What is malaria?

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QUESTION:

What is malaria?

ANSWER:

Malaria is a disease caused by parasites of the genus Plasmodium. Transmitted by mosquitoes, there are several different kinds of malaria distributed throughout the tropical and sub-tropical regions of the world, causing somewhere between 300-500 million cases of disease each year, and as many as 1 million deaths. In fact, malaria is one of the biggest killers of children under the age of five in sub-Saharan Africa, one of the regions of the world where the burden from malaria is the highest. Malaria is usually an acute disease, manifesting itself with severe fever, chills, headache and often nausea as well. Some types of malaria can have relapsing episodes over a time period of many years.

Having said this, malaria is easily preventable, through avoiding mosquito bites by wearing appropriate clothing and sleeping under insecticide-treated bednets, or through taking preventative medication (called prophylaxis). Malaria is also treatable once symptoms appear, through ingesting safe, effective and relatively cheap drugs. With such control measures at hand, you may ask why malaria is still such a huge problem in our world; the answer is that delivering control strategies and treatment to populations most at risk is difficult, and often countries with high malaria burdens don’t have efficient and effective health systems in place to coordinate control efforts.

International non-governmental organisations such as the World Health Organisation, as well as a multitude of non-profit organisations such as the Malaria Consortium and Malaria No More, work tirelessly to bring malaria control and treatment to the places that need it most, with the aim to eradicate malaria as a disease of public health importance.

 

Treatment for Malaria

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QUESTION:

How do you treat malaria?

ANSWER:

Malaria can be treated with a number of different types of medication; which one to use depends on the type of malaria you have, as well as whether resistant strains are known to occur in your area. Below I have copied the response I wrote to a similar question on malaria treatment, posted on the 2nd of May, 2011:

In most cases of non-Plasmodium falciparum malaria (the most deadly form of malaria, found throughout the world but most prevalent in sub-Saharan Africa), and even in some places where P. falciparum has not yet developed resistance, treatment with chloroquine is sufficient.

The dosage will depend on body weight (usually approximated by age). Where there is a risk of chloroquine-resistant malaria occurring, treatment of non-complicated cases will usually consist of orally-administered artemisinin-based combination therapy (or ACT) – again, the dosage will depend on age/weight.

For severe malaria, parenteral ingestion of drugs is required. For the treatment of cerebral malaria, caused by P. falciparum, quinine is the traditional drug of choice, though artemisinin has also been shown to be effective. Anti-convulsants and anti-pyretics (to reduce fever) should also be administered.

In cases of infection with P. vivax or P. ovale, the parasite can become dormant in the liver and result in a relapse of the disease if not treated properly. As such, patients with either of these forms of malaria should also be treated with primaquine.

If you have, or suspect you have a health problem, you should visit a physician for a medical diagnosis and treatment.

How serious is malaria as a disease?

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QUESTION:

(In conclusion to an earlier question regarding the seriousness of the disease and the way it is likely to affect population vigour if not controlled) –  What can the community, the government, individuals (school children, parent, and teachers) do to improve the situation?

ANSWER:

The best way to improve the impact that malaria has upon populations afflicted by malaria is to prevent the disease in the first place.

At a community level, this can be done through the use of long-lasting insecticide treated bednets, which have been shown to be extremely effective in preventing exposure to malaria-carrying mosquitoes. The nets are furthermore cheap and easy to use; the problem is distributing them, and ensuring that the highest-risk groups of people (pregnant women and children under 5 years old) have priority access to the bednets.

In some places, bednets are given out for free at antenatal clinics to target pregnant women; in other places, bednets have been sold at subsidised prices as a way of maintaining the sustainability of the delivery program.

For more information about bednet distribution and the debate surrounding whether they should be free or paid for, please see the post “Malaria – Free Bednets?”

These high risk groups may also benefit from intermittent preventive therapy (IPT) whereby individuals are given treatment for malaria at set intervals, to reduce the risk of suffering from a full-on malaria infection. More information on IPT can be seen in the comments to the question “Reduce risk of P. falciparum.”

