1. FACTS ABOUT MALARIA Cynthia Dike, MPH student Walden University PUBH 6165-2 Instructor: Patrick Tschida 3 rd Quarter, 2011

2. This presentation on malaria is created to increase the knowledge of visitors and foreign workers traveling to the Tropics and Subtropics region.

3.  What is malaria?  Epidemiology of the disease globally  Basic pathogenesis of the disease.  Vulnerable population.  The economic impact  Diagnosing and advise on seeking medical attention.  Prevention of the Disease.

4. 1. What is malaria? Malaria is a vector borne disease. 2. Where is malaria found? Malaria is one of the most serious diseases to affect people in developing countries with tropical and subtropical climates. Malaria is prevalent in Africa, Central and South America.

5. 3. The burden of malaria. Globally, 300–500 million episodes of malaria illness occur each year, resulting in over one million deaths. Socio-economic conditions and anti-malaria interventions have gradually reduced the areas of the world where malaria is endemic. 4. Types of malaria and the most fatal parasite. Species of malaria parasites are P. falciparum, P. vivax, P. malariae and P. ovale, P. falciparum is more likely to cause a severe and fatal disease

6. 5. The life cycle of malaria. Human malaria (Plasmodium parasite) is transmitted from an infected person to another person by Anopheles mosquitoes. 6. The symptoms and signs of malaria. The most important symptom of malaria is fever (or a history of fever within the last two to three days) after visiting a malaria infested area. An attack often begins with shivering (body shaking). This is followed by a period of fever, and finally there is profuse sweating. During an attack the patient often complains of headache and pains in the back, joints, and all over the body. Malaria can lie dormant for months after infection.

7. 7. The incubation period of malaria. Symptoms of malaria usually start to appear 7 to 21 days after the bite of an infected mosquito. 8. The danger signs of severe malaria. Confusion, seizures, weakness (unable to stand or sit), jaundice, dehydrated and anemia and kidney failure are some danger signs.

8. 9. How malaria is diagnosed? Microscopic diagnosis involves taking a small amount of blood from the patient, staining it and looking at it under a microscope to check for malaria parasites. 10. The treatment of malaria and list the different anti- malaria drugs. Drugs used in treatment are chloroquine, atovaquone- proguanil, artemether-lumefantrine, mefloquine, quinine, quinidine, doxycycline, primaquine and clindamycin. Some drugs may be resistant to the parasite.

9. 11. The prevention of malaria. Sleep in rooms with screened windows and doors. Use a mosquito net around the bed, impregnated with an insecticide such as pyrethrum or permethrin. Wear long-sleeved clothing and socks to protect against mosquitos’ bite. Mosquito repellent creams containing diethyl toluamide (DEET) and prophylaxis medications are also recommended.

10. An infectious disease caused by a parasite. Transmission is by the bite of an female anophele mosquito(WHO). Reference: World Health Organization http://www.who.int/topics/malaria/en/

11.  Plasmodium falciparum  Plasmodium vivax  Plasmodium ovale  Plasmodium malariae Reference: Davis C,. Malaria. Medicinenet.com http://www.medicinenet.com/malaria/article.h tm

12. Predominantly in tropics and subtropics region. Regions:- Asia, Africa, Central and South America Malaria endemic in 109 countries worldwide References: 1. World Health Organization http://www.who.int/mediacentre/factsheets/fs094/en/index.html 2. Centers for Disease Control and Prevention http://www.cdc.gov/malaria/about/distribution.html

14.  In 2006 - 3.3 billion people at risk worldwide (WHO). Approximately 247 million cases diagnosed (WHO).  In 2008 – 863,000 malaria deaths  In the U.S. approximately 1500 cases diagnosed annually (CDC). Reference: 1. World Health Organization http://www.who.int/mediacentre/factsheets/fs094/en/index.html 2. Centers for Disease Control and Prevention http://www.cdc.gov/malaria/about/distribution.html

15. In the United States:- Travelers Immigrants In endemic countries Children Pregnant women Reference: World Health Organization http://www.who.int/mediacentre/factsheets/fs094/en/index.html

16. Individuals who have a trait of sickle cell disease. Parasite cannot live in abnormal red cells. Protected from lethal complications of malaria Reference: Aidoo M., Terlouw D. J., Kolczak M.S., McElroyP.D., ter Kuile F. O., Kariuki S., Nahlen B. L., LalA. A., Udhayakumar V. Protective effects of the sickle cell gene against malaria morbidityand mortality.(2002) Lancet, 359: 1311–12 http://www.biomed.emory.edu/PROGRAM_SITES/PBEE/pdf/Udhayakumar6.pdf

17. 1. Anophele mosquito gets infected by infected human blood. 2. Mosquito transmit parasite to uninfected human through biting. 3. Parasite mature in human liver.

