EPIDEMIOLOGY

PREVENTION &
CONTROL OF MALARIA

DR. NEHA TYAGI

ASSISTANT PROFESSOR
DEPARTMENT OF COMMUNITY MEDICINE
 INTRODUCTION
 Malaria is a protozoal disease caused by infection with
parasites of genus Plasmodium transmitted to man by
certain species of infected female Anopheline mosquito.
 A typical attack is characterized by 3 distinct stages: cold
stage, hot stage & sweating stage. Clinical picture can vary
from mild to severe depending upon the species of parasite
present , patient’s state of immunity, the intensity of
infection and the presence of concomitant conditions such as
malnutrition.
PROBLEM STATEMENT(WORLD)

 There were 216 million cases of Malaria in 2016 with 445,000

deaths .
 Between 2010-2016, malaria incidence among population at risk
decreased by 18 % globally, during the same period malaria
mortality rates among population at risk decreased by 32%.
 Sub Saharan Africa continues to carry high share of the global
malaria burden. In 2016 this region was home to 90 % of global
malaria burden and 91% of malaria death.
 • Malaria is widely
distributed in tropics and
subtropics of Africa,
Asia and LatinAmerica.

Epidemiology of
malaria
 INDIA- PROBLEM STATEMENT
 In India 21.98% population lives in malaria high transmission
(>1/1000 population) areas and about 67% in low transmission
(0-1 case/1000 population)
 91% of cases and 99% deaths due to malaria is reported from
North-East states, Chhattisgarh, Jharkhand, MP, Gujrat,
Maharashtra, WB, and Karnataka.
 India predominantly characterized by unstable malaria
transmission. It is seasonal and intensity increase with rains. As a
result all individuals of all age groups living in Malarious areas
are at risk of infection.
 Definition of Malaria and type of
malaria parasite
Is an infection of liver and RBCs caused by protozoan
parasites of the genus plasmodium.

Malaria is caused by 4 species of plasmodium:

• P.falciparum (the most common anddangerous).
• P. vivax.
• P. ovale.
• P. malaria.
  There are 6 primary
vectors of Malaria in
India:
1. An. Culicifacies
2. An. Stephansi
3 An. Fluvitalis
4. An. Minimus
5. An. Dirus
6. An. Epiroticus

VECTORS OF
MALARIA
What do you think aboutthe
risk factor of malaria?
 Risk factors of malaria
 Living or traveling in a region where malaria is present.

 Traveling to area where malaria is common:

 Without taking medicine to prevent malaria.

 Being outdoors, especially in rural areas.
 Not taking steps to protect yourself from mosquito bites.

 Pregnant women.
 Children under 5 years of age.
 Patients with HIV/AIDS.
Life cycle of malaria
 Incubation period of theparasite

species Incubation period (Liver cycle)

P. falciparum 7-14 days

P. vivax 12-17 days ( with relapse up to 3 years)

P. ovale 9-18 days ( with relapse up to 20 years)

P. malaria 13-40 days.

 Con…
• The time between the fever episodes can be
characteristics of the infecting plasmodium species.

species Duration of fever (erythrocytic cycle)

P. falciparum 36-48 h, Malignant tertian malaria.
P. vivax 48h, Benign tertian malaria.
P. ovale 48h, Ovale tertian malaria.
P. malaria 72h, Quartan malaria.
 Epidemiology of malaria
 Reservoir of infection- With the possible exception of
Chimpanzees in tropical Africa no other animal reservoir of
human plasmodia is known to exist.
 Human reservoir carries the sexual forms of the malaria
parasite i.e gametocytes. Children are more likely to be
gametocyte carrier if compared to adults.
 Conditions required to be a carrier-
1. Person should have both male and female gametocytes
2. They should be viable
3. Gametocytes should be mature
4. At least 12 gametocytes per cubic mm of blood to infect
mosquito
 Cont…
 Relapse- Vivax and Ovale usually relapse more than 3 years after
the first attack.
 P. Malariae tends to cause prolonged low level parasitaemia
 Relapse are un common in P. Falciparum infection.

 Host factors- it can affect all age groups and sexes

 Newborn infants have considerable resistance to infection
because of persistence of fetal haemoglobin for first few months
of life
What do you think about the signs
and the symptoms of malaria?
 Signs and symptoms of malaria
• Cycles of shaking chills followed by fever and profuse sweating.
• Hemolytic anemia.
• Jaundice.
• Dark pigmented urine (blackwater fever)
• Stools became increasingly loose.
• Hepatomegaly.
• Splenomegaly.
• Headache.
• Dry cough.
• Lost weight.
 Diagnosis of malaria
• 1) Medical history.
• 2) Physical examination.
• 3) Laboratory diagnosis:
Microscopy Immunological techniques Molecular
techniques

1Films of blood (Thick 1- Antibody-based Polymerase Chain

and thin blood smear techniques(serologic tests): Reaction (PCR)
study). • Indirect fluorescent antibody
test (IFAT)
• Enzyme- linked immunosorbent
assay (ELISA)
2- Antigen-based techniques
• Rapid Diagnostic Tests (RDTs)
 Treatment of malaria
To treat Malaria we most understand 2 concept:
• The geographic pattern of susceptibility of P. Falciparum
to antimalarial drugs.
• The type of plasmodium species causing the infection.

P. Falciparum P. Vivax P. Malaria P. Ovate

Chloroquine Chloroquine-
-resistant sensetive Chloroquine
areas areas With
primaquine.
Quinine, Mefloquin, Chloroquine.
Sulfadoxine and
Pyrimethamine.
T/T MALARIA -UNCOMPLICATED
MALARIA IN PREGNANCY
 Prevention of malaria
1Prevent mosquito bite by:
Covering the limbs.
Using insects repellents.
Sleeping under mosquito nets.
Stagnant water should be avoided.

2Chemical prophylaxis for travelers:

When you traveling to area:
Without chloroquine resistance: chloroquine is used.
With chloroquine resistance: melfloquine or doxycycline
may be used.
 Complication of malaria

species Major complication

P. falciparum Cerebral malaria, haemolytic anaemia

(blackwater fever), jaundice,
hypoglycaemia
P. vivax Relapse due to liver hypnozoites.

P. malaria Nephrotic syndrome

P. Ovate Relapse due to liver hypnozoites

 Complication of malaria
CNS Renal
Cerebral malaria * Hemoglobinuria (black water
fever)
(coma, convulsions)
*Oliguria
*Acute renal failure

Blood Metabolic
*Severe hemolytic anemia.
*DIC(Disseminated
*Hypoglycemia.
*Metabolic acidosis
intravascular coagulation).
*ARDS

Gastrointestinal /liver Other

*Diarrhea. *Shock-hypotention.
*Jaundice. *Hyperpyrexia.
*Splenic rupture.
 Summary
• Malaria is an infection of liver and RBCs.

• Caused by 4 different species of plasmodium.

• Malaria is one of the most serious problems.

• Symptoms: Fever( which may be periodic), chills, sweeting,

hemolytic anemia and splenomegaly.

• Diagnosis is by seeing plasmodium in a peripheral blood

smear.

• Treatment and prophylaxis depend on the species and

drug sensitivity.