If bednet coverage is not thorough an thus prevention not complete, the next stage in reducing the burden of the disease on endemic communities is through accurate, effective diagnosis followed by appropriate treatment. This requires a functional and efficient health services system as well as a well developed transportation network, to ensure that people are encouraged to seek assistance at a clinic or hospital if they develop malaria symptoms, and that they can easily and quickly reach these facilities.

Advanced health systems and transportation networks are the goal of many developing countries, and many regions in the world have made huge amounts of progress in these areas recently. However, momentum must be maintained, and governments throughout the regions of the world where malaria continues to be a huge public health burden need to continue their efforts to strengthen the availability of malaria diagnostics and treatment, in order to remove malaria as an obstacle to people’s well-being and development.

Key Malaria Scientists

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QUESTION:

I would like to know what key scientists are involved with the cure of Malaria.
Thanks

ANSWER:

There are literally hundreds of scientists around the world who are all working on different aspects of curing malaria. The complexity of the life cycle of the parasite means that there are lots of different areas of potential research, and some scientists specialise very precisely on one tiny aspect of the life cycle, hoping to find a way in which it can be exploited as a vulnerability, and used to develop new medications. I will resist naming any particular names, as that would be unfair to all the other scientists, whose work is equally important, that I don’t have space to list!

For example, some scientists devote their attention to the reproduction of the parasite inside human red blood cells or the process of infection; a paper came out very recently which looked at ways in which the malaria parasite uses host proteins to fulfill its own reproductive processes, and how that cycle can be disrupted as a way of treating malaria. A review of that paper will be appearing on this website in the very near future. Other scientists focus on the life cycle of the parasite inside the mosquito, or indeed even just the mosquito itself; some very cool research came out last year, for example, by scientists at Cornell University on how manipulating proteins in the mosquitoes’ kidneys can prevent them from successfully flying off after drinking human blood, thus killing them. Other scientists focus on treatment; for example, the quest for a vaccine against malaria has been a lifelong devotion for many teams of scientists around the world. Other cutting edge research involves looking at whether existing drugs can be used to tackle malaria; recently, it was discovered that a common drug used for treating cancer also has anti-malarial effects.

Finally, there are a whole army of scientists who work away from the lab at ways of curing malaria; this includes, for example, epidemiologists who look at disease distribution and burden at different scales, and geospatial statisticians who apply their research to informing health professionals where the highest risk locations for malaria are, and so treatment and resources can be targeted effectively and efficiently. Many of these control interventions also involved scientists, whose job is to evaluate the success of such operations, and design strategies that can even more rapidly deliver malaria diagnosis, treatment and prevention information to the people who need it most.

Hopefully by now you will see why it is impossible to give you a list of the most important malaria scientists in the world; there are so many people working on so many different facets of treating the disease that I would never be able to include them all! However, we are encouraging many of the scientists who work on malaria to join this website; as such, keep an eye on the membership and feel free to contact any members who are engaged directly in research; I am sure they would be happy to give you more information as to the research groups working on specific areas of malaria control.

Malaria Treatment

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QUESTION:

What is the proper treatment for people with malaria symptoms?

ANSWER:

The proper treatment for malaria depends on the type of malaria parasite that the patient is infected with. Therefore, before treatment begins, the patient should be accurately diagnosed.

In most cases of non-Plasmodium falciparum malaria (the most deadly form of malaria, found throughout the world but most prevalent in sub-Saharan Africa), and even in some places where P. falciparum has not yet developed resistance, treatment with chloroquine is sufficient.

The dosage will depend on body weight (usually approximated by age). Where there is a risk of chloroquine-resistant malaria occurring, treatment of non-complicated cases will usually consist of orally-administered artemisinin-based combination therapy (or ACT) – again, the dosage will depend on age/weight.

For severe malaria, parenteral ingestion of drugs is required. For the treatment of cerebral malaria, caused by P. falciparum, quinine is the traditional drug of choice, though artemisinin has also been shown to be effective. Anti-convulsants and anti-pyretics (to reduce fever) should also be administered.

