by guest contributor Pat Roba
On April 25, 2009, the world will join together to celebrate World Malaria Day. World Malaria Day has been designated to spur global action on the disease with the aim of achieving universal access to malaria prevention and treatment tools in Africa by 31st December, 2010. This year’s World Malaria Day theme is “Counting Malaria Out”.
According to UNICEF, of the more than 350 million people infected with malaria every year, 90 per cent live in sub-Saharan Africa. In spite of this focus on Africa and other malaria-endemic nations, malaria is truly a disease without borders as global partners in the fight against malaria such as governments and public and private organizations pool resources to combat the disease.
MALARIA INFECTION AND SYMPTOMS
Contracting malaria can be a harrowing experience, both for those of us who live in endemic areas and are therefore used to regular bouts of malaria and for visitors who might not have heard of the disease until they travel to malaria endemic areas.
Malaria has many symptoms, some that are classified as minor and not so obvious and some that are quite obvious. However most of the time symptoms of malaria infection are not so dramatic and can be easily dismissed as unimportant.
Malaria causes a flu-like illness characterized by fevers, headaches, sweating, tiredness, abdominal pain, diarrhea, loss of appetite, nausea, slight jaundice and vomiting.
It’s easy to confuse malaria with flu, especially in the early stages of infection. It might start with flu-like aches in the joints, followed by a mild head-ache, then a fever which finally breaks into a torrent of sweat at night. Sometimes its starts with fatigue and a lack of appetite, pain in the neck and lower back and severe headaches.
In other instances it begins with vomiting, diarrhea and feeling bad all over. It then develops into bouts of sweating and a lack of concentration as the infected person becomes really weak. Some people have even reported that they feel as if their hands and feet are burning all the time.
Clearly it’s difficult to tell whether its flu or malaria infection within the first couple of hours. However, bouts of high fever followed by torrents of sweat in alternating phases are usually strong indicators of malaria infection. Fever remains the most important sign of malaria.
Symptoms vary from person to person, with some experiencing acute symptoms while others experience mild symptoms of the disease.
You are therefore advised to seek medical advice as soon symptoms appear since malaria can be lethal if treatment is delayed.
People at particular risk, and who should take extra precautions to prevent contracting malaria would include children under 5 years, adults over 65, pregnant women, people on long term steroids or those receiving chemotherapy, aids patients, people who have had their spleens removed and people with porphyry (porphyria), epilepsy and chronically ill patients.
Although the people that fall in the categories listed above are more at risk, please do not be under the impression that healthy, young adults with strong immune systems can withstand this type of infection.
Should any person be infected, they should receive the proper medical attention as soon as possible.
MALARIA IN CHILDREN
Malaria poses a serious threat to children, especially children under 5 years. According to UNICEF malaria kills a child somewhere in the world every 30 seconds. Most of the 1-3 million who die every year from malaria are children and mainly from Africa.
Children may not contract malaria in the first two months of life or the manifestations may be mild with low parasite counts in the blood (parasitemia) due to the passive immunity offered by the maternal antibodies
The parasite rate increases with age from 0 to 10% during first three months of life to 80 to 90% by one year of age and the rate persists at a high level during early childhood. Death from malaria among children is highest during the first two years of life.
By school age, a considerable degree of immunity would have developed, especially in areas with high cases of malaria. The opposite is true in areas of low cases of malaria, immunity is generally low and severe malaria infection occurs in all age groups including adults.
In children below the age of 5 years, particularly infants, malaria tends to be atypical and more severe whereas in older children the disease has a similar course as in adults.
In Kenya apart from death cases which are estimated to be in the thousands every year, children who survive malaria may still be affected in the long run. Repeated episodes of fever and anemia end up affecting their mental and physical development, impairing their education, and their growth into productive adults.
Although the recommendations for most antimalarial drugs are the same as for adults, it is crucial to use the correct dosage for the child. The dosage of drug depends on the age and weight of the child.
MALARIA IN PREGNANT MOTHERS
Malaria may pose a serious threat to a pregnant woman and her pregnancy. Malaria infection in pregnant women may be more severe than in women who are not pregnant. Malaria may also increase the risk of problems with the pregnancy, including prematurity, abortion, and stillbirth. Malaria infection in pregnant women is particularly undesirable as it may lead to malaria-related anemia in the mother and the presence of parasites in the placenta, which contributes to low birth weight – a leading cause of impaired development and infant mortality
Statistics indicate that in sub-Saharan Africa, between 75,000-200,000 infants die from malaria per year; worldwide estimates indicate over 1 million children die from malaria each year. Therefore, all pregnant women who are living in or traveling to a malaria-risk area should consult a doctor and take prescription drugs to avoid contracting malaria.
