What is Malaria?
Malaria is a parasitic infection transmitted from person to person by the bite of infected female Anopheles mosquitoes. These mosquitoes usually bite from around dusk to dawn. Once transferred to the human body, the infection travels to the liver where it multiplies and then enters the red blood cells. Inside the red blood cells the parasites multiply rapidly until they burst releasing even more parasites into the blood stream.
Malaria begins as a flu-like illness, with symptoms first occurring 9-14 days after infection. Symptoms include fever (typical cycles of fever, shaking chills, and drenching sweats may develop), joint pain, headaches, frequent vomiting, convulsions and coma. Malarial death may be due to brain damage (cerebral malaria), or damage to vital organs. The reduction of red blood cells can cause anaemia.
There are four main species of the malaria parasite: P. falciparum, P. malariae, P. vivax and P. ovale. P. falciparum is the main cause of severe clinical malaria and death.
It is possible to be re-infected with the same strain of malaria a number of times, as minimal resistance (and protection) is provided by previous infection.
If simple malaria is left untreated it can become severe;around 8 million malaria cases progress to severe malaria annually. Severe malaria, usually caused by the Plasmodium falciparum, causes organ damage and leads to death if untreated.
People suffering from severe malaria are more likely to experience convulsions and coma. This can cause damage to organs including the brain, lungs, kidneys and blood vessels. If early diagnosis is not performed and effective drugs are not available for the treatment of severe malaria, the infection can rapidly become life-threatening.
The majority of deaths due to malaria are due to severe complicated malaria. Children and pregnant women are the most at risk.
Treatment and Prevention
Currently, artemisinin-based combination therapy (ACT) is the most effective treatment for malaria caused by Plasmodium falciparum. ACTs are a combination of an artemisinin derivative (artesunate, artemether or dihydroartemisinin) and a partner drug. The choice of the combination is based on the efficacy in the area, as well as other aspects such as the national protocol and the (expected) effectiveness. ACTs work quickly and have few side effects.
For uncomplicated malaria, the treatment is a three-day course of ACT. For severe malaria it is injectable artesunate. Artesunate reduces the risk of death by 39 percent in adults and 24 percent in children. In 2010, World Health Organisation (WHO) guidelines were altered to recommend the use of artesunate, a derivative of artemisinin, for the treatment of severe malaria in children.
In 2011, MSF treated 364,848 patients in outpatient departments and 10,503 in inpatient departments for malaria. The majority of these cases were severe, and half of them were treated at Baraka hospital – one of our projects in Democratic Republic of Congo.
In many countries, MSF piloted the introduction of ACT and malaria Rapid Diagnostic Tests (RDTs). Since 2002, MSF has been advocating for systematic parasitological confirmation of diagnosis of malaria before treatment to ensure proper diagnosis and treatment of all patients. Since 2010, this has been integrated into WHO guidelines, but it is still yet to be integrated into many national protocols.
Long lasting insecticide-treated bed nets are an important means of controlling malaria. In endemic areas, MSF systematically distributes nets to pregnant women and children under the age of five, who are most vulnerable to severe malaria with staff giving patients advice on the most effective way to use the net.. In 2011, 171 650 bed nets were sent to the field to be distributed to those most at risk
Indoor residual spraying is implemented in all our health facilities and in the houses of some of the local communities.
Educating communities about malaria and its symptoms and teaching them how to use their bed nets and what they should do after their houses have been sprayed with insecticide is an important part of prevention.
Despite ongoing research, there is no vaccine against malaria.
Children with malaria
In areas where the malaria infection rate is high year after year, morbidity and mortality fall mainly on children and pregnant women. Children are particularly at risk for severe malaria as their immune system is less developed. If not treated quickly it can cause a coma with the chance of long-term neurological damage. Furthermore, children often suffer from anaemia due to malaria, leaving them vulnerable to other diseases.
Pregnant Women with malaria
Pregnant women are also particularly at risk of developing severe malaria. WHO estimates that 1 in 10 maternal deaths can be attributed to malaria, and that each year 200,000 babies will die because their mother is infected with the disease.
There is increasing evidence of the danger of malaria in pregnancy for the woman and her unborn child, both for whom, it can cause life-threatening complications. For the woman these complications could be anaemia or miscarriage; for the unborn child, low birth weight or premature birth.
Due to this we regularly test all women in our antenatal clinics for malaria, and provide them with two bed nets at their first visit.
The Cost of Malaria Prevention and Treatment Material (*prices as of November 2011)
|Bed Net||€4||Long-lasting insecticide-treated bed net|
|Spray||€0.40 to €1.60||Insecticide spray that provides six months effective protection against the infected mosquitoes|
|Tests||€0.40||Rapid diagnostic test for malaria|
|€10||ACT pills to cure 13 adults with uncomplicated malaria in three days|
|€0.31||Three-day course of ASAQ or €0.36 for Coartem for babies (2-11 months)|
|€0.35||For three-day course of ASAQ or €0.72 for Coartemfor children (1-5 years)|
|€0.54||For three-day course of ASAQ or €0.95for Coartem for an older child (6-13 years)|
|€0.77||For a three-day course of ASAQ or €1.05 for Coartem for an adult|
|€2.30||Treatment for severe malaria is artesunate via injection for a child|
Depending on the local situation regarding procurement of medicines we use ASAQ, Coartem, or other ACT combination
For more information contact:
Médecins Sans Frontières / Doctors Without Borders (MSF)
Tel: +27 (0) 11 403 4440
Fax: +27 (0) 11 403 4443
For more about MSF South Africa, refer to www.msf.org.za.