MALARIA 3.

In the liver sporozoite reproduces

sexually (schizogony), producing
Introduction:
thousands of merozoites.
Malaria continues to be a major health 4. The merozoites infect red blood
problem in the country having an annual cells, where they develop into ring
parasite incidence of 5.1/1000 pop. In forms, trophozoites and schizonts.
1994, it was aimed that there be a 20% 5. Other merozoites develop into
reduction in morbidity annually. The precursors of male and female
nature of malaria as a public health gametes.
problem requires sustained and 6. When the mosquitos bite an infected
systematic efforts toward two major person, gametocytes are taken up
strategies, namely prevention of and mature in the mosquito gut.
transmission through vector control and 7. The male and female gametocytes
the detection and early treatment of fuse and form an ookinete.
cases to reduce morbidity and prevent 8. Ookinetes develop into new
mortality. sporozoites that migrate to the
insect’s salivary glands.
Signs and Symptoms
 Recurrent chills
 Fever
 Profuse sweating
 Anemia
 Malaise
 Hepatomegaly
 Splenomegaly
Infectious Agents
Malaria is produced by intraethrocytic of
the genus plasmodium. Four plasmodia
produce malaria in humans:
 Plasmodium falciparum Early Diagnosis and Prompt
 P. vivax Treatment
 P. ovale
 P. Malariae  Early diagnosis is the
identification of a patient with
Life Cycle of the Malaria Parasite malaria as soon as he/she is
seen, through clinical and/or
1. Mosquito transmits a motile
microscopic method.
Sporozoite.
2. A sporozoite travels through the  Clinical method is based on the
blood vessels to liver cells. signs and symptoms of the
patient and the history of his/her
 having visited a malaria endemic
area.
 Microscopic method is based on
examination of the blood smear
of the patient through a
microscope.
 This shall be done by the medical
technologist or microscopist at
the main health center where
there are microscopy facilities
during regular consultations. She
should take smear of patients
with fever or history of recent
fever with one month and are
residing or have stayed in malaria
endemic area, of clinically
diagnosed patients and of
patients who did not respond to
appropriate anti-malarial
treatment.
Chemoprophylaxis
Only Chloroquine drug should be given.
It must be taken at weekly intervals,
starting from 1-2 weeks before entering
the endemic area. In pregnant women, it
is given throughout the duration of
pregnancy.
Sustainable Preventive and Vector
Control Measures
Sustainable preventive and Vector
control measures refer to the adaptation
of the measures for the prevention and
control against the malaria parasites and
the mosquito vector. Such measures
being affordable, applicable and
appropriate are under our local
conditions so that these measures can
be sustained throughout the duration of
malaria control operations.
Objectives of this measure is to reduce
the source of infection in the human
population; man – vector contact, and
the density of the mosquito vector
population.
a. Insecticide – Treatment of
Mosquito Net
This involves the soaking the
mosquito net in an insecticide
solution and allowed to dry. Such
trated net is used as protective
measure against the vector
mosquito during sleeping time at
night. Insecticide – treated
contains may be used in areas
where they are more culturally
acceptable than mosquito nets.
b. House Spraying
This is the application if
insecticide on the indoor surfaces
of the house through spraying.
c. On Stream Seeding
This involves the construction of
bio-ponds for fish propagation
which shall be the responsibility
of the LGUs and their
corresponding communities.
d. On Stream Clearing
This is the cutting of vegetation
overhanging along stream banks
to expose the breeding stream to
sunlight, rendering it unsuitable
for mosquito vector habituation.
Recommended Anti-Malaria Drugs
Blood Schizonticides - drug acting on
sexual blood stages of the parasites
which are responsible for clinical
manifestations.
 Chloroquine phosphate 250mg
(150mg base/tablet)
  Sulfadoxine (or Sulfalene) 50mg
– pyrimethamine 25 mg/tablet
 Quinine sulfate 300mg tablet
 Quinine hydrochloride 300mg/ml,
2ml ampule
 Tetracycline hydrochloride
250mg/capsule
 Quinidine sulfate 200mg/durules
 Quinidine glucolate 80mg (50mg
base) ml, 1 ml vial
Other Preventive Measures
 Wearing of clothing that covers
arms and legs in the evening.
 Avoiding outdoor night activities,
particularly during the vector’s
peak biting hours from 9pm to
3am.
 Using mosquito repellents such
as mosquito coils, soap lotion or
other personal protection
measures advocated by the DOH
/ MCS – Malaria control service.
 Planting of Neem tree or other
herbal plants which are (potential)
mosquito repellents as advocated
by the DOH/MCS _ Malaria
Control Service.
 Zooprophylaxis – the typing of
domestic animals like the
carabao, cow, etc., near human
dwellings to deviate mosquito
bites from man to these animals.
Early Recognition Prevention and
Control of Malaria Epidemics
 Early recognition prevention and
control of malaria epidemics refer
to the establishment of a system
that will immediately recognize an
impending malaria epidemic.
