Malaria

Malaria is a parasitic infection spread by the bite of infected female Anopheles mosquitoes, which acquire the parasite when they bite an infected person. Once inside the human body the parasites make their way to the red blood cells, where they multiply rapidly until the cells burst and release even more parasites into the bloodstream.

Infants and children under five years old are especially vulnerable to infection and serious consequences of malaria since they haven't yet developed immunity. People displaced from their villages because of conflict or natural disaster are also at an increased risk of malaria. Those coming from non-malaria areas lack the partial immunity developed by continuous exposure since childhood; when infected, they tend to get very sick. They also often live with poor or no housing in overcrowded camps near water and livestock, all of which contribute to malaria transmission. Pregnant women are at an increased risk of anemia, severe sickness, and death when infected with malaria; there is also a higher chance that the pregnancy will develop complications or end in miscarriage, or cause fetal growth restriction.

Malaria often begins as a flu-like illness. Fever typically appears 9-14 days after infection (typical cycles of fever, shaking chills, and drenching sweats may develop) and may be accompanied by multiple non-specific symptoms, which makes clinical diagnosis difficult. The disease also causes destruction of red blood cells, leading to anemia. If simple malaria is not treated it can become severe, increasing the risk of death. That’s why early diagnosis and quick treatment are vital. In severe malaria parasites may attack the brain, causing convulsions and coma and leading to breathing problems, kidney failure, and/or severe anemia. Each year about eight million malaria patients develop life-threatening complications.

Malaria-carrying mosquitoes usually bite from dusk to dawn. Since mosquitoes breed in water they are especially plentiful during the rainy season, causing malaria infections to increase. The most basic prevention is to avoid bites through indoor spraying of homes with safe, long-lasting insecticides and by sleeping under bednets treated with long-lasting insecticide. More recently, antimalarial drugs have been used to prevent infection among the most at-risk populations for limited periods of time. Seasonal malaria chemoprevention (SMC) is now recommended for children during the four highest-transmission months in some regions. Preventive drug treatment is also recommended for pregnant women at routine prenatal care visits after the first trimester of pregnancy.

Diagnosing malaria is usually done with rapid diagnostic tests using blood from a finger prick. The tests are easy to perform, and community health workers can be trained to do them. A more accurate test is done by using a microscope to look directly for malaria parasites in a drop of blood. But most primary health facilities don't have microscopes or trained lab technicians, and microscopy is much more labor-intensive, So this diagnostic test is often not feasible. In some settings, neither test is available so community health workers must diagnose sick children based on symptoms alone. This often leads to the overdiagnosis of malaria while the real cause of patients’ symptoms goes untreated.

The most effective treatment for malaria is a combination of two drugs as artemisinin-based combination therapy (ACT), which cure most infections in three days. Early treatment is essential since the longer the disease lasts, the more likely it will progress to severe malaria. Severe malaria requires hospitalization so patients can be given intravenous antimalarials along with supportive treatment. Patients often need blood transfusions, which in turn requires a safe, adequately-stocked blood bank—something that’s difficult to achieve in under-resourced areas, especially in sub-Saharan Africa. Without treatment, or with significantly delayed treatment, severe malaria kills. Treatment with artemisinin is usually very effective but the malaria parasite has developed resistance to artemisinin in some regions, particularly in Southeast Asia, meaning that ACT may no longer be effective. If the spread of resistance cannot be stopped, it could mean a resurgence of malaria, since there aren’t currently any new drugs available.