Community Based Management for Malaria

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QUESTION

what are the methods for community based management for malaria?

ANSWER

Community-based management of malaria revolves around three main principles: prevention, diagnosis and treatment.

Prevention mainly revolves around stopping mosquitoes from biting people. Methods for this include distribution of long-lasting insecticide treated bednets (and teaching people to use them properly!), indoor residual spraying to stop mosquitoes from living in houses, screening houses properly and removing sources of stagnant water from the community to stop mosquitoes from breeding. Collectively, these methods are considered “vector control”. They have benefit for the individuals who practice the methods, as well as collective benefit at the community level from reduced transmission. Within the community, pregnant women and young children, who are most at risk of severe infection, are often targeted for preventive measures. In addition, transmission of malaria from a pregnant mother to her unborn child can be prevented through chemoprophylaxis, administered usually twice during pregnancy, in a process known as intermittent preventive therapy (IPT).

Diagnosis and treatment involves educating people about the symptoms of malaria so that if they suspect they are infected, they know how and where to seek appropriate medical care. The community therefore has to provide a clinic or hospital that is sufficiently equipped to do accurate diagnosis, which requires blood testing. Clinicians should also be able to identify which type of malaria the patient is infected with, since this determines treatment. Identification of the type of malaria is usually done via looking at the blood of the patient under a microscope, a process which requires a significant amount of training. The type of treatment depends on the severity of infection as well as the type of parasite they are infected with.

All of the above interventions depend on sustained investment in community health care, training of local health workers and clinicians and education the community about the transmission of malaria and how this can be interrupted.

Can Child Be Affected by Mother’s Malaria

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QUESTION
If the baby’s mother has malaria, can it affect the child?

ANSWER

If the mother is pregnant when she gets malaria, particularly if it is her first pregnancy and particularly if she has never had malaria before, the effects on both the mother and child can be very serious. For the mother, this is because her immune system changes when she gets pregnant. This leaves her more vulnerable to the effects of malaria, including anaemia.

The most dangerous type of malaria, P. falciparum, also seems very able to infect cells in the placenta, leading to a higher intensity infection, and also reducing oxygen delivery to the baby. This, combined with the mother’s illness and anaemia, can lead to low birth weight, anaemia and other complications in the child once it is born. Malaria can also pass through the placenta, or be transferred to the baby through blood during childbirth, resulting in “congenital malaria”; that is, malaria which has been passed from mother to infant. Since newborns have inexperienced immune systems, malaria in the first days or weeks of life, and especially if the child is already low birth weight, can be very dangerous.

As such, a lot of effort has gone to finding ways to prevent malaria in pregnancy and to treat women who do get malaria while pregnant to prevent negative effects both to her and her unborn child. These efforts mainly involve the distribution of long-lasting insecticide treated bednets, and in some places also include the administration of intermittent preventive therapy, where women are given periodic doses of anti-malarials during pregnancy to protect against the disease.

Malaria Prevention

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QUESTION

What is malaria and the preventive measures?

ANSWER

Malaria is a disease caused by single-celled parasites of the genus Plasmodium. There are currently five species which cause disease in humans, and while each is slightly different, they all act in basically the same way, and cause similar symptoms. Of the five, the most dangerous is Plasmodium falciparum, which can lead to death in a matter of days if not treated promptly.

In terms of prevention, the same basic methods are used to prevent all types of malaria. These can be placed into two categories: medication and vector protection.

For medication, there are drugs you can take to prevent the malaria parasite from developing after someone is bitten by an infected mosquito. These drugs are known as “chemoprophylaxis.”

There are several different kinds, such as doxycycline, mefloquine (marketed as Lariam), atovaquone-proguanil (marketed as Malarone) and chloroquine—the type you use depends on the type of malaria present in the area. For example, in much of Africa and India, malaria is resistant to chloroquine, so this cannot be used as a prophylactic. In parts of Thailand, resistance to mefloquine has emerged. However, if the appropriate type of prophylaxis is used, it is very effective against malaria.

The problem is that these drugs have not been tested for long-term use, can be expensive and may have side-effects. Therefore they are of limited use for people who live in areas where malaria is endemic, and are more appropriate for travelers who are in malarial areas for short amounts of time. However, anti-malarial medication may be used in a very specific way for people at particularly high-risk for malaria, such as pregnant women and young children. In these cases, the high-risk individuals receive a dose or series of doses of malaria medication in order to prevent malaria. This form of prevention is known as intermittent preventive therapy (IPT).

Vector prevention involves protecting oneself against getting bitten by mosquitoes. This can involve wearing long-sleeved clothing in the evenings and at night, when malaria mosquitoes are most active, or wearing insect repellent on exposed skin. Indoor residual spraying, whereby repellent and insecticides are sprayed inside the house, can also be used to bring down the number of mosquitoes.

Another very effective technique for preventing malaria is to sleep under a long-lasting insecticide-treated bednet. The mesh acts as a barrier against the mosquitoes, and the insecticide impregnated in the mesh further repels the mosquitoes and prevents them from biting through the mesh.

Malaria and Pregnancy

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QUESTION

Can your baby become immune if you’re pregnant and you have malaria?

ANSWER

Some of the protective antibodies that the mother produces when she has malaria can pass to her baby via the placenta. There is also evidence for immune system “priming” in foetuses when their mothers have been infected my malaria during pregnancy. However, these potentially protective effects are usually far outweighed by the negative effects of malaria during pregnancy.

Due to changes to the mother’s immune system and also perhaps due to the creation and physiology of the placenta, pregnant women are very vulnerable to malaria. For reasons which are not fully understood, women experiencing their first pregnancy (primagravidae) are most susceptible to malaria and their foetuses are most likely to have severe effects. These effects vary depending on the immune status of the mother and whether she is from an endemic or low transmission malaria environment, but typical results include low birth weight, anaemia and spontaneous abortion—abortion rates due to malaria can vary between 15-70%.

There is also the risk (up to 33% in some studies) that malaria will pass directly from the mother to the baby, either through the placenta or in blood during childbirth—this is called “congenital malaria,” and can manifest as early as 1 day after delivery but a late as months after. The symptoms are similar to that of adult malaria, with fever, anaemia, lethargy, etc.

Given these negative effects, it is very important to protect pregnant women against malaria, and bednet distribution schemes in many places target these women. In high transmission settings, women may also be offered intermittent preventive therapy (IPT) which consists of at least two doses of anti-malarial medication, usually once during the second and once during the third trimester.

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.

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.