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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