NORTH SOUTH UNIVERSITY Department

Of
The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Assignment Cover Sheet

Section-PBH101.9
Topic: Malaria: A life threatening disease
Name ID
06. Taimum Islam 1721196030
Student’s name & ID 09. Ove Kabir Eon 1731923630
13. Mashtura Binte Alam 1813313630
19. Arshiana Afroza Niha 1821219630
20. Sumaiya Tabssum Rafa 1821267630
30. Adman Alvee Maula 1822013030

Due date : Date submitted:

Submitted To: Dr. Ariful Bari Chowdhury ( ABy)

All work must be submitted by the due date. If an extension of work is required, please complete and submit a Special
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Where there are reasonable grounds for believing that plagiarism or collusion has occurred, this will be reported to the Department Chairman , who will disallow the work
concerned by prohibiting assessment or refer the matter to the Academic Committee.

Student’s Statement:
 I/We have read the university’s statement on cheating and plagiarism,
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Signature of the students:
Date:
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 NORTH SOUTH UNIVERSITY Department
Of
The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Table Of Content:

1.Introduction

2.Malaria In Bangladesh

3.Current Situation Of The Problem

4.Existing Policy For Prevention

5.Recommendation

6.Conclusion

7.Reference

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 NORTH SOUTH UNIVERSITY Department
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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Acknowledgements

"I would like to express my special thanks of gratitude to my teacher Dr. Ariful
Bari Chowdhury ( ABy) Sir who gave me the golden opportunity to do this

wonderful assignment on the topic “Malaria: A life threatening disease ”

which also helped me in doing a lot of Research and I came to know about so
many new things. Secondly, I would also like to thank my course mate who
helped me a lot in finishing this project within the limited time. I am making
this project not only for marks but to also increase my
knowledge.”

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 NORTH SOUTH UNIVERSITY Department
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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Introduction:
The word Malaria comes from the Italian word “Mal “ and “aria” which means Bad
Air .this derive from the old days when it was thought all the disease are cause by dirty or
Bad air. Malaria is a parasitic disease that is transmitted when a human is bitten by a female
Anopheles mosquito infected with one of five parasite species from the genus Plasmodium
those are Plasmodium falciparum, P. vivax, P. malariae, P. ovale and P. knowlesi. Among the
five two of them are P.falciparum and P.vivax parasite - pose the greatest threat.
 P.falciparum is the most prevalent malaria parasite on the African continent. It is
responsible for most malaria-related deaths globally.

 P.vivax is the dominant malaria parasite in most countries outside of sub-Saharan

Africa.

In most cases, symptoms appear 9 to 14 days after the infectious mosquito bite and typically
include fever, headache, vomiting, and other flu-like symptoms. The infection can rapidly
become life-threatening if drugs are not available for treatment.
Origin of MALARIA
In 2700 BC the symptoms of malaria were described in ancient Chinese medical writings. In
1880 6th of November Charles Louis Alphonse Laveran, a French army surgeon stationed in
Constantine, Algeria, was the first to notice parasites in the blood of a patient suffering from
malaria. Then in 1886an Italian neurophysiologist named Camillo Golgi established , that
there were at least two forms of the disease, one with tertian periodicity (fever on every other
day) and one with quatrain periodicity (fever on every third day). He also observed that the
forms produced differing numbers of merozoites (new parasites) upon maturity and that fever
coincided with the rupture and release of merozoites into the blood stream.

Overview of the disease

Malaria infection is still to be considered a major public health problem in 2016, there were
an estimated 216 million cases of malaria in 91 countries, an increase of 5 million cases over

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 NORTH SOUTH UNIVERSITY Department
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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

2015.In terms of morbidity and mortality, causing more than 200 million cases and 655.000
deaths worldwide every year.
Malaria deaths reached 445 000 in 2016, a similar number (446 000) to 2015.The WHO
African Region carries a disproportionately high share of the global malaria burden. In 2016,
the region was home to 90% of malaria cases and 91% of malaria deaths. Total funding for
malaria control and elimination reached an estimated US$ 2.7 billion in 2016. Representing
31% of funding those are contributions from governments of endemic countries amounted to
US$ 800 million. According to the World Health Organization (WHO) Malaria Report 2011,
a total of 106 countries in the world are at risk of transmission of malaria infection. A total of
216 million estimated malaria cases occurred in 2010, 81% of which were reported in the
African Region followed by South East Asia (14%) and Eastern Mediterranean Region (6%).
The total number of malaria deaths was estimated to be 655.000 in 2010; 91% of whom
occurred in the African Region, 5% in South-East Asia and 4% in Eastern Mediterranean
Region.
Symptoms
Malaria is an acute febrile illness. In a Non-Immune individual, symptoms usually appear 12-
15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills–
may be mild and difficult to recognize as malaria. If not treated within 24
hours, P.falciparum malaria can progress to severe illness, often leading to death.
Children with severe malaria frequently develop one or more of the following symptoms:
severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In
adults, multi-organ involvement is also frequent. In malaria endemic areas, people may
develop partial immunity, allowing asymptomatic infections to occur.

