Malaria, its fatal impact and treatment
From time immemorial men have been surviving amongst a lot of deadly diseases among which Malaria is a primitive one. It is no exaggeration to say that Malaria has been responsible for much of the human suffering and misery accompanying the process of social and economic development.
Malaria is caused by the bite of the female Anopheles mosquito which carries the germ of Plasmodium, the causative agent of Malaria.
Malaria has got a very deleterious effect on health especially if it is recurrent. Malaria is always accompanied by haemolysis i.e. destruction of red blood cells causing severe or prolonged attack of anaemia that sometimes lead to death. Besides Plasmodium falciparum, malaria may have following complications: brain damage due to cerebral Malaria causing coma and death; kidney damage leading oliguria (less urine) and uraemia causing death due to acute renal failure; lung complications causing severe cough and respiratory distress due to pulmonary oedema; intestinal complication in the form of diarrhoea; liver damage causing jaundice, intravascular haemolysis causing Black water fever; hypoglycaemia especially with Quinine treatment; hypotensive shock; splenic rupture; in pregnancy: maternal death, abortion, still birth, low birth weight baby.
Malaria fever should be diagnosed first with clinical features and then it must be confirmed with blood slide examination and ICT for Malaria test before starting anti-malarial drugs. If there is no immediate facility for MP test, anti-malarial drugs can be started on the basis of clinical feature, especially the type of fever. But once the drug is started the full course of it must be completed whether temperature remains or not. Otherwise resistance to drugs and relapses will occur.
For positive case of Plasmodium vivax and ovale, radical cure should be achieved by a course of Primaquin, otherwise there may be relapses. In Bangladesh anti-malarial regimes suggested by the World Health Organisation (WHO) should be strictly followed for uncomplicated Malaria, treatment failure Malaria and severe Malaria separately.
Absolute prevention or eradication of Malaria is very tough. However, this may be achieved to some extent by undertaking following measures:
(1) To prevent breeding of mosquito by application of insecticides and larvicides in their breeding places like stagnant water, bushes etc.
(2) Jungles and bushes around houses should be cleared for preventing mosquitoes to hide and reproduce
(3) The windows and doors of the household should be netted or screened to prevent entry of mosquitoes.
(4) Personal protective measures like reduction of exposure to mosquito bites especially during mosquito feeding times (from dusk to dawn) by using mosquito repellents and mosquito nets preferably impregnated with Pyrethroids, ICON etc. and covering the skin by wearing long clothing, thick socks may be effective.
(5) Individuals should avoid nocturnal outdoor activities as much as possible.
(6) Pregnant women should not travel to Malaria endemic zones especially where chloroquine-resistant Plasmodium falciparum malaria is present.
(7) Along with the above measures travellers should receive chemo-prophylaxis before, during and after exposure to the malrious areas of the world. But a single control strategy will not be helpful and individual circumstances require different or combined approach.
The writer is a Medical Officer, Ahsanullah University of Science and Technology, Dhaka.
E-mail: dr.ahmadmunir@gmail.com