Malaria Control & Elimination

India has among the highest rates of malaria mortality, inoculation and infection, human and socio-economicadministrative costs. India is a subcontinent having monsoon climate (most variable). Meteorology being all about atmospheric processes and dynamics envelopes much of the ecology and environment. This communication presents Indian sub-continental atypical monsoon meteorology, east coast’s geography, geomorphology of eosin plateaus (plateau environment in particular), orography (delta type sea with parabolic shore line) as having a nexus with the ever present human health hazard of malaria infection. There is not much scope for inter-disciplinary studies. Ongoing decadal works have been cited to indicate the historical etiology of the term ‘Medical Meteorology’ in clinical-cum- met domains. The finding is that due to such all-pervading meteorology the nature of the nexus is planetary in scale and all enveloping. Malaria is part of ecology. It is aided and abetted by Mother Nature. Malaria is here to stay.

Background: Malaria remains a major global public health and development challenge especially in tropical Africa. Plasmodium falciparum, the deadliest form of the malaria parasite, is responsible for the vast majority of the mortality and morbidity associated with malaria infection. This study therefore, aims to evaluate the caregiver’s knowledge, attitude and practice regarding malaria and treatment of children below five (5) years in the rural community.
Methods: A community-based cross sectional survey was conducted in different households among mothers’ with children below five (5) years of age selected by systematic random sampling. In total, 50 respondents were interviewed in the rural community using a semi-structured, paper-based questionnaire designed to capture information on socio-demographic characteristics, active knowledge, treatment seeking behaviour of caregivers/ parents, types of treatment employed by the care-givers and personal protective measures against Malaria.
Results: Most respondents correctly associated malaria with infected female anopheles mosquito bites (99.7%) and reported that they will seek treatment within 24 hours of noticing the first symptoms of malaria. Although the respondents were unaware of the susceptibility of children to malaria parasite, thirty seven percent (37%) preferred to use herbs while (17%) will take children to the clinic/dispensary for treatment. Caregivers also make use of artemisinin based combination therapy (ACT) (7%), analgesics (5%), antibiotics (5%) but majority of the respondents use self-prescribed palliative drug combinations/over-the-counter drugs (40%) in treating malaria. They were also aware of preventive measures against malaria such as insecticide treated bed-nets (28%), but there was low ownership and usage of the bed nets among respondents as only 19% of them have access to bed nets. Other preventive measures include spraying with insecticide (29%), wearing long sleeved clothes (29%), and draining of stagnant water (13%).
Conclusion: There was dearth of information percolating to mothers most especially on current trends in management, control and prevention of acute uncomplicated malaria in the endemic rural community. Provision of affordable healthcare facilities by government and improved patronage coupled with sound integration of health information and education policy would enhance and promote change of attitude, behaviour and practice will help in combating malaria in the rural endemic settings.

Introduction: Since 2004, the Kingdom of Saudi Arabia has pursued a policy of malaria elimination. The distribution of malaria at this time was constrained to regions located in the South Western part of the country. The present study aimed to understand the risk of malaria infection and factors associated with these events between March 2006 and August 2007 in one part of Aseer region.
Methods: The study was carried out in Tihama Qahtan area in the far southeastern part of Aseer, historically the most malaria endemic area of this region. The area covers 54 villages served by three primary health care centres (Wadi Alhayah, Alfarsha and Albuqaa). Malaria cases were detected using passive case detection (PCD) at the three health centres for 18 months from March 2006, each positive case was investigated using patient and household level enquiries. In addition, four cross-sectional surveys in 12 villages were undertaken using rapid diagnostic tests within the catchments of each health centre coinciding with malaria transmission seasons.
Results: Among 1840 individuals examined in the PCD survey, 49 (2.7%) were positive for malaria, most were Plasmodium falciparum cases and one was a P. vivax case. The majority of these infections were likely to have been acquired outside of the area and represent imported cases, including those from the neighboring region of Jazan. Among the 18 locally acquired cases, the majority were adult males who slept outdoors. 3623 individuals were screened during the cross-sectional surveys, 16 (0.44%) were positive and infections only detected during peak, potential transmission periods.
Conclusion: There was evidence of local malaria transmission in the Tihama Qahtan area in 2006-2007, however prevalence and incidence of new infections was very low, making the future ambitions of elimination biologically feasible. The constant source of imported infections must be considered in the area’s elimination ambitions, alongside strong behavioural community messages about sleeping outdoors unprotected and travel to malaria endemic areas outside the region.