Transmission cycle of MALARIA parasite in both Human and Mosquito

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 NORTH SOUTH UNIVERSITY Department
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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Malaria spreads when a mosquito infected with malaria parasites bites a non infected human;
the parasites enter that person's bloodstream and migrate to the liver. When the parasites
mature, they leave the liver and infect red blood cells. Mosquitoes become infected when
they feed on infected people and this way the cycle continues.

Malaria in Bangladesh:

Figure-1: Overview of malaria condition in Bangladesh

Malaria is a severe public health problem in 90 countries around the world including
Bangladesh. WHO considers Bangladesh as one of the major malaria endemic countries in
South Asia. The epidemiology of malaria in Bangladesh is highly complex, varying from
location to location and from one population group to another. Malaria was nearly eradicated
from the country by 1970 but it re-emerged in 1990s and remains so. Out of 64 districts the
disease is high endemic in 13 border districts (Figure-1). Among these 13 districts,

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 NORTH SOUTH UNIVERSITY Department
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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Rangamati, Khagrachari and Bandarban contribute 93% of total case burden of malaria
disease.

A survey conducted in 2006-2007 by ICDDR,B found that the overall malaria prevalence in
these 13 districts was 3.1% and it was significantly higher in children. An NMCP estimate
says the number of people diagnosed with Malaria dropped by 50% in 2016 with 27,737
cases, whereas the figure stood at 39,719 and 57,840 in the 2015 & 2014.
Some 55, 837 cases were registered in 2010.

In the past decade, Bangladesh has made significant progress in reducing malaria morbidity
and mortality. Deaths from malaria were dipped by 54% in 2016 when 17 people died.
Malaria claimed nine lives in 2015, which is one-fifth the figure recorded a year ago. In
2010, malaria saw 37 people dying (Figure-2).

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

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 NORTH SOUTH UNIVERSITY Department
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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Figure-2: Reported deaths from malaria in Bangladesh from

2000 to 2014
To ensure that the country remains on track to eliminate malaria by the regionally adopted
goal of 2030, the Bangladesh Government has developed a new National Strategic Plan
2017–2021. This will also greatly contribute towards overall national development and the
Sustainable Development Goals (SDGs). As part of the new plan, Bangladesh aims to
achieve a “Malaria Free Bangladesh By 2030”. To achieve this, the country sets a target of
five related objectives, as follows-
 Reduce annual parasite incidence in the 13 endemic districts to less than 0.46 by 2021.

 Interrupt local transmission of malaria in 8 of the 13 endemic districts by 2021.

 Ensure that the remaining 51 districts are free from local malaria transmission by
2021.

 Prevent the re-establishment of malaria in districts where transmission has been

interrupted.

 Prevent the emergence of strains of Plasmodium falciparum malaria that are resistant
to artemisinin-based combination therapies (ACT) in the country.

Despite significant success in preventing malaria between 2010 and 2016 throughout

Bangladesh, the prevalence rate of malaria still remains very alarmingly high across
Chittagong Hill Tracts (CHT), especially in the remote areas. However, about 17 million
people still at risk from the disease, Bangladesh has a long way to go until elimination. So,
this is a challenge. If we really want to eliminate (malaria), we have to put focus on those in
the highest policy level and engage with them to invest more, considering the elimination
need.

