World Malaria Day 25 April 2020
In recent weeks, the COVID-19 pandemic has tested the resilience of robust health systems around the world. It is therefore of critical importance to continue to sustain the efforts to prevent, detect and treat malaria because of the heavy toll that malaria exacts on these vulnerable populations in countries with fragile health systems
What is malaria?
Malaria is a mosquito-borne disease caused by any one of five malaria parasite species i.e Plasmodium falciparum, ovale, vivax, malariae. The disease is transmitted to people by the female Anopheles vector mosquito. Malaria is a leading cause of debilitating illness, with over 200 million cases each year from around the world. The disease is widespread in Africa, and over one million people die of malaria every year on the continent, mostly children under the age of five.
Who gets malaria?
Any person residing in or travelling to a country where malaria is prevalent is at risk for contracting the disease. Malaria is currently a problem in tropical or subtropical areas of Asia, Africa and Central and South America.
Which areas harbour malaria?
Within South Africa’s borders, the disease is encountered mainly in Northern & Eastern Mpumalanga, Northern KwaZulu-Natal and the border areas of Northern and North West provinces.
Considering South Africa’s neighbours, malaria is also considered to be a threat to travellers visiting the lower-lying areas such as Swaziland, while it is encountered throughout Mozambique and Zimbabwe, much of Botswana. Northern Namibia is also a malaria area.
Within South Africa’s borders, malaria transmission is at its highest during warmer and wetter months of November through to April. For May through to October, the risks of acquiring malaria are reduced, but the low risk does not mean that there is no risk!
How is malaria spread?
Malaria is spread by the bite of an infected Anopheles mosquito. With certain malaria species, dormant forms can be produced which may cause relapses of malaria months to years later. Malaria can also be transmitted by transfusion of blood from infected people or by the use of contaminated needles or syringes.
Symptoms of malaria may include:
- Fever
- Chills
- Sweats
- Generalized body of ache
- Tiredness
- Headaches
- Diarrhoea
Cycles of chills, fever and sweating occurring every one, two or three days is a good indicator of malaria in a person recently returning from a malaria area.
How soon do symptoms occur?
The time between the infective mosquito bite and the development of malaria symptoms can range from 12 to 30 days depending on the type of Plasmodia involved. When infection occurs by blood transfusion, the incubation period depends on the number of parasites transferred but is usually less than two months.
What is the treatment for malaria?
Malaria can be detected by using a microscope and Rapid Diagnostic Test kit (RDT). Malaria can be very dangerous and even fatal if it is not treated. Early treatment reduces the chances of complication.
Anti-Malaria tablets (prophylaxis)
There are a number of different types of anti-malaria tablets available.
Prophylactic medicine must be taken at least 24 hours before entering a malaria-endemic area and then for the duration of stay in the area and for four weeks after leaving the area. No method of malaria prevention is 100% effective, and there is a small chance of contracting malaria despite the taking of anti-malaria medication and the adoption of personal protection methods.
Why is Malaria dangerous?
Most of the malaria found within South Africa is caused by Plasmodium falciparum. It is potentially the most dangerous type of malaria, and can prove rapidly fatal.
Symptoms may develop as soon as seven days after entering a malaria area and as long as six months after leaving a malaria area. Symptoms of malaria can be mild in the initial stages, resembling influenza.
What can be done to prevent the spread of malaria?
Avoid malaria areas.
If in a malaria area:
- Avoid being outdoors at night
- Wearing long-sleeved clothing, especially from dusk until dawn
- Use mosquito repellents
- Sleeping under mosquito nets
- Use insect repellent containing di-ethyl toluamide (DEET)
- Spray sleeping quarters at night with a pyrethoid containing insecticide
- Burn insecticide coils
Malaria vaccines
RTS,S/AS01 (RTS,S) is the first and, to date, the only vaccine to show that it can significantly reduce malaria, and life-threatening severe malaria, in young African children. It acts against P. falciparum. Among children who received 4 doses in large-scale clinical trials, the vaccine prevented approximately 4 in 10 cases of malaria over a 4-year period. In view of its public health potential, WHO’s top advisory bodies for malaria and immunization have jointly recommended phased introduction of the vaccine in selected areas of sub-Saharan Africa
Current COVID 19 and Malaria:
Efforts must be sustained to prevent, detect and treat malaria cases while preventing the spread of COVID-19 and ensuring the safety of those who deliver the services.
WHO is actively following the ongoing clinical trials that are being conducted in response to COVID-19, including studies looking at the use of chloroquine and its derivative, hydroxychloroquine, for treatment and/or prevention. Currently, there is insufficient data to assess the efficacy of either of these medicines in treating patients with COVID-19, or in preventing them from contracting the coronavirus.
NB Chloroquine is currently recommended by WHO for the treatment of P. vivax malaria. In the context of the COVID-19 response, the dosage and treatment schedules for chloroquine and hydroxychloroquine that are currently under consideration do not reflect those used for treating patients with malaria. The ingestion of high doses of these medicines may be associated with adverse or seriously adverse health outcomes.
By Dr Ashmika Gokhul.