Incredible – Malaria Kills 300,000 Children Yearly …The Prevention, The Cure

Despite the awareness about preventing malaria, it still remains the number one killer of children in Nigeria, but UNICEF, the government and ‘Roll Back Malaria’ body are of the belief that the death of thousands of children under five years old annually could be prevented by simple cost effective measures including consistent use of long-lasting insecticide treated mosquito nets by families and anti-malaria treatment for pregnant women.
Malaria remains a major health problem in Nigeria. An estimated 300,000 children die of the disease each year and up to 11% of maternal mortality is caused by it. It represents one in every four deaths of children and one in 10 deaths of pregnant women. It is further estimated that about half of the population of Nigeria adults suffer from at least one episode of malaria annually while children under five years suffer three or four episodes every year.

There are nearly 110 million clinically diagnosed cases of malaria here annually, accounting for 60% of outpatient visits and 30% of hospitalizations. It is not difficult to see that in addition to its direct health impact, the disease imposes a heavy social and economic burden; indeed about N132 billion (about $900million) is spent on malaria annually in prevention and treatment costs. Both the global incidence of disease and mortality have declined in recent years.
Malaria is a mosquito-borne infectious disease of human and other animals caused by protists of the genus plasmodium. It begins with a bite from the infected female anopheles mosquito which introduces the protists through saliva into the circulatory system-malaria infection develops into two phases;  the exocrythrocytic phase  that involves the liver and the erythrocytic phase that involves the red blood cells. When an infected mosquito pierces a personal skin to take a blood meal, sporozoites in the mosquito saliva enters the bloodstream and migrates to the liver where they infect the hepatocytes multiplying asexually and asymptomatically for a period of 8-30 days. After a potential dormant period in the liver, these organisms differentiate to yield thousands of merozoites which following nupture of the host cells escape into the blood and infects the red blood cells to begin the erythrocytic stage of the life cycle. The parasite escapes from the liver undetected by wrapping itself in the cell membrane of the infected host liver cells.
Five species of plasmodium can infect and be transmitted by humans. The vast majority of deaths are caused by P.falaiparum and P.Vivax, while P.Ovale and P.Malariae cause a generally milder form of malaria that is rarely fatal. The zinotic species P. Knowles, prevalent in South-East Asia, causes malaria in macaques that can also cause severe infections in humans. Malaria is common in tropical and sub-tropical Nigeria but it can be prevented by mosquito nets and insect repellants or spraying of insecticides and draining stand water.
Malaria signs and symptoms begin at 8-23 days following infection, however, symptoms occur later in those that have taken anti-malarial medications as preventions. Initial manifestation of the disease is similar to flu-like symptoms. The presentation may include headache, fever, shivering, arthrailgian, vomiting, jaundice, retinal damage and convulsions. The classic symptom of malaria is parooxygen which is a cyclical occurrence of sudden coldness followed by fever and sweating occurring every two days.
There are several serious complications of malaria among them is the development of respiratory distress which occurs in up to 25% of adults and 40% of children with severe P.falciparum malaria caused by respiratory compensation of metabolic acidosis, non-cardiogenic pulmonary oedema, concomitant pneumonia and severe anaemia. Surprisingly, it was found that co-infection of HIV with malaria increases mortality. Malaria in pregnant women is an important cause of still births, infant mortality and low birth weight.
Symptoms of malaria can re-appear after varying symptoms-free periods depending on the cause of the infection and these symptoms could be recrudescence, relapse or infection.
Recrudescence is when symptoms return after a symptom free period. It is caused by surviving parasites as a result of inadequate or ineffective treatment. Relapse is when symptoms re-appear after the parasites have been eliminated from the blood but still persists and exists as dormant gypnozoites in liver cells.
Malaria is usually diagnosed by the microscopic examination of blood films. Microscopy is the most commonly used method to detect the malaria parasite. Despite the widespread usage, diagnosis by microscopy suffers drawbacks. Many settings especially rural areas are not equipped to perform the test and the accuracy of the results depends on both the skill of person examining the blood films and the levels of the parasite in the blood.
In regions where laboratory tests are readily available, malaria should be suspected and tested for in any area where malaria is endemic. In areas that cannot afford laboratory diagnostic tests, it has become routine to use only a history of subjective fever as the indication to treat for malaria. The drawback in this laboratory practice of over diagnosis of malaria and mismanagement of non-malarial fever which wasted limited resources erodes confidence in the health-care system and contributes to drug resistance.

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