Malaria: A Silent Killer
Malaria is an ailment we see everyday and we suffer it often, because our environment is conducive for the vector and at times people tend to treat it by themselves which is one of the reasons why it is a silent killer. self medication is dangerous and disastrous to human life, because as one treats him/herself of the disease he/she may not take the correct dose or might make wrong decision because of frequency of malaria when a person falls ill he/she automatically believe that is malaria and will start to treat it by himself and this act has stolen the lives of many unknowingly.
In definition, malaria is a mosquito borne infectious disease caused by a eukaryotic protest of the genus plasmodium. Or a serious, notifiable chills, fever, sweating and spleenomegaly, serious and often fatal complications may arise in falciparum malaria. BAILLIER’S nurses Dictionary. Each year more than 250 – 300 million deaths occur due to malarial infection Nicky, September 26, 2010 “Gorillas in midst of malaria mystery” in some parts of Africa, like Asia and central south America 100million cases of malaria occur each year the majority of whom are young children in sub- Saharan African ninety percent of malaria – related deaths occur in Sub-Sahara Africa. Most of the 1-3 million who die each year from malaria is children, mainly in Africa, which is hyper-endemic for malaria WHO 2007 in older children, malaria has a similar course as in adults. However, in children below the age of 5 years the disease tends to be atypical and more severe pregnant women in endemic areas are highly susceptible to malaria and both the severity and frequency are higher in pregnant women than non- pregnant women.
Objectives of the Study
1. Concept of malaria
2. Causes of malaria
3. Pathophysiology of malaria
4. Signs and symptoms of malaria
5. Malaria as a killer disease
6. Treatment of malaria
7. Nurses role in treatment/prevention of malaria
Concept of Malaria
Malaria is widespread in tropical and subtropical regions, including parts of the Americans 22 Countries Asia and Africa.
There are five species of the plasmodium parasite that can infect humans Taylor TE, Nov, 2006” malaria life cycle”. The most serious form of the disease are caused by
1. Plasmodium falciparum.
2. Plasmodium vivax,
3. Plasmodium malaria,
4. Plasmodium ovale
5. Plasmodium Knowles causes malaria in macaques but can also infect humans.
It is naturally transmitted by the bite of a female Anopheles mosquito, when a mosquito bites an infected person, a small amount of blood is taken, which contains parasites. These develop within the mosquito and about one week later when the mosquito takes a blood meal it then infects the person. A wide variety of anti – malaria drugs are available to treat malaria. In the last 5 years, treatment of
P. falciparum infections in endemic countries has been transformed by the use of combinations of drug containing an artemisinin derivatives. Severe malaria is treated with intravenous or intramuscular quinine, several drugs are also available to prevent malaria in travelers to malaria endemic countries. Resistance has developed to several antimalaria drugs most notably chloroquine.
Malaria transmission can be reduced by preventing mosquito bites by distribution of inexpensive mosquito nets and insect repellents or by spraying of insecticides inside houses. The challenges of producing a widely available vaccine that provides a high level of protection for a sustained period is still to be met.
Pathophysiology of Malaria
Malaria fever is a communicable disease that is cause by the malaria parasite called plasmodia and characterize by recurrent attacks of fever with rigors, enlargement of the liver and spleen, anaemia, joint – pains and body aches R.A Mustapha 2002. The four species that causes malaria include
– P. Vivax
– P. Malarial
– P. Orale
– P. falciparum
In man fever commences when the female Anopheles mosquito injects the sporozoites of these parasite into the mans blood stream. After about 30 minutes the sporozoites enter into the liver cell and start the pre- erythrocytic phase of development. This causes inflammation of the liver cells causing hepatitis. Within the liver the sporozoites subdivide several times to form merozoites to form filling up the liver cells. At this point there will be proliferation of the reticulo- endothelial cells (especially in the liver, spleen, bone marrow) producing more lymphocytes and phagocytic cell like neutrophils and monocytes. The lymphocytes produce antibodies to inactivate these parasites while the Antitoxins neutralize the parasite toxins, they phagocytose these parasites.
The filling up of the liver causes Hepatomegally (enlargement of the liver) and spleenomegally with tenderness. The liver cells burst to release the merozoites and their toxins into the blood stream. Some of there merozoites enter fresh blood cells to set up erythrocytic phase, the merozoite divided inside the red blood cells to form mature schizonts containing daughter merozoites. The red blood cells then rupture to release these parasites into the blood stream. It is this rupturing of the red blood cells (haemilysis) that causes the characteristic attack with a rigor in malaria fever. Excessive destruction of the red blood cells leads to severe anaemia anaemia causes tiredness the victim then complains of pain in the joints due to inflammation.
The rigor starts with intense cold leading to a feeling of hotness and dryness of the skin. The body temperature rises upto 39.40C – 400C. Due to the parasites and their toxins acting as pyrogens and endogenous pyrogens which resets the thermostat in the regulating centre in the hypothalamus causing more production of heat.
Signs and Symptoms of Malaria
The symptoms of malaria include
Fever
Shivering
Vomiting
Arthralgia (Joint pain)
Anaemia (caused by haemolysis)
Haemoglonuria
Convulsion
Retinal damage.
