUESTION

what is the prevention of malaria?

ANSWER

There are many ways in which to prevent malaria. I’ll break them down into three categories: 1) medical prevention, 2) protection from getting mosquito bites and 3) vector control.

1) Medical prevention

Malaria can be prevented using certain medications. Taking drugs to prevent a disease is known as “chemoprophylaxis”, and so these drugs are often referred to as “malaria prophylactics”. There are several different types of malaria prophylactic: the most common ones are chloroquine, a mix of atovaquone and proguanil (marketed as Malarone), mefloquine (marketed as Lariam) and doxycycline. The mode of taking these medications vary (Lariam is taken once a week, for example, whereas the others are usually taken once every day), and they also have different restrictions and side effects. Chloroquine is not effective in areas where local forms of malaria have become resistant, for example, and Lariam is not recommended for people with a history of mental instability, as it is known to cause hallucinations and otherwise impair consciousness. Here on Malaria.com, we are actually currently running a survey on side effects of malaria prophylactic drugs, so if you have ever taken medication to prevent malaria, please take the survey: Malaria Medication Side-effects Survey: Treatment and Prophylaxis

It is worth noting that these drugs have not been tested for long term use, plus they can be expensive if taken for an extended period of time. As such, they may not be appropriate for people living in endemic areas for malaria. However, medication can be useful for preventing malaria in high risk groups, even when they are living in a malaria endemic area. One example is the use of intermittent preventive treatment (IPT) for preventing malaria infection in pregnant women, infants and young children. For more information on this, please see the review article written by Dr Felicia Lester for this website: http://www.malaria.com/research/malaria-pregnancy-preventive-treatment

2) Protection from getting mosquito bites

This section links in with the more general vector control strategies, which will be discussed below. Since malaria is transmitted through the bite of infected mosquitoes, preventing mosquito bites is a very effective way of reducing malaria incidence. One of the most popular methods for personal protection, especially in areas where malaria is endemic, is through sleeping under a mosquito bednet. The mesh prevents mosquitoes from being able to fly close to the person sleeping; however, if there are holes in the net, or the person skin is pressed directly against the mesh, the mosquito may still be able to bite them. This is where insecticide-treated bednets come in – they are impregnated with mosquito repellents to stop mosquitoes from biting through the mesh or passing through holes. Newly developed long-lasting insecticide treated bednets (LLINs) are even more effective, in that they don’t require “re-dipping” to maintain the level of repellent in the fibres, and so can protect a person for several years without losing efficacy. These LLINs have been instrumental in reducing cases of severe and fatal malaria, especially among pregnant women and young children, who are often targeted by bednet distributors.

Other methods for preventing mosquito bites include wearing long-sleeved clothing and personal application of mosquito repellent, particular those containing a percentage of DEET, which is a very effective insecticide. These measures should be especially taken in the evening, early morning and at night, which is when the Anopheles mosquitoes that carry malaria are most active.

3) Vector control

Finally, malaria can be prevented from reducing numbers of mosquitoes directly. Some methods target the adult mosquitoes; one such initiative is indoor residual spraying (IRS), whereby the inside of a house is sprayed with an insecticide to kill mosquitoes. Twelve different insecticides are approved by the World Health Organisation for this purpose, though pyrethroids are among the most popular, as they can be used on a variety of surfaces, do not leave a visible stain and can also protect against other insect pests, such as bedbugs.

Other methods for vector control focus on other parts of the mosquito lifecycle. Mosquito larvae require stagnant freshwater for their development, so some projects have worked to eliminate standing water sources, such as unnecessary ditches and puddles, which reduces the amount of habitat available for mosquitoes to lay their eggs and sustain larvae. Other programmes have spread insecticides directly in stagnant water to kill the larvae, or sought to introduce fish or other aquatic organisms, such as copepods, which consume mosquito eggs and larvae. This latter biological control approach is popular because it can also supply an area with fish for local consumption, and doesn’t contaminate water sources with chemicals.

Aging and Malaria

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QUESTION

Is there any evidence that successfully treated malaria (when young or a young adult), has any deleterious effects for patients in their 70s and 80s? Is risk of vascular disease, stroke, or MIs any greater?

ANSWER

I don’t think there is any evidence for any long-term deleterious effects of malaria that was successfully treated, particularly if the malaria infection was non-complicated and did not result at the time in any severe cerebral complications (coma, impaired consciousness, etc).

Is it Common to Die of Malaria?

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QUESTION

is it common to die of malaria? Why? Why not?

ANSWER

Thankfully, these days it is not very common to die from malaria. Out of an estimated 250 million cases of malaria around the world every year, there are only about 700,000 fatalities. However, 700,000 deaths every year is still a lot!

If left undiagnosed and untreated, malaria can progress very rapidly and be a very serious disease. This is particular true of Plasmodium falciparum, a specific type of malaria which is found throughout tropical regions in South America, Africa and Asia.