In cases of infection with P. vivax or P. ovale, the parasite can become dormant in the liver and result in a relapse of the disease if not treated properly. As such, patients with either of these forms of malaria should also be treated with primaquine.

If you have, or suspect you have a health problem, you should visit a physician for a medical diagnosis and treatment.

What is Malaria?

by

QUESTION:

What is malaria?

ANSWER:

Malaria is a disease caused by parasites of the genus Plasmodium. Transmitted by mosquitoes, there are several different kinds of malaria distributed throughout the tropical and sub-tropical regions of the world, causing somewhere between 300-500 million cases of disease each year, and as many as 1 million deaths. In fact, malaria is one of the biggest killers of children under the age of five in sub-Saharan Africa, one of the regions of the world where the burden from malaria is the highest. Malaria is usually an acute disease, manifesting itself with severe fever, chills, headache and often nausea as well. Some types of malaria can have relapsing episodes over a time period of many years.

Having said this, malaria is easily preventable, through avoiding mosquito bites by wearing appropriate clothing and sleeping under insecticide-treated bednets, or through taking preventative medication (called prophylaxis). Malaria is also treatable once symptoms appear, through ingesting safe, effective and relatively cheap drugs. With such control measures at hand, you may ask why malaria is still such a huge problem in our world; the answer is that delivering control strategies and treatment to populations most at risk is difficult, and often countries with high malaria burdens don’t have efficient and effective health systems in place to coordinate control efforts.

International non-governmental organisations such as the World Health Organisation, as well as a multitude of non-profit organisations such as the Malaria Consortium and Malaria No More, work tirelessly to bring malaria control and treatment to the places that need it most, with the aim to eradicate malaria as a disease of public health importance.

Malaria symptoms

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QUESTION:

When a person is ill he or she will have what symptoms?

ANSWER:

Malaria can have many different symptoms, but the initial signs are similar to a flu-like illness, with high fever, chills, headache and muscle soreness or aches. A characteristic sign of malaria is cyclical fever, with peaks of severity every two or three days. Additionally, some people will experience nausea, coughing, vomiting and/or diarrhea.

Because these symptoms are quite generic of a wide variety of illnesses, if you live in a malaria-endemic region, it is crucial to be tested when you develop such symptoms, rather than assuming it’s just the flu and soldiering on! If you have recently traveled to a malarial area and start to experience these signs of infection, similarly you should inform your doctor of your travel history, as otherwise they might not recognize your symptoms as potentially that of malaria.

If treated rapidly and with the correct medication, malaria is almost always completely treatable; it is only if treatment is delayed that it becomes more serious, with long-lasting and potentially fatal consequences. Similarly, if you take sensible precautions while living or traveling in malarial areas, such as taking prophylaxis (and taking them as per the instructions, for the full required amount of time!), avoiding being bitten by mosquitoes and sleeping under an insecticide-treated bed-net, you vastly reduce your chances of getting infected in the first place.

It’s also worth noting that different species of Plasmodium, the parasite that causes malaria, cause slightly different manifestations of the disease, and also require different forms of treatment. Plasmodium falciparum has a unique way of affecting the red blood cells it infects, which eventually can result in loss of function of internal organs. ‘Cerebral malaria’ is a particularly deadly version of this, whereby the function of the brain is affected. The cycles of fever, mentioned above, are caused by synchronous rupturing of the red blood cells in the body by the malaria parasite; P. falciparum, P. vivax and P. ovale complete this cycle every 48 hours, resulting in fever cycles of roughly two days (though P. falciparum can be unpredictable); P. malariae, on the other hand, has a cycle lasting 72 hours, so three day cycles of fever are expected. Finally, although many types of malaria can be successfully treated with the drug chloroquine, some strains, and notably of P. falciparum, have become resistant to this treatment. In these cases, artemesinin-based treatment is recommended, usually in combination with other therapies (artemesinin-combination therapy, or ACT). P. vivax, in addition, requires an additional drug, called primaquine, which is used to treat lingering liver stages of the parasite, to prevent recurrence of the infection.

Malaria Treatment

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QUESTION:

Is there any treatment for malaria?

