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8/14/2019 Malaria Dr Sanjay Panchal
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Humanity has but three enemies: fever, famineand war ; of these by far the greatest, by far themost terrible is fever
Dr William OslerDr William Osler
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SCHEME OF PRESENTATION
History Problem statement
Epidemiology
Clinical features
Diagnosis and treatment
Prevention of malaria & NVBCDP
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HISTORY
Probably been a human pathogen for the entirehistory of the species
First record of periodic fevers from China in 2700BC
Term malaria derived from the Italian for bad air mala aria
Also known as ague or marsh fever
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In 1880, Laveran, a French physician in Algeria identified
causative organism of Malaria. Recieved Nobel Prize in 1907.
August 20th1897 Sir Ronald Ross, while working in India
demonstrated oocyst in gut of Anophelene mosquito. This day is
celebrated as Mosquito Day
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PROBLEM STATEMENT
40% of world population ( > 240 Cr. people ) are exposed tomalaria in 100 countries.
50 Cr. get it every year ,
10 L people die of malaria every year
India contributes 80% of total cases
Orissa with only 3% of Indias population contributes 25% of totalreported cases of malaria in India
NMEP ( 1997 ) reported P Falcip 40% & P Vivax 60%.
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WORLD SCENARIO 2008
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INDIAN SCENARIO
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EPIDEMIOLOGY
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CAUSATIVE PARASITE
Cause:Plasmodium species
Types:P. vivax
P. malariae
P. ovale
P. falciparum
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FACTS ABOUT ANOPHELES
MOSQUITO
They choose their victim by odor.
Males are more frequently bitten.
Most common time of bite is late evening to early morning with peak at
midnight.
Stylets cut & proboscis probe for tiny blood vessels in the skin. If it doesnot strike blood proboscis is withdrawn and struck again at different angle.Their saliva has anti haemostatic & anti inflammatory chemicals.
They can fly for few Km.
Their life span is 2 3 weeks.
Human blood is needed to lay eggs and nourish eggs.
Deny them blood and mosquito growth will be controlled.
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LIFE CYCLE OF
ANOPHELES
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LIFE CYCLE OF MALARIA
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CLINICAL FEATURES
CLINICALLY MILD MALARIA
An abrupt onset of an initial 'cold stage'associated with dramatic rigors in which the
patient visibly shakes; An ensuing 'hot stage' during which the
patient may have a temperature of well over104F (40C), may be restless and excitable,
and may vomit or convulse; and Finally, the sweating stage, during which the
patient defervesces and may fall asleep
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DIAGNOSIS
1) Thick blood films
One or two drops of blood from a fingerprick are stirred in
a circle on a glass slide, allowed to air dry and then stainedwith Giemsa or Field's .
With this method, the red cells lyse whereas the whitecells and parasites remain intact. Parasites are identified byrecognizing both the eosinophilic nucleus and the basophiliccytoplasm of the malarial parasite. Parasite density can berelated to the number of white cells present. This methodhas far greater sensitivity than the thin blood film.
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2) Thin blood films
A thin film is produced by spreading a smalldrop of blood across a slide using the edge of asecond slide, thereby producing a monolayer ofred cells.
The thin blood film allows accurate speciation ofthe parasite and quantitation, in which thenumber of parasites is related to the number ofred cells present
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PREPARATION OF THICK AND
THIN SMEARS
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RECENT DIAGNOSTIC
TEST
Malaria PF antigen capture tests use a monoclonalantibody to the P. falciparum and are very useful tests inthose who have not had malaria before .can only detect
the presence ofP. falciparum.
The OptiMAL test detects parasite lactate dehydrogenase(pLDH) which can be distinguished from human LDH. Thistest can also distinguish falciparum from vivaxinfections.
The polymerase chain reaction is useful for making anaccurate species diagnosis and detecting low levelparasitemias
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TREATMENT
Uncomplicated Malaria Presumptive :
Tab. Chloroquine (CQ) CQ4
Severe Malaria : IV Quinine drip / IM Quinine followed by Oral Quinine for a total of 7 days
Or, IM Artemether / IVArtesunate followed by
Oral Artesunate tablet
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Plasmodium vivax:
Tab. Chloroquine (CQ) + Tab. Primaquine (PQ) CQ3 +PQ14
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MALARIA PROPHYLAXIS
CHLOROQUINE - PROPHYLAXIS Preferred where P. falciparum remainsfully sensitive (Adult dose 300mg weekly taken with a meal, at the sametime and on the same day each week).