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 NORTH SOUTH UNIVERSITY Department
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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Current Situation of the Problem:

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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

As above picture shows the area highlighted were the malaria is present.
Malaria remains one of the world's worst health problems with 1.5 to 2.7 million deaths
annually, these deaths are primarily among children under 5 years of age and pregnant
women in sub-Saharan Africa. Of significance, more people are dying from malaria today
than 30 years ago. This review considers the factors which have contributed to this gloomy
picture, including those which relate to the vector, the female anopheles mosquito, to human
activity such as creating new mosquito breeding sites, the impact of increased numbers of
people, and how their migratory behaviour can increase the incidence and spread of malaria;
and the problems of drug resistance by the parasites to almost all currently available anti
malarial drugs. In a selective manner, this review describes what is being done to ameliorate
this situation both in terms of applying existing methods in a useful or even crucial role in
control and prevention and in terms of new additions to the anti malarial armory that are
being developed. Topics covered include biological control of mosquitoes, the use of
insecticide-impregnated bed nets, transgenic mosquitoes manipulated for resistance to
malaria parasites, old and new anti malarial drugs, drug resistance and how best to maintain
the useful life of anti malarias’ immunity to malaria and the search for anti malarial vaccines,
and the malaria genome project and the potential benefits to accrue from it. Malaria remains
a killer disease and that’s why world health organization (WHO) declared April 25 as world
Malaria day.

Existing Policy for Prevention of Malaria:

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 NORTH SOUTH UNIVERSITY Department
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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Malaria is a serious tropical disease spread by mosquitoes that leads to fever, chills, and flue
like symptoms. It is a chronic parasite infection which can be deadly if it is left untreated. A
single mosquito bite is all it takes for someone to become infected. So we have to know about
Malaria prevention. There is several existing policy for prevention, some of those are given
below.

Malaria can often be avoided using the ABCD approach to prevention, which stands for:

 Bite prevention – avoid mosquito bites by using insect repellent, covering our arms and
legs, and using a mosquito net.
 Check Awareness of risk – find out whether we're at risk of getting malaria.

 Whether we need to take malaria prevention tablets – if we do, make sure we

take the right tablets at the right dose, and finish the course.

 Diagnosis – seek immediate medical advice if we have malaria symptoms, including up to a

year after we return from travelling.

These are outlined in more detail below.

Being aware of the risks

To check whether we need to take preventative malaria treatment for the countries we're
visiting.

It's also important to visit our GP or local travel clinic for malaria advice as soon as you
know where we're going to be travelling.

Even if we grew up in a country where malaria is common, we still need to take precautions
to protect our self from infection if we're travelling to a risk area.

Nobody has complete immunity to malaria, and any level of natural protection we may have
had is quickly lost when you move out of a risk area.

Preventing Bites

It's not possible to avoid mosquito bites completely, but the less you're bitten, the less likely
we are to get malaria.
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 NORTH SOUTH UNIVERSITY Department
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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

To avoid being bitten:

 Stay somewhere that has effective air conditioning and screening on doors and windows. If
this isn't possible, make sure doors and windows close properly.

 If we're not sleeping in an air-conditioned room, sleep under an intact mosquito net that's
been treated with insecticide.

 Use insect repellent on our skin and in sleeping environments.

 Wear light, loose-fitting trousers rather than shorts, and wear shirts with long sleeves. This is
particularly important during early evening and at night, when mosquitoes prefer to feed.

Ant malarial tablets

There's currently no vaccine available that offers protection against malaria, so it's very
important to take ant malarial medication to reduce your chances of getting the disease.

However, ant malarias’ only reduce your risk of infection by about 90%, so taking steps to
avoid bites is also important.

When taking ant malarial medication:

 make sure you get the right ant malarial tablets before we go – check with our GP or
pharmacist if we're unsure

 follow the instructions included with your tablets carefully

 Depending on the type we're taking, continue to take our tablets for up to four weeks after
returning from your trip to cover the incubation period of the disease.

Get immediate medical advice

We must seek medical help straight away if you become ill while travelling in an area where
malaria is found, or after returning from travelling, even if we've been taking ant malarial
tablets.

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The first private university in Bangladesh Public Health
(Established by the North South University Foundation)

Malaria can get worse very quickly, so it's important that it's diagnosed and treated as soon as
possible. If you develop symptoms of malaria while still taking ant malarial tablets, either
while we're travelling or in the days and weeks after we return, remember to tell the doctor
which type we have been taking. The same type of ant malarial shouldn't be used to treat us
as well.

If we develop symptoms after returning home, visit your GP or a hospital doctor and tell
them which countries we've travelled to in the last 12 months, including any brief stopovers.

DEET insect repellents

The chemical DEET is often used in insect repellents. It's not recommended for babies who
are less than two months old.

