Malaria is a serious tropical disease spread by mosquitoes. If not diagnosed and treated promptly, it can be fatal. India is doing a lot of projects and these awareness programs to eradicate malaria. A single mosquito bite is all it takes to become someone to become infected. According to a WHO report, India has contributed to the largest drop in cases worldwide. In India, we were having cases of 20 million some years back. Now it has dropped to around 6 million, which is a remarkable achievement for India. In spite of this outstanding achievement, In India for the cases of malaria, strict intervention is needed to eradicate malaria completely from India to zero cases.

At Medicircle, we are conducting a series on malaria with eminent doctors for World malaria day to boost awareness and educate people about the preventions from it.

Dr. Sundar Krishanan senior consