Malaria
94 per cent of all malaria deaths occur on the African continent

Malaria is caused by infection with a parasite after being bitten by an infected mosquito.  Malaria causes symptoms that typically include fever, headache, chills and tiredness. The disease may initially be mild and difficult to recognize as malaria. If not treated malaria can progress to severe illness, often leading to death.

This disease is easy enough to treat, but access to the most effective treatments is inadequate.The parasite that causes malaria in Asia is starting to show resistance to resistance to the current therapies with few new drugs being developed at this moment. Rapid diagnostic tests for malaria exist but are not available everywhere, leading to misdiagnosing other diseases as malaria, while the real cause of the symptoms is left untreated.

229

MILLION

New infections per year

/

94

%

Of infections and deaths in Africa

/

0.5

MILLION

Dead per year

What causes Malaria

Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria is caused by infection with a single-celled micro organisms of the Plasmodium group.

Five species of Plasmodium can infect humans. Most deaths are caused by P. falciparum, whereas P. vivax, P. ovale, and P. malariae generally cause a milder form of malaria. P. knowlesi rarely causes disease in humans.

Malaria  is most commonly spread by an infected female Anopheles mosquito.

Photo: Anopheles stephensi mosquito, the main vector of malaria

Where is Malaria found

The disease is widespread in the tropical and subtropical regions, in a broad band around the equator. This includes much of sub-Saharan Africa but also South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas are at risk.

An increase in temperature, rainfall, and humidity may cause a proliferation of the malaria-carrying mosquitoes to other regions, resulting in an increase in malaria transmission in areas in which it was not reported earlier.

Image: Geographical distribution of Malaria

What are the symptoms of Malaria

Malaria frequently starts as a flu-like disease 8 to 20 days following infection. Common symptoms may include headache, fever, shivering, joint pain, vomiting.

A classic symptom of malaria is paroxysm, a cyclical occurrence of sudden coldness followed by shivering, then fever and sweating. This occurs every two or three days.

Severe malaria can cause neurological symptoms, respiratory distress, pneumonia, severe anemia, spontaneous bleeding, kidney failure, coma and ultimately death.

Serious complications occur in up to 25% of adults and 40% of children with severe P. falciparum malaria. It is also an important cause of stillbirths, infant mortality, miscarriage in pregnant women.

Photo: Plasmodium falciparum infected red blood cell - center

How can Malaria be prevented

Controlling mosquito populations is the main way to prevent and reduce malaria transmission, along with insecticide-treated mosquito nets.

The presence of malaria in an area requires a combination of high human population density, high anopheles mosquito population density and easy transmission of the disease. If any of these is lowered sufficiently, the parasite eventually disappears from that area.

There are a number of medications that can help prevent or interrupt malaria in travelers to places where infection is common. Many of these medications are also used in treatment. Even a vaccine exists.

How is Malaria diagnosed

Due to the non-specific symptoms, diagnosis of Malaria based on symptoms can be difficult. Malaria is usually confirmed by the microscopic examination of blood films or by antigen-based rapid diagnostic tests. Microscopy is the most commonly used method to detect the malaria parasite, but the sensitivity ranges from 75 to 90% in optimum conditions and to as low as 50%. Commercially available rapid diagnostic test are often more accurate, but they are widely variable in sensitivity and specificity.  In some areas, rapid diagnostic tests must used to distinguish whether the malaria symptoms are caused by P. falciparum or by other species of parasites since treatment strategies could differ for non-P. falciparum infections.

Malaria can also be detected by polymerase chain reaction (PCR) tests, such as the ones made available by the WoIDMo, but they are not widely in use in areas where malaria is common.

Lack of tests for malaria often leads to the over-diagnosis of malaria while the real cause of disease symptoms goes untreated.

How is Malaria treated

Simple or uncomplicated malaria may be treated with oral medications. Artemisinin in combination with other antimalarials is about 90% effective when used to treat uncomplicated malaria. Artemether-lumefantrine (six-dose regimen) is more effective than the artemether-lumefantrine (four-dose regimen) or other regimens not containing artemisinin derivatives in treating falciparum malaria. Another recommended combination is dihydroartemisinin and piperaquine. There is limited safety data on the antimalarial drugs in pregnancy.

Severe and complicated malaria are almost always caused by infection with P. falciparum. Parenteral artesunate is superior to quinine in both children and adults. Artemisinin derivatives (artemether and arteether) were as efficacious as quinine in the treatment of cerebral malaria in children.

Resistance is now common against all classes of antimalarial drugs apart from artemisinins. Some malaria strains are resistant to all therapies, making the disease untreatable.

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