18. 4. Parasite leaves the liver and 5. Invade red blood cells to multiple. In this process red cell are damaged and symptoms of disease are produced. Reference: Malaria and the red cell http://sickle.bwh.harvard.edu/ malaria_sickle.html

20.  Symptoms: Fever, rigors, sweating, malaise, headaches, vomiting, jaundice.  History of recent visit to a malaria endemic location.  Laboratory work – blood drawn to observe the parasite microscopically. Reference: Centers for Disease Control and Prevention http://www.cdc.gov/malaria/about/distribution.html

21. P. falciparum is the most dangerous species. In pregnancy causes maternal death, abortions, still birth and low birth weight babies. Reference: World Health Organization http://www.who.int/mediacentre/factsheets/fs094/en/index.html

22. In Africa malaria accounts for  20% of childhood deaths.  200,000 children die annually.  maternal death rate is 10–50%.  abortion rate - 60%. Reference: World Health Organization http://www.who.int/mediacentre/factsheets/fs094/en/index.html

23. P. falciparum causes cerebral malaria, blackwater fever, acute renal failure, pulmonary edema, hypotensive shock and death. P. vivax malaria can result in relapses after treatment. Reference: World Health Organization http://www.who.int/mediacentre/factsheets/fs094/en/index.html

24. Significant economic losses Decrease gross domestic product (GDP) The health costs is a heavy-burden countries Reference: World Health Organization http://www.who.int/mediacentre/factsheets/fs094/en/index.html. Sachs J. and Malaney P. (2002). The economic and social burden of malaria. Nature, 415, 680- 685. http://www.rbm.who.int/cmc_upload/0/000/015/330/415680a_r.pdf

25. Treatment depends on the type of parasite, drug susceptibility and patient clinical characteristics. A rapid diagnosis is very important. Contact a health care provider if develop fever after visiting a country in the tropics. Reference: Centers for Disease Control and Prevention http://www.cdc.gov/malaria/about/distribution.html

26. Avoid skin exposure- wear long sleeves and trousers, hats and boots Use insect repellants on exposed areas. Sleep under Mosquito nets and coils. Screen houses with mesh Reference: World Health Organization http://www.who.int/topics/malaria/en/

27. Spray houses and surrounding area with insecticides. The use of DDT insecticide is controversial. Chemoprophylaxis- prescribed by relevant authorities. Reference: 1. World Health Organization http://www.who.int/topics/malaria/en/ 2. United States Environmental Protection Agency http://www.epa.gov/pbt/pubs/ddt.htm

28. Avoid the outdoor in the evening and nights. Remove pools of stagnated or standing water. Reference: World Health Organization http://www.who.int/topics/malaria/en/

29. Malaria is causes by a parasite, transmitted by the anophele mosquito is the vector. Endemic areas are tropics and subtropics. Protective measures is necessary when visiting these region.

30. If complain of fever, headaches or feeling unwell during and after travel visit a doctor immediately to rule out malaria. The key to a good outcome of treatment is early diagnosis.

31. 1. Centers of Disease Control and Prevention. 2. World Health Organization. 3. United States Environmental Protection Agency. 3. Malaria and the red cell http://sickle.bwh.harvard.edu/malaria_sickle.html 5. Davis C,. Malaria. Medicinenet.com http://www.medicinenet.com/malaria/article.htm

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34. 6. Salazar-Garcia F., Gallardo-Diaz E., Cerón-Mireles, P., Loomis, D., & Borja-Aburto, V. (2004). Reproductive effects of occupational DDT exposure among male malaria control workers. Environmental Health Perspectives, 112(5), 542-547.