DEET is safe for older children, adults and pregnant women if we follow the manufacturer's
instructions:
 use on exposed skin

 don't spray directly on to your face – spray into your hands and pat on to your face

 avoid contact with lips and eyes

 wash your hands after applying

 don't apply to broken or irritated skin

 make sure you apply DEET after applying sunscreen, not before

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Recommendation:
 First what we can do is, finding out which areas are more friendly to
mosquitoes to breed. Those are the area we should mainly focus on.
 National improvements on health and hygiene should take more seriously.
 Rain fall is can be an issue as it washes away the road dirt and blockage the
drains, and those drains breeds more mosquitoes and spread malaria
 Government should take more effective steps to minimize the risk of Malaria.
Cleaning the drains and keep the roadside dustbins clean to stop malaria can
be taken as steps.
 Sometimes we grow plants in our house or rooftop. To change the water daily
is recommended, as we know mosquitoes are likely to breed in stored water.
 Public health can play a vital role to minimize epidemic malaria. By public
health people will be more aware and conscious about the diseases and take
necessary measures to prevent it
 Organizations like US Aid can have campaigns against Malaria
 Mosquito killer gases should be used more regularly
 Many NGOs can work on field to make rural people know about it more.

Even after all the preventions invented, malaria still proves to be a life threatening disease.
Malaria poses a scientific challenge because of the complex parasite that causes the disease,
one that lives half its life within a cold-blood mosquito and the other half within a warm-
blooded human. With reported documents it’s been proven that malaria has caused more than
500 deaths per year in Bangladesh since 1990’s. But the question is why does malaria still
persist in human population?
Reasons why malaria is still a threat to humans
Malaria is a vector-borne disease that is difficult to stop completely. The mosquito is the
vector that is known for potentially having malaria and transporting it to human beings via
bites. A lot of preventions methods available to us nowadays fail to stop the disease from
spreading.

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Prevention methods and why they fail

Preventing bites: it’s not possible to prevent mosquitoes from biting. Even though there are
many mosquito repellents in the markets nowadays but they all wear off after a certain period
of time. As malaria takes place near irrigation it means that farmers and people with a lower
levels of income who may not be able to buy the repellents on the first place are highly prone
to malaria and mosquito bites.

Ant malarial tablets: the malaria parasite has become resistant to some of the current drugs
used to treat malaria patients. Drug-resistant means that the organism with the disease has
developed a tolerance for the harming mechanisms of that medicine. This resistance to some
of the medicines will only give the malaria parasite more opportunity to grow among human
populations. This is one of the biggest challenges the scientists are facing now to prevent
malaria. Therefore, ant malarial tablets only work for a while before the mosquitoes are
immune to it.
Using mosquito nets: Mosquito nets help prevent the mosquitoes from biting at night but do
not provide any protection during the day time when people are out of their houses or at
work.

Conclusion:
Fight between malaria and humans have been going on for a very long time. The disease has
been proven to be preventable for a short time only as it quickly gets immune to the
medications. Each time a new vaccine is invented; malaria gets stronger and more immune to
it. Having resistance to ant malarial drugs, suitable mosquito vectors, innumerable mosquito
breeding sites and favourable ecological conditions provide scope for intense malaria

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(Established by the North South University Foundation)

incidence in the district both spatially and temporally. In some countries, ant malarial
interventions are applied in broad swaths, without regard to underlying differences in the
epidemiology of the disease. It’s a disease that requires more in-depth studying and research.
Providing with cleaner environment, better living standards, more funding for the research of
malaria and better drainage systems is a long term goal of the government which will aid in
decreasing the rate of malaria. Moreover, until the vaccine for curing and preventing malaria
is developed, to which malaria doesn’t grow immunity towards, malaria may still be a threat
to human lives.

References:
1. Maude RJ, Dondorp AM, Faiz MA, Yunus EB, Samad R, Hossain A, et al. Malaria in
southeast Bangladesh: a descriptive study.Bangladesh. Med Res Counc Bull
2008;34:87e9.
2. Islam N, Bonovas S, Nikolopoulos GK.An epidemiological overview of malaria
inBangladesh. Travel Med Infect Dis. 2013;11 (1) :29-36.
3. National Malaria Control Program (NMCP).

4. World malaria report. World Health Organization; 2011.

5. Haque U, Ahmed SM, Hossain S, Huda M, Hossain A, Alam MS, et al. Malaria
prevalence in endemic districts of Bangladesh. PLoS One 2009;4:e6737.
6. https://www.dhakatribune.com/feature/health-wellness/2018/04/24/malaria-deaths-
districts-coxs-bazar

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7. https://www.sciencedirect.com/science/article/pii/S2214109X13701761

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