ANSWER:

Yes, treatment is available for malaria and most cases can be cured easily if diagnosed accurately and early. There are several different drugs that are used to treat malaria, and different modes of ingestion.

Most cases of malaria can be treated effectively with oral drugs, usually artemisinin-based combination therapies (which contain a drug called artemisinin, long used in Chinese medicine to treat malaria) or chloroquine. The choice between these will depend on the type of malaria you have (hence the need for accurate diagnosis) as well as whether the area you are in is known to have types of malaria that are resistant to chloroquine. In addition, some types of malaria, notably P. vivax and P. ovale, require an additional drug, known as primaquine, to prevent later relapses of malaria from dormant forms of the parasite, that hide in the liver.

Severe malaria may require the administration of drugs directly into the body, usually intravenously. Quinine is often the first-choice drug at this stage, though artemisinin-based compounds have also been shown to be effective. Severe malaria, sometimes manifesting as cerebral malaria, is usually only caused by P. falciparum, the most deadly of the types of malaria found in humans.

Diet Therapy for Malaria?

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QUESTION:

Is there any tested and proven diet therapy for acute malaria? What food nutrients are essential for prevention of malaria?  And what are their food sources?

ANSWER:

Thanks for your question, Ekuma. I am not aware of any proven and scientifically tested diet therapy for acute malaria, apart from that which is recommended for all severe fevers, which is to hydrate regularly and thus increase intake of water and diluted juices. Some doctors advise to steer clear of solid food during the worst of the fever, but I am not sure whether this is actually to speed recovery or just because patients tend to lose their appetite during this phase anyway.

In terms of nutritional prevention of malaria, again I don’t think there are any dietary supplements as such which have been proven to prevent all malarial episodes. However, quinine is a natural chemical which has anti-malarial properties and so including quinine-rich foods in one’s diet may in this way reduce incidence of malaria. Tonic water is a good example of an everyday foodstuff which contains quinine; the soda known as “bitter lemon”  likewise contains quinine, which is partially why both were popular with colonial expatriates living in malarial countries over the last hundred-odd years.

Finally, there are reports that grapefruit contains a quinine-like substance, and so might help prevent malaria or indeed increase recovery from malarial episodes, but I am not sure if this has been scientifically established as fact. There are a number of other plants, herbs and fruits which advocates of traditional, home remedies suggest may help prevent or treat malaria, but I can’t find ANY solid scientific basis for these claims, nor any reports of trials where these remedies have been shown to be effective.

Overall, the best thing to do if you think you have malaria is to get diagnosed (either at the doctor, a hospital or using a self-diagnosis kit) and then seek medical treatment. Local clinics will be able to tell you what kind of malaria you have, and therefore what treatment is recommended.

For prevention while in malarial areas, sleep under an insecticide treated bednet and try not to get bitten by mosquitoes. If you’re a visitor to a malarial zone, look into getting prophylaxis (preventative medicine) before you travel, and make sure the type of medication you are prescribed is appropriate to the types of malaria found in the regions to which you are going.

In terms of what malaria parasites themselves eat, they infect red blood cells in the human body and use the cells’ own hemoglobin (the protein we need to carry oxygen around our bodies) for energy. This why one of the reasons why malaria sufferers can become anemic; as such, it is important to maintain iron levels after a malarial attack, to prevent any further side effects of the infection.

 

Malaria Treatment While Pregnant?

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QUESTION:

1) I am two months pregnant. Please, what drug can I use to treat malaria? 2) How often should I treat malaria?

ANSWER:

The specific answer to your question depends a bit on whether you believe you are already actively infected with malaria (in other words, you are feeling ill right now, or have done recently) or if you would like information on preventing malaria during your pregnancy.

In both cases, there are certain drugs which have been tested as safe for pregnant women, but whether these drugs are appropriate for you depends on where you live, what types of malaria you might have been exposed to, and, as I mentioned first, whether you are seeking treatment for an existing episode of malaria or want to prevent future illness.

I have asked one of our board members, who is an expert on maternal health and pregnancy, to comment further, so please check back here soon!