Contents:

1. Introduction.

2. Life cycle.

3. Causes, incidence, and risk factors.

4. Symptoms.

5. Diagnosis and tests.

6. Malaria Situation in Bangladesh.

7. Treatments.

8. References.
 Introduction
Malaria is a mosquito-borne infectious disease of humans and other animals
caused by eukaryotic Protists of the genus Plasmodium. The disease results
from the multiplication of Plasmodium parasite within red blood cells, causing
symptoms that typically include fever and headache, in severe cases progressing
to coma or death. Five species of Plasmodium can infect and be transmitted by
humans. Plasmodium knowlesi is a zoonosis that causes malaria in macaques
but can also infect humans.
Malaria transmission can be reduced by preventing mosquito bites by
distribution of mosquito nets and insect repellents, or by mosquito-control
measures such as spraying insecticides and draining standing water (where
mosquitoes breed). The challenge of producing a widely available vaccine that
provides a high level of protection for a sustained period is still to be met,
although several are under development. A number of medications are also
available to prevent malaria in travelers to malaria-endemic countries
(prophylaxis).
A variety of antimalarial medications are available. Severe malaria is treated
with intravenous or intramuscular quinine or, since the mid-2000s, the
artemisinin derivative artesunate, which is superior to quinine in both children
and adults. Resistance has developed to several antimalarial drugs, most
notably chloroquine.

As of the latest World Malaria Report of the World Health Organization, there
were 219 million cases of malaria worldwide in 2017, up from 216 million cases
in 2016. This resulted in an estimated 435,000 deaths. Almost every malarial
death is caused by P. falciparum, and 93% of death occurs in Africa. Children
under five years of age are most affected, accounting for 61% of the total
deaths. In Sub-Saharan Africa, over 75% of cases were due to P. falciparum,
whereas in most other malarial countries, other, less virulent plasmodial species
predominate
 Life Cycle
A female Anopheles mosquito carrying malaria-causing parasites
feeds on a human and injects the parasites in the form of
sporozoites into the bloodstream. The sporozoites travel to the
liver and invade liver cells.
Over 5-16 days, the sporozoites grow, divide, and produce tens of
thousands of haploid forms, called merozoites, per liver cell. Some
malaria parasite species remain dormant for extended periods in
the liver, causing relapses weeks or months later.
The merozoites exit the liver cells and re-enter the bloodstream,
beginning a cycle of invasion of red blood cells, asexual replication,
and release of newly formed merozoites from the red blood cells
repeatedly over 1-3 days. This multiplication can result in
thousands of parasite-infected cells in the host bloodstream,
leading to illness and complications of malaria that can last for
months if not treated.
Some of the merozoite-infected blood cells leave the cycle of
asexual multiplication. Instead of replicating, the merozoites in
these cells develop into sexual forms of the parasite, called male
and female gametocytes that circulate in the bloodstream.
When a mosquito bites an infected human, it ingests the
gametocytes. In the mosquito gut, the infected human blood cells
burst, releasing the gametocytes, which develop further into
mature sex cells called gametes. Male and female gametes fuse to
form diploid zygotes, which develop into actively moving ookinetes
that burrow into the mosquito midgut wall and form oocysts.
Growth and division of each oocyst produces thousands of active
haploid forms called sporozoites. After 8-15 days, the oocyst bursts,
releasing sporozoites into the body cavity of the mosquito, from
which they travel to and invade the mosquito salivary glands. The
cycle of human infection re-starts when the mosquito takes a blood
 meal, injecting the sporozoites from its salivary glands into the
human bloodstream

Causes, incidents, and risk factors:

Malaria is caused by a parasite that is passed from one human to another by
the bite of infected Anopheles mosquitoes. After infection, the parasites
(called sporozoites) travel through the bloodstream to the liver, where they
mature and release another form, the merozoites. The parasites enter the
bloodstream and infect red blood cells.
The parasites multiply inside the red blood cells, which then break open within
48 to 72 hours, infecting more red blood cells. The first symptoms usually occur
10 days to 4 weeks after infection, though they can appear as early as 8 days or
as long as a year after infection. The symptoms occur in cycles of 48 to 72
hours.
Most symptoms are caused by:
1. The release of merozoites into the bloodstream
2. Anemia resulting from the destruction of the red blood cells
3. Large amounts of free hemoglobin being released into circulation after red
blood cells break open
Malaria can also be transmitted from a mother to her unborn baby
(congenitally) and by blood transfusions. Malaria can be carried by mosquitoes
in temperate climates, but the parasite disappears over the winter.
The disease is a major health problem in much of the tropics and subtropics.
The CDC estimates that there are 300-500 million cases of malaria each year,
and more than 1 million people die from it. It presents a major disease hazard
for travelers to warm climates.
In some areas of the world, mosquitoes that carry malaria have developed
resistance to insecticides. In addition, the parasites have developed resistance
to some antibiotics. These conditions have led to difficulty in controlling both
the rate of infection and spread of this disease.
There are four types of common malaria parasites. Recently, a fifth type,
Plasmodium knowlesi, has been causing malaria in Malaysia and areas of
southeast Asia. Another type, falciparum malaria, affects more red blood cells
than the other types and is much more serious. It can be fatal within a few
hours of the first symptoms.
Symptoms:
Anemia

