malaria dr sanjay panchal

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 If it doesnot strike blood proboscis is withdrawn and struck again at different angle.Their saliva has anti haemostatic & anti inflammatory chemicals.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

malaria dr sanjay panchal

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