It is dangerous because it reproduces very rapidly in the body and can cause red blood cells to clog up inside blood vessels in organs, restricted blood flow. When this occurs in blood vessels in the brain, the patient may suffer “cerebral malaria,” which can rapidly lead to loss of consciousness, coma and even death if not treated promptly.

The people most at risk from malaria are children under the age of 5 and pregnant women, and so it is particularly important for these people to seek medical care very quickly if they suspect they have malaria.

On a positive note, deaths from malaria are becoming less common around the world due to a number of factors. First of all, there have been many very successful prevention strategies, for example through distribution of long-lasting insecticide treated bednets to at-risk communities living in malaria endemic regions. Indoor residual spraying with insecticides have also drastically reduced the number of mosquitoes in households where this procedure has been carried out, thus reducing transmission. Moreover, improvements to point-of-care diagnostics and other health infrastructures have enabled poor people in developing countries to have access to ways in which their infections can be diagnosed, and then given the appropriate treatment. All of these measures have brought the number of annual deaths down from 1 million just a few years ago to 700,000 today.

The goal is yet more ambitious: organisations such as Malaria No More seek to eliminate deaths from malaria, all over the world, by the year 2015. So, we hope in 2015 we can add to this answer by saying it is now very rare indeed to die from malaria!

Long term health effects of malaria when young?

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QUESTION

I’m trying to find out if having malaria at a young age can have long term effects on health.

Around 25 years ago when I was 4 years old I contracted malaria when living in central Africa. Unfortunately I do not know the type of malaria, only that I received medication and recovered without complications.

Over the last few years I’ve had a general feeling of poor health and fatigue. Blood tests indicate I have some level of liver damage but I’m at a loss for the cause.

Is there any chance of having picked up liver damage (or other long term effects) from contracting malaria at a young age?

ANSWER

There is little evidence for any long term complications associated with uncomplicated malaria infection. One thing to investigate might be the type of malaria you had as a child; Plasmodium vivax and Plasmodium ovale, while not as common as Plasmodium falciparum in Central Africa, both occur in this region, and differ from P. falciparum in that they can have a dormant liver stage.

While I still have not heard of liver problems being associated with dormant malaria parasites, it is conceivable that if you had one of these two types of malaria and did not have the liver stages treated, you might later feel some ill effects; relapse from P. vivax has been known to occur decades after the initial infection. The good news is that there is a drug available, called primaquine, which can kill these liver stages (known as hypnozoites). So, if you know you had P. vivax or P. ovale, you could mention this possibility to your doctor—prior to taking primaquine you should have a test for G6DP deficiency, as such as deficiency makes it dangerous to take this medication.

If you have ever taken anti-malaria medication, please take Malaria.com’s brief Malaria Medication Side-effects Survey: Treatment and Prophylaxis.

Will Malaria Test Work with No Symptoms Present?

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QUESTION

I believe my fiance who lives in Kenya has malaria but refuses to go for a test. She has headaches and now flu like symptoms. I am returning in late December, if the symptoms have gone can I still take her for a blood test to see if malaria is still present even if the symptoms subside?

ANSWER

Most malaria diagnosis in Kenya is done by looking at a small sample of the patient’s blood under the microscope. Unfortunately, using this method, it is almost impossible to detect malaria that is non-symptomatic. In this case, one option would be to use a rapid diagnostic test which looks for antibodies in the blood against malaria – as these antibodies can sometimes persist after the infection has subsided, it can sometimes tell you whether that person recently had malaria. These rapid diagnostic tests are available in most of the main cities in Kenya, in larger pharmacies, and maybe even in some big supermarkets like Nakumatt. However, given how rapidly malaria can progress and how serious is can become, I would highly recommend that your girlfriend goes to a clinic or doctor and has a malaria test! That way she can receive treatment early, before her symptoms get worse.

Is Malaria Related to Chronic Fatigue and Hair Loss?

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QUESTION

I was in Ghana one year ans 6 months ago when I contracted malaria. I was hospitalised for one day and treated with coartem for 3 days. I was treated with antibiotics for typhoid also however I had been vaccinated against this prior to my trip.

Since my return I began loosing significant amount of hair from my head and suffer fatigue after small amounts of exercise and work. I never suffered from these ailments before having malaria. I consulted my doctor who suggested multivitamins which have reduced the hair loss however the fatigue persists.

I wish to know is the fatigue related to malaria and is there anything I can do to improve this problem. Generally I am fit and healthy, eat well and engage in regular exercise.

ANSWER

It is very unusual for malaria to have any long term health effects once the infection has been successfully treated. It is possible that you are suffering from some residual anemia, which can be caused by malaria, though is more likely due to iron deficiency in your diet. Given that you clearly were deficient for other nutrients (as shown by the positive effects seen when you started taking multivitamins), I would think that if you do have anemia, it is more likely due to diet than anemia! Try asking for a blood test for anemia from your doctor, and if you are indeed anemic, you can look into taking iron supplements as well, or try to include iron-rich foods in your diet.