According to Bovin 2002 defined classic symptom of malaria as a cyclic accurance of sudden coldness followed by rigor and fever and sweating lasting for about four to six hours. For reasons poorly understood but may be related to high intracranial pressure. Malaria has been found to cause cognitive impairments especially in children, it causes widespread anaemia during a period of rapid brain development and also direct brain damages severe malaria caused by P. falciparum infection cause coma and death if untreated, young children and pregnant women are especially vutnerable. Splenomegally, severe headache, cerebral Ischemia, hepatomegally, hypoglycemia and hemoglobinuria can progress rapidly and cause death within hours or days and in most cases fatality rates can exceed 20% even with intensive care and treatment.
Malaria as a Killer
Malaria according to medical dictionary is defined as an infectious disease due to the presence of parasitic protozoa of the genus plasmodium within the red blood cells. Malaria is a killer as it is a major cause of complication which leads to death.
Malaria As a Silent Killer will be Discussed Under
- Malaria as a cause of Complication
- Malaria and our economy
- Malaria and Pregnancy
- Malaria and Children
Malaria as a Cause of Complication
Malaria has stolen many lives today knowingly and unknowingly because of our environment is too conducive for the vector, it is an everyday occurrence in our homes, hospitals and communities 75% of death that occur in our society today is due to malaria and its complications also out of neglect and poor sanitary environment. This thief penetrates into the human blood stream and damage some vital organs and because of it’s common occurrence people tend to neglect it and they will not treat it properly most people engage in self medication and at the end of the day will not be appropriately treated, it then develop complications which can cause death. Cerebral malaria is caused as a result of accumulated malaria, which can even lead to death. Untreated malaria has also caused abortions in pregnant mothers. Untreated or inappropriately treated malaria cause severe anaemia, convulsions, jaundice in children, Diarrhoea even delirium.
Malaria as a Cause of Complication
Malaria can sap a family financially especially a family that is poor, because when not treated well and complications occurs it will then require more financial involvement, anxiety and crisis, it will also affect every other member of the family, because money for daily feeding will be channeled into caring for the sick one. A man who has severe malaria attack cannot work efficiently to meet his family’s daily need as before.
Malaria and Our Economy
Programmes for malaria eradication has gradually taken up to 35,000,000,000 of the national budget, which would have been channeled to other sectors in the absence of malaria attack. A worker with malaria can be absent from work for days thereby affecting our economy. Malaria attack can affect the learning ability of a student thereby affecting his educational pursuit and career
Malaria and Pregnancy
Malaria has put tears in the eyes of many families and pregnant women today it causes abortions and some other dangerous effects. Women and children are the most vulnerable group. 35, 000 pregnant women die yearly as a result of malaria in pregnancy
Malaria is an ailment we must prevent and eradicate from our society today because of it’s dangerous effect in human life all health institutions must embark on campaign programme to enlighten people on the process and effect of this disease, so that preventive measures will be taken
Malaria and Children
Most of the children 1-3 million who die each year from malaria are children, mainly in Africa, which is hypendermic for malaria. In older children, malaria has a similar course as in adults. In children below the age of 5 years, particularly infants the disease tend to be atypical and more severe.
Treatment of Malaria
Malaria can be treated in 2 major broad ways
(1) Preventive measures
(2) Drug treatment
Preventive Measures
(a) Prophylactic drug
Prophylactic drugs are those drugs that can be used to prevent malaria especially for travelers and some in pregnancy example: (mefloquine (lariam), doxycycline.
Mefloquine is used in areas of high risk areas it should be started 2 – 3 weeks before travel to enable any adverse reactions to be identified before exposure and should be continued for 4 weeks after last exposure. It can also be used in early pregnancy if alternative drugs are not available.
Doxycycline is an alternative to mefloquine in areas of high risk, it can be given during pregnancy.
(B) Mosquito Eradication
Effort to eradicate malaria by eliminating mosquito
have been successful in some areas. Malaria was once common in the United State and southern Europe but vector control programmes in conjunction with the monitoring and treatment of infected humans eliminated it from those areas.
(C) Prevention of Mosquito Bites
(a) The draining of wetland breeding grounds and better sanitation where adequate: This involves draining of stagnant water in containers, reservoir or anything that labours water around the environment to prevent breeding of mosquito and also ensuring adequate sanitary environment.
(b) Cutting of grasses around the house
(c) By removing or poisoning the larva stage through filling or applying oil to places with standing water. This destroys the larva stage of the mosquito
(d) Indoor residual spraying: it is the practice of spraying insecticides on the interior walls of the homes. If the walls of the homes have been coated with insecticides the resting mosquito will be killed before they can bite another victim.
(e) The use of mosquito treated nets and bedclothes: the nets are often treated with an insecticide which kills the mosquito before it has time to search for a way past the net. Insecticide treated nets are estimated to be twice effective as untreated nets and offer greater than 70% protection compared to no net.
Drug Treatment
The treatment of malaria depends on the severity of the disease.