MEFLOQUINE - PROPHYLAXIS May be used in areas where multiple-drug resistance has been reported.
DOXYCYCLINE - PROPHYLAXIS Short term prophylaxis of multiple drugresistant falciparum malaria.
PROGUANIL PROPHYLAXIS Prophylaxis for pregnant women and non-
immune individuals at risk of exposure
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CONTROL OF
MOSQUITOES
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History ofmalaria controlin India
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1.1. 1953 - Estimated Malaria Cases in India 75 Million1953 - Estimated Malaria Cases in India 75 Million
Estimated Deaths Due to Malaria 0.8 MillionEstimated Deaths Due to Malaria 0.8 Million
1.1. Launching of NMCPLaunching of NMCP
1.1. 1958 - Launching of NMEP1958 - Launching of NMEP
2.2. 1966 - Cases Reduced to 0.1 Million1966 - Cases Reduced to 0.1 Million
3.3. Early 70s - Resurgence of MalariaEarly 70s - Resurgence of Malaria
4.4. 1977 - Modified Plan of Operations Introduced1977 - Modified Plan of Operations Introduced
5.5. 1981- National Drug policy for1981- National Drug policy for
6.6. treatment of Malaria - Introducedtreatment of Malaria - Introduced
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1984 - Annual Malaria Incidence Reduced to 2.2 Million Cases1984 - Annual Malaria Incidence Reduced to 2.2 Million Cases
1984 -1998 - Annual Reported Incidence Within 2-3 Million Cases1984 -1998 - Annual Reported Incidence Within 2-3 Million Cases
1994 - Resurgence of Malaria outbreaks in Some States1994 - Resurgence of Malaria outbreaks in Some States
1997 - World Bank Assisted Enhanced Malaria Control Project1997 - World Bank Assisted Enhanced Malaria Control Project
2006- onwards WB agreed for Retroactive financing2006- onwards WB agreed for Retroactive financing
2004 -Introduction of ACT for Pf cases in drug resistance areas2004 -Introduction of ACT for Pf cases in drug resistance areas
2005 ( July) GFATM- IMCP- (106 districts of 10 states )2005 ( July) GFATM- IMCP- (106 districts of 10 states )
2007- National Drug policy revised2007- National Drug policy revised
2008- New project on Malaria Control & Kala Azar Elimination with2008- New project on Malaria Control & Kala Azar Elimination with
World Bank Assistance is likely to startWorld Bank Assistance is likely to start
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CONTROL STRATEGIES
1) SOURCE REDUCTION
Environmental methods forcontrolling most of the breedinginclude source reduction by
filling ditches, areas, pits, lowlying areas, streamlining,
channelizing,
desilting, deweeding,
trimming of drains, waterdisposal and sanitation,
empty water container once in aweek, etcction
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2) CHEMICAL CONTROL
Recurrent anti-larvalmeasures withapproved larvicidesto control the vectormosquitoes arerecommended.
Temephos
Fenthion
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3) BIOLOGICAL CONTROL
Bilogical control ofmosquito breeding
through biologicalagents speciallylarvivorous fish and bylarvicides
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4) AEROSOL SPACE SPRAY
Space spraying of
Pyrethrum extract(2%) in50 houses in and aroundevery malaria positive caseto kill the infective
mosquitoes
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5)ANTI-PARASITIC MEASURES
Anti-parasitic measures throughpassive agencies like hospitals,dispensaries, clinics and privatepractitioners to reduce the reservoir ofinfection, by early case detection and
prompt treatment(EDPT)
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CONCLUSION
Malaria still continues to be the most common infectiousdisease affecting mankind
There still remains continuous threat of resurgence ofmalaria if adequate treatment and anti mosquito measuresare not used
Malaria still contributes to be one of the most common
cause of loss of healthy life years (morbidity)
Problems of anti malarial resistance continues to haunthealth providers
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PRESENT SITUATION OF
MALARIA
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RECOMMENDATION
1) Community participation and Awareness
2) Consolidation of Gains and sustainment of futureefforts
3) Research in field of genetic engineering is highlydesirable
4) Vaccine is eagerly awaited
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At last ..Stick to fight when you are the
hardest hit ,
Thats why when things go wrong
DONT QUIT
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Thanks
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