Bloody stools

Chills
Symptoms of Malaria
Coma

Convulsion

Fever

Headache
Transfusing a child with severe

Jaundice anemia due to Malaria

Muscle pain

Nausea

Sweating
A patient suffering from jaundice
due to severe malaria

Vomiting
Diagnosis and tests:
In order to make a malaria diagnosis, the healthcare provider may ask a number
of questions concerning:
Current symptoms
Medical conditions
Family medical history
Current medications
Recent travel history.

The healthcare provider will also likely perform a physical exam, looking for
signs or symptoms of malaria. He or she may also order certain tests to help in
diagnosing malaria or another condition.

The doctor may suspect malaria based on the patient's symptoms, and the
physical findings at examination; however, to make a definitive diagnosis of
malaria, laboratory tests must demonstrate the malaria parasites, or their
components. The best test available to diagnose malaria is called a blood smear.
In this test, malaria parasites can be identified by examining a drop of the
patient's blood under the microscope, spread out as a "blood smear" on a
microscope slide. Prior to examination, the specimen (blood) is stained to give
to the parasites a distinctive appearance. There are other blood tests available
that may be used along with a blood smear to confirm a malaria diagnosis. A
malaria diagnosis can be difficult to make, especially in areas where malaria is
not very common. A number of other conditions share similar symptoms with
malaria. Some of these conditions the healthcare provider will consider before
diagnosing malaria include:
 The flu (influenza)
 Common cold
 Meningitis
 Typhoid fever
 Dengue fever
 Acute schistosomiasis (disease caused by worms)
 Bacteremia/septicemia (infection in blood)
 Hepatitis
 Viral gastroenteritis (stomach flu)
Malaria situation in
Bangladesh:

Malaria has been a major public health problem in Bangladesh. Approximately

33.6% of the total populations are at risk of malaria Majority of malaria cases
are reported from 13 out of the total 64 districts in the country. About 4 million
populations living in 34 upazillas of eight of the thirteen districts live in the
epidemic-prone border areas. Focal outbreaks occur every year, and the
response to control the epidemic is inadequate. Malaria cases are grossly under-
reported due to shortcomings in surveillance and information.
Country is reporting on average 50,000 confirmed malaria cases with around
70% of Pf cases (killer malaria) and 450 malaria deaths annually. The case
finding is very poor and <2% population at risk of malaria screened every year.
In 2008-09, with the help of Global funds enhanced surveillance and case finding
activities including vector control through bed nets and treatment through ACTs
resulted in a increase in lab
confirmed cases and significant
decrease in malaria deaths.
Country did not report any
probable malaria case in 2009.
Programme is promoting LLINs
& ITNs amongst the community
as a vector control measure in
these areas which has increased
tremendously in last few years.
Total 2.57 million bed nets (LLINS Trends of confirmed malaria cases in Bangladesh, 1970-2009
+ ITNs) were distributed and 6.42 million people are covered by it. However, it’s
coverage in high endemic districts ranges between 40% to 63%.
Pogramme Goals and Targets:
To reduce malaria morbidity and mortality until the disease is no
longer a public health problem in the country.

Control strategy:
Malaria control activities are integrated with the general health
services
Active Case Detection (ACD) and Passive Case Detection (PCD)
with laboratory diagnosis Prompt treatment.
Case management of severe malaria and complicated cases in
hospital.
Vector control minimal, no IRS with DDT since 1993.
SEAR working group recommendation on revised control
strategy has been adopted
Due to spread of chloroquine resistance, drug regimen has been
revised and COARTEM has been introduced by programme
Strengthening programme management is of high priority

Best practices and success stories

Establishment of partnership with NGO consortium.
Promotion and use of ITNs/LLINs
Quality diagnosis using RDT and effective treatment using ACTs
Issues and Challenges:

Inadequate access to treatment and diagnostic facilities especially in the remote

areas.

Inadequate programme management capacity at various level and management of

severe malaria in hospitals.

Poor coverage of prevention and control methods (IRS, ITN/LLIN coverage still low) in
the community.

Referral system is weak and pre-referral treatment provisions are limited;

Optimum treatment of cases of severe malaria in different categories of hospitals are

inadequate.

Cross-border malaria at the Bangladesh India and Ban- Myanmar border .