Driven by the sustainability agenda and development prerogatives, the UN system has devised the ‘Global Technical Strategy for Malaria 2016-2030’ as an open plan to combat malaria and a hidden program to combat population growth in countries where previous efforts to lower fertility to replacement level have failed. The chemical and pharmacological arsenal used to combat malaria and subvert fertility by chemoprophylaxis and vector control under the direction of the WHO poses great risks to health and even greater risks to society as it is aimed at stabilizing the still growing populations of the Americas, Eastern Mediterranean, Asia Pacific and Africa through involuntary and mass sterilization. This methodology of combatting population growth is enabled by the moral loophole created by the Holy See for secular authorities to subvert fertility only while healing disease, which has debased medicine and public health into handmaidens of genocide, has perverted the integrity of medical authorities and has shattered the credibility of medical research. The lives it will save in the present outside the womb will be exceeded many times over by the lives it will take in the future inside the womb and the imaginary benefits it will bring to child mortality rates will be overshadowed many times over by the real rise in morbidity rates through chronic diseases that a sustained chemical and pharmacological attack on the human reproductive system will inevitably trigger. Unless stopped and replaced with open and legal methods of population control it will inevitably lead to violent conflict.

It is part of efforts of every passionate government in Africa to reduce, if not eliminate morbidity and mortality due to malaria being transmitted by female anopheles mosquito. Part of this struggle is the malaria indicator survey annually conducted by the Federal Bureau of Statistics (FBS) in Nigeria. It therefore important to communicate community based investigation and communication of entomological data vital for malaria control using appropriate statistical tools. This study generally aims to investigate seasonal abundance of Anopheles mosquito species and their compositions in some selected human settlements. The specific objective is to determine which particular specie of such Anopheles mosquitoes are most abundant and which of the human settlements requires most intervention due to high prevalence of such Anopheles.

Malaria is the most important parasitic disease in the world related to high morbidity and mortality. Jaundice is one of the common manifestation of severe malaria in adults and its incidence vary from 10-45% in different regions. Presence of jaundice in malaria indicates a more severe illness with higher incidence of complication. Jaundice plus evidence of other vital organ dysfunction vital as one of manifestation of severe malaria based on WHO guideline 2010. Jaundice in severe malaria caused by multi factorial and can result from haemolysis of parasitized and nonparasitized red blood cell, hepatic dysfunction and possibly an element of microangiopathic haemolysis associated with disseminated intravascular coagulation. Awareness of malaria biliosa is important to prevent complication and mortality. Death from severe malaria often occurs within hours of admission to hospital or clinic, so it is essential that therapeutic concentrations of a highly effective antimalarial are achieved as soon as possible. Management of severe malaria comprises four main areas: clinical assessment of the patient, specific antimalarial treatment, adjunctive therapy and supportive care. Many trials are consistent and suggest that artesunate is the treatment of choice for adults with severe malaria. Management of malaria biliosa is not different from management the other severe malaria. Here we report one case of jaundice in falciparum malaria (malaria biliosa). There was problematic in management but the treatment malaria with jaundice with adequate dose of artesunate injection improved patient’s health status and parasitological improvement.

The recognition of deficiencies in control programs of antimalarial vaccines and drugs have acquired importance as a frontline protection in malaria therapy. Since antimalarial drug resistance has been reported for all existing drugs worldwide, leaving combination therapy, this includes artemisinin and its derivatives, as the only choice of chemotherapy. In case of artemisinin combination therapy, it is very interesting to know that once the protection is noticed after the treatment in experimental malaria model, they get protected for second, third and subsequent infections. This is also true in case of infected patients in malaria endemic areas. The picture that emerges is of that immunity to malaria is playing a main role during infection. However, the protection after antimalarial drug treatment also gives us a picture that the protection leads to a step-up in immunity.

Olyset® nets are effective for malaria control; approved as best choice for rural areas. It is unclear to what extent insecticide persists in the use period. Washing frequency under different methods, soap and drying methods may conceivably lead to a change over time in insecticide concentration. This study examined net ownership, types, handling; and changes in permethrin concentration in Olyset® nets over time.