Treatment of malaria in the pregnant female is similar to the usual treatment for any other infected adults. However some drugs are not recommended to be used during pregnancy as they may harm the fetus. The correct drugs for each type of malaria in pregnant mothers must be prescribed by a doctor who is familiar with malaria treatment protocols.
MALARIA IS PREVENTABLE AND CURABLE
Despite the huge annual deaths from malaria, it is a curable and preventable disease.
PREVENTION
Malaria is transmitted by a bite from a malaria parasite carrying mosquito. One is at most risk of being bitten by a mosquito, both outdoors and indoors, between dusk and dawn. Consequently the best way to prevent malaria would be to avoid getting bitten by a mosquito in the first place.
Simple and cheap measures such as putting on protective clothing to cover your otherwise exposed skin greatly reduces one’s risk of being bitten by mosquitoes. For example exposed areas on your body such as ankles should be covered with thick socks to prevent mosquito bites.
Other methods of preventing mosquito bites include the use of insect repellents, which are applied to the skin or otherwise sprayed or vaporized in a room. There is a wide range of insect repellents in the market and care should be taken when buying a mosquito repellent since they differ in concentrations and effectiveness.
Alternatively, one can opt to use natural oils to keep mosquitoes away. Mosquitoes are known to strongly dislike citronella essential oil and its citrus like smell so much so that it can be used effectively when contained in a cream, lotion or when sprayed or vaporized in a room.
Use of mosquito nets, especially insecticide treated mosquito nets (ITNs) also offer effective protection against mosquito bites. On top of protection from mosquito bites, nets give users the chance to have undisturbed sleep, free from the nuisances and buzzing noises made by mosquitoes when one is asleep.
Nets can be purchased already treated with insecticides or a proprietary insecticide can be bought and applied separately. Care should be taken to ensure the net is free of even tiny holes as even small holes will allow the mosquitoes to enter the protected area.
Other methods of preventing mosquitoes from entering your place of residence and biting you include fitting all rooms with mosquito mesh screens on the windows and doors to keep mosquitoes at bay while providing fresh air as doors and windows are kept open. Alternatively, use of air-conditioners to provide cool air while keeping the room mosquito-free is also a great way to keep out mosquitoes.
CURE
Malaria is becoming increasingly resistant to drugs and thus prevention of malaria infection is still highly recommended and advised. When you have contracted malaria and the diagnosis is confirmed by symptomatic evaluation by your medical practitioner, backed up by a malaria blood test to check for the plasmodium parasite your doctor would prescribe a combination of medication to deal with this sometimes lethal parasite that has invaded your body by means of a simple bite of the anopheles mosquito.
Three main factors determine treatments:
i) The infecting species of Plasmodium parasite (the plasmodium parasite which causes human malaria can be divided into four different species, namely plasmodium falciparum, plasmodium vivax, plasmodium ovale and plasmodium malariae),
ii) The clinical situation of the patient (for example, adult, child, or pregnant female with either mild or severe malaria),
iii) The drug susceptibility of the infecting parasites.
Drug susceptibility is determined by the geographic area where the infection was acquired. Different areas of the world have malaria types that are resistant to certain medications. The correct drugs for each type of malaria must be prescribed by a doctor who is familiar with malaria treatment protocols..
Mild malaria can be treated with oral medication; severe malaria (one or more symptoms of either impaired consciousness/coma, severe anemia, renal failure and a host of other complications requires intravenous (IV) drug treatment and fluids.
People infected with malaria can die and often because of delayed treatment. Immediate treatment for malaria is necessary, both for children and adults.
This year as we mark World Malaria Day, it’s important to note we have to pool our resources, join hands and participate in a concerted effort against malaria if we are to Roll Back Malaria and eventually achieve success in “Counting Malaria Out.”
In September 2008, we achieved our initial accreditation under NHIF. At that time, NHIF provided a list of medications with an estimated cost of $1500 and explained that these are required be in stock at all times. The hospital staff were told that if they were not able to maintain these medications, they risked losing the accreditation they worked so hard to obtain. With the reimbursement they received at the end of October, the first month they were able to accept insurance cards, they were able to purchase over half of the medications that NHIF required be stocked in the hospital pharmacy.
November 2008 brought more NHIF card carrying patients to the hospital as word spread that Arrow Web Hospital could now accept these cards. The hospital ended up being reimbursed over $700 USD at the end of November and was able to purchase the remaining stock needed for their pharmacy. NHIF officials have been checking in regularly with the hospital and have been very pleased with the progress and management of funds to date. 