 Malaria epidemic is a situation
where there is an incidence of
new malaria cases in excess of
the expected. Any transmission in
a previously malaria-free area is
obviously in excess of the
expected and constitutes and
epidemic by the above definition,
with the premise that,
traditionally, small epidemics are
usually called outbreaks.
 Epidemic potential is a situation
wherein an area is vulnerable to
malaria case upsurge due to
causal factors such as climatic
changes, ecological changes or
socio-economic changes.
Prevention of the Epidemic
1. The following should be done in
the event that an imminent
epidemic occurs:
 Mass blood smear (MBS)
collection
 Immediate confirmation
and follow – up of cases
 Insecticide – treatment of
mosquito nets
 Focal spraying
 Stream clearing
 Intensive IEC campaign
2. All cases should be given drug
treatment and followed-up until
clinically and/or microscopically
found negative.
3. Continuous surveillance
measures should be implemented
for three years.
4. The Local Government Units in
collaborating with the
nongovernmental organization
and with the technical assistance
 from the provincial malaria 4. Availability of anti-malarial drugs
coordinator should contribute in and chemoprophylaxis drugs.
terms of IEC campaign and
logistics support.
Public Health Nursing
Responsibilities
1. Participation in the COMMUNICABLE DISEASES
implementation of the following:
a. Treatment policies
b. Provision of drugs EPIDEMIOLOGICAL TRIAGE
c. Laboratory confirmation of
diagnosis
d. Training of barangay health
workers and volunteers on the Host
diagnosis and treatment of
malaria.
e. Supervision of malaria control
activities of all health
personnel in the area
f. Collection, analysis and
submission of required reports Environ-
2. Recognition of early signs and Agent ment
symptoms for management ad
further referrals.
3. Educate the dividual / families
The Epidemiologic Triangle consists of
/community of the importance of
three component – host, environment
the following:
and agent. The model implies hat each
a. Taking of chemoprophylaxis
must be analyzed and understood for
b. Wearing long-sleeved clothing
comprehensions and prediction of
and trousers when going out
patterns of a disease. A change in any
at night
of the component will alter an existing
c. Application of insect repellant
equilibrium to increase or decrease the
to skin
frequency of the disease.
d. Use of mosquito net
e. Use of screen in doors and 1. The host is any organism that
windows. If no screen, close harbors and provides
windows and doors during nourishment for another
night time. organism.
f. Use of insecticide aerosols 2. Agent is the intrinsic property of
and pyrethroid mosquito coils microorganism to survive and
g. Clearing of hanging branches multiply in the environment to
of trees along the stream produce disease.
 3. Environment is the sum total of all 2. Host factors (intrinsic factors) –
external condition and influences influences exposure,
that affects the development of susceptibility or response to
an organism which can be agents
biological, social and physical. a. Genetic
The environment affects both the b. Age
agents and the host. c. Sex
Three components of the d. Ethnic group
environment: e. Physiologic
a. Physical Environment – is f. Immunologic experience
composed of the inanimate  Active
surroundings such as the  Passive
geophysical conditions of the g. Inter-current or pre-existing
climate. disease
b. Biological environment makes h. Human behavior
up the living things around us 3. Environmental factor (extrinsic
such as plants and animal life. factors) – influences existence of
c. Socio-economic environment the agent, exposure, or
which may be in the form of susceptibility to agent.
level of economic a. Physical environment
development of the b. Biologic environment
community, presence of social  Human population
disruptions and the like.  flora
Classifications of Agents, Host and c. Socio-economic environment
Environment  Occupation
 Urbanization
1. Agents of disease  Disruption
a. Nutritive elements
 Excess
 Deficiencies CHAIN OF INFCTION
b. Chemical agents
 Poisons
 Allergens
c. Physical agents
d. Infectious agents
 Metazoan
 Protozoa
 Bacteria
 Fungi
 Rickettsia
 Viruses
Agent - These are the pathogens that
cause communicable disease. Most
commonly these are bacteria, virus,
fungi or parasites.
Reservoir – the reservoir (source) is a
host which allows the pathogen to live,
and possibly grow, and multiply. Human
animals and the environment can all be
reservoirs from microorganism.
Portal of exit – this refers the route by
which the infectious microorganisms
escape or leave the reservoir.
Mode of transmission – since
microorganisms cannot travel on their
own, they require a vehicle to carry them
to other persons a place.
Portal of entry – the path for the
microorganism to get into a new host
(the reverse of the portal of exit). The
mode of entry refers to the method by
which the pathogens enter the person.
Susceptible host – the future host is the
person who is next exposed to the
pathogen. The microorganisms may
spread to another person but does not
develop into an infection if the person’s
immune system can fight it off.
STAGES OF DISEASE
Infections progress through a common
pattern. The severity and duration of the
steps in the pattern may vary among
pathogens and hosts to some degree,
but the overall pattern is similar.
Differences in severity and duration of
the stages in disease progression are
often of diagnostic value.
Icubation period - is the initial stage of
the disease process before symptoms
become apparent and the pathogen is
actively replicating. There are no signs
or symptoms during the incubation
period.
Prodromal phase - is the stage of the
disease process when symptoms first
become apparent. These symptoms are
typically unspecific to the pathogen and
vague; they may include fever, fatigue,
and headaches.