Partners and donors:

WHO
World Bank
Global fund
BRAC and 14 member NGO Consortium
4 Local NGOs in Chittagong Hill Tract (CHT)
Treatments:
Preventing malaria - four steps
There is an ABCD for prevention of malaria. This is:
Awareness of risk of malaria.
Bite prevention.
Chemoprophylaxis (taking antimalarial medication exactly as prescribed).
Prompt Diagnosis and treatment.

Awareness of the risk of malaria:

The risk varies between countries and the type of trip. For example, back-packing or
travelling
to rural areas is generally more risky than staying in urban hotels. In some countries the risk
varies between seasons - malaria is more common in the wet season. The main type of
parasite,
and the amount of resistance to medication, varies in different countries. Although risk
varies,
all travellers to malaria-risk countries should take precautions to prevent malaria.
The mosquitoes which transmit malaria commonly fly from dusk to dawn and therefore
evenings and nights are the most dangerous time for transmission.

Bite prevention:

We can an effective insect repellent to clothing and any exposed skin. Diethyltoluamide
(DEET)
is safe and the most effective insect repellent and can be sprayed on to clothes. It lasts up to
three hours for 20%, up to six hours for 30% and up to 12 hours for 50% DEET. There is no
further increase in duration of protection beyond a concentration of 50%. When both
sunscreen and DEET are required, DEET should be applied after the sunscreen has been
applied.
DEET can be used on babies and children over two months of age. In addition, DEET can be
used, in a concentration of up to 50%, if anyone is pregnant. It is also safe to use if you are
breast-feeding.
If we sleep outdoors or in an unscreened room, we should use mosquito nets impregnated
with
an insecticide (such as pyrethroid). The net should be long enough to fall to the floor all round
your bed and be tucked under the mattress. We should check the net regularly for holes. Nets
need to be re-impregnated with insecticide every six to twelve months (depending on how
frequently the net is washed) to remain effective. Long-lasting nets, in which the pyrethroid is
incorporated into the material of the net itself, are now available and can last up to five
years.
If practical, we should try to cover up bare areas with long-sleeved, loose-fitting clothing, long
trousers and socks - if we are outside after sunset - to reduce the risk of mosquitoes biting.
Clothing may be sprayed or impregnated with permethrin, which reduces the risk of being
bitten through our clothes.

Sleeping in an air-conditioned room reduces the likelihood of mosquito bites, due to the
room
temperature being lowered. Doors, windows and other possible mosquito entry routes to
sleeping accommodation should be screened with fine mesh netting. we should spray the
room
before dusk with an insecticide (usually a pyrethroid) to kill any mosquitoes that may have
come into the room during the day. If electricity is available, we should use an electrically
heated device to vaporize a tablet containing a synthetic pyrethroid in the room during the
night. The burning of a mosquito coil is not as effective.
Herbal remedies have not been tested for their ability to prevent or treat malaria and are
therefore not recommended. Likewise, there is no scientific proof that homoeopathic
remedies
are effective in either preventing or treating malaria, and they are also not recommended.

Antimalarial medication
(chemoprophylaxis):

Antimalarial medication helps to prevent malaria. The best medication to take depends on
the
country you visit. This is because the type of parasite varies between different parts of the
world. Also, in some areas the parasite has become resistant to certain medicines.
There is a possibility of antimalarials that we may buy in the tropics or over the Internet,
being
fake. It is therefore recommended that we obtain our antimalarial treatment from our
doctor's
surgery, a pharmacist or a travel clinic. Medications to protect against malaria are not funded
by the NHS. We will need to buy them, regardless of where we obtain them.
The type of medication advised will depend upon the area you are travelling to. It will also
depend on any health problems we have, any medication you are currently taking, the length
of
our stay, and also any problems we may have had with antimalarial medication in the past.
We should seek advice for each new trip abroad. Do not assume that the medication that we
took for your last trip will be advised for your next trip, even to the same country. There is a
changing pattern of resistance to some medicines by the parasites. Doctors, nurses,
pharmacists and travel clinics are updated regularly on the best medication to take for each
country.
We must take the medication exactly as advised. This usually involves starting the medication
up to a week or more before you go on your trip. This allows the level of medicine in our
body
to become effective. It also gives time to check for any side-effects before travelling. It is also
essential that we continue taking the medication for the correct time advised after returning
to
our home (often for four weeks). The most common reason for malaria to develop in
travellers
is because the antimalarial medication is not taken correctly. For example, some doses may
be
missed or forgotten, or the tablets may be stopped too soon after returning from the journey.

References:
http://www.mayoclinic.com/health/malaria/DS00475/DSECTION=compli
cations

http://malaria.emedtv.com/malaria/malaria-diagnosis-p2.html

http://www.malariasite.com/malaria/Complications2.htm

http://en.wikipedia.org/wiki/Malaria

http://www.patient.co.uk/health/Malaria-Prevention.htm

http://www.google.com/imghp?hl=en&tab=wi