Uncomplicated malaria is treated with oral drugs. Example:
(a) Amodiaquine
Indication- Uncomplicated malaria caused by P. falciparum
Contra Indication: hepatic impairment, renal impairment
Precautions: Pregnancy, breastfeeding
Adverse Effects: gastro- Interestinal disorders, visual disturbances, hepatitis
Dose: by mouth, Adult and children over 5 mouths, 10 mg/kg daily for 3 days
For Children: Amodiaquine 50 mg per 5 ml pack:
60 ml
For adult: Amodiaquine Hcl 200mg. 200mg – 95
For combination therapy
Artesunate + Amodiaquine
For adult: 1 Amodiaquine tablet + 1 Artesunate tablet to be taken together daily for 3 consecutive day 5
For children: 1Amodiaquine sachet + (Artesunate sachet to be dissolved in 30ml water and taken once daily for 3 consecutive days.
Severe Malaria Requires the Parenteral administration of antimalaria
(b) Drugs. Example: Artemether
Indication: treatment of severe P. falaparum malaria in areas where quinine is ineffective.
Contra- Indication: First trimester of pregnancy.
Adverse effects: Headache, nausea, vomiting, abdominal pain, diarrhea.
Dose: by Im injection. Adult and Child over 6 months, loading dose of 3.2 mg/kg, then 1.6 mg/kg daily until patient can tolerate oral medication or to maximum of 7 days, this is followed by a single dose of mefloquine 15mg/kg.
Administration: Since small volumes are required for children, a 1- ml syringe should be used to ensure correct dosage. And administer in the upper-outer guardant of the buttock.
The treatment of malaria involves supportive measures as well as specific antimalaria drugs.
Nurses Role in the Prevention of Malaria:
(1) Community education and awareness on the dangers of malaria
(2) Ensure that people who receive a net knows how to use it. “ Hang up” campaigns. Ensuring it’s proper use and that the people most vulnerable to malaria such as young children and the elderly sleep under it.
(3) Health education to people on the signs and symptoms of malaria and the consequences associated with it.
(4) Teach people to cover over areas of stagnant, still water which are ideal breeding grounds for the parasite thus reducing the rate of transmission between people.
(5) Health educate them on the need of proper medical cheek up and treatment
Nurses Role in the Treatment of Malaria
(1) Proper medical diagnosis pearly detection
(2) In severe case hospitalization is necessary
(3) Administer drug as prescribed by ensuring that you have a clear written order for each drug administered
(4) Take and monitor vital signs always
(5) Tapid sponge in cases of recurrent high fever
(6) In treating the person ensuring that you are using the right drug, right dose, right route right time and to the right patient
(7) Encourage the patient in taking the drug
(8) Promote comfort and offer psychological support
(9) Educate the patient and family on the ways of reducing mosquito bite
(10) Advice patient on the need of medical checkup
Complications of Malaria
(1) Severe anaemia: due to excessive destruction of the red blood cells.
(2) Convulsion: due to the toxins acting as pyrogens in the heat regulating centre of the hypothalamus
(3) Jaundice due to severe haemolysis
(4) Severe headache due to irritation and poisoning of the brain by the toxins
(5) Diarrhoea due to presence of the toxins along the gastro – intestinal track which causes increase peristalsis thus leading to diarrhea
(7) Deurium which can lead to coma due to blockage of tiny cerebral blood vessels by the parasites and the debris of the ruptured red blood cells.
Summary
Summarily malaria is a common ailment that occur almost everyday. All average Nigeria are prone to and almost everybody in Africa have suffered malaria and are still prone to it. It is commonly found in sub- Saharan African and is responsible for most death that occur. Malaria is serious disease which people neglect and because of this has killed millions every year. People take it to be minor but it is the commonest cause of death today.
Malaria is a serious disease which everybody must join hand to eradicate, and this could be achieved through
– Environmental sanitation
– Health education on the need for proper medical checkup and treatment
– Early reorganization of symptoms
– Use of prophylactics for travelers
– Use of insecticide treated net.
Recommendation
From this piece of work I have discovered some ways in which malaria can be prevented and I encourage people to practice it they include:
(1) Proper and regular environmental sanitation
(2) Use of insecticide treated nets
(3) Destruction of still waters and clearing of bushes around the house
(4) Use of insecticide
(5) Use of prophylactics especially for travelers
References
Carpenito, L.J. (2006) Community Health Text, 8th edition.
Philadelphia: Lippincott.
Centres for Disease Control and Prevention (C.D.C.) (2008).
Transmitted Disease, (Treatment and guidelines, (2008). Mortality and mobility. Weekly Report 51(RR-6) . 1-85
Philips, Nicky September 26, 2010 Gorillas in midst of
Malaria mystery” Sydney morning Hearald.
Snow RW, Guerra CA, Noor Am, myint HY, Hay SI 2005 “The Global distribution of clinical episodes of P. falciparum malaria
Kilama W, Ntoumi F October 2009 “malaria: a research
Agenda for the eradication era”
Mustapha R.O 2002 “ a Path to success for the student
Nurses”.