Illness period - the infected person
shows noticeable symptoms of
infectious disease. The symptoms may
be localized or systemic.
Decline phase - is the stage of disease
when symptoms begin to abate and the
pathogen population begins to decline.
Damaged tissues begin to repair, and
pathogen numbers decrease.
Convalescence period - is the stage of
the disease process when symptoms
disappear. It is considered a recovery
period, when host strength is regained.
Host tissues are repaired to their pre
infection health.
TYPES OF IMMUNITY
Immunity is the ability of the body to
protect against all types of foreign
bodies like bacteria, virus, toxic
substances etc. which enter the body.
Innate Immunity – it is called natural or
native immunity, consist of mechanisms
that exist before infection and are
capable of rapid responses to microbes.
It is comprises four types of defense
barriers:
a. Physical barriers
b. Chemical barriers
c. Cellular defenses
Types of innate immunity
a. Species immunity – is the total
immunity shown by all members
of a species against pathogen;
e.g. birds immune to tetanus.
b. Racial immunity – is that in which
various races show marked
difference in their resistance to
certain infectious disease.
c. Individual immunity – is very
specific for each and every
individual despite having same
racial background and
opportunity for exposure.
Adaptive/Acquired Immunity – is the
immunity that is developed by the host
in its body after exposure to suitable
antigen or after transfer of antibodies or
lymphocyte from an immune donor.
Characteristics of acquired immunity:
a. Antigenic specificity
b. Diversity
c. Immunologic memory
d. Self/non-self-recognition
Types of Acquired Immunity
1. Active Immunity – it is induced by
natural exposure to a pathogen or
by vaccination. It can be
categorized into two types:
a. Naturally Acquired Active
Immunity
b. Artificially Acquired Active
Immunity
2. Passive Immunity – is achieve by
transfer of immune products,
such as antibody or sensitized T-
cell, from an immune individual to
non-immune one. It has two
types:
a. Naturally Acquired Passive
Immunity
b. Artificially Acquired Passive
Immunity
Mechanism of Active Immunity
Primary immune response – takes place
when the host is attacked by certain
microbes for first time. The antibodies
start to generate after certain period as
the binding of an antigen with its
particular antibody is very specific.
Secondary immune response – occurs
when an individual is being attacked by
the same antigen subsequently. It is a
rapid process.
PATTERN OF DISEASE OCCURANCE
The variables of disease as to person,
time and place are reflected in distinct
patterns of occurrence and distribution
in a given community.
1. Sporadic occurrence is the
intermittent occurrence of a few
isolated and unrelated cases in a
given locality. The cases are few
and scattered, so that there is no
apparent relationship between
them and they occur on and off,
intermittently, through a period of
time.
2. Endemic occurrence is the
continuous occurrence
throughout a period of time, of the
usual number of cases in a given
locality. The disease is therefore
always occurring in the locality
and the level of occurrence is
more or less constant through a
period of time. The level of
occurrence maybe low or high,
when the given level is
continuously maintained, then the
pattern maybe low endemic or
high endemic as the case maybe.
3. Epidemic occurrence is of
unusually large number of cases
in a relatively short period of time.
There is a disproportionate
relationship between the number
of cases and the period of
occurrence, the more acute is the
disproportion, the more urgent
and serious is the problem.
4. Pandemic is the simultaneous
occurrence of pandemic of the
same disease in several
countries. It is another pattern of
occurrence from an international
perspective.
TYPES OF ISOLATION
Isolation precautions create barriers
between people and germs. These
types of precautions help prevent the
spread of germs in the hospital.
Standard Precautions
When you are close to patients or close
to handling blood, bodily fluid, bodily
tissues, mucous membranes, or areas
of open skin, you must use personal
protective equipment (PPE). Depending
on the anticipated exposure, types of
PPE that may be required include:
 Gloves
 Masks and goggles
 Aprons, gowns, and shoe covers
Transmission-based Precautions
Transmission-based precautions are
extra steps to follow for illnesses that
are caused by certain germs.
Transmission-based precautions are
followed in addition to standard
precautions. Some infections require
more than one type of transmission-
based precaution.
 Airborne precautions - may be
needed for germs that are so
small they can float in the air and
travel long distances. Germs that
warrant airborne precautions
include chickenpox, measles, and
 tuberculosis (TB) bacteria
infecting the lungs or larynx
(voicebox).
 Contact precautions - help keep
staff and visitors from spreading
the germs after touching a person
or an object the person has
touched. Some of the germs that
contact precautions protect from
are C difficile, norovirus, and
COVID-19. These germs can
cause serious infection in the
intestines or lungs.
 Droplet precautions - are used to
prevent contact with mucus and
other secretions from the nose
and sinuses, throat, airways, and
lungs. When a person talks,
sneezes, or coughs, droplets that
contain germs can travel about 3
feet (90 centimeters). Illnesses
that require droplet precautions
include influenza (flu), pertussis
(whooping cough), mumps, and
respiratory illnesses, such as
those caused by coronavirus
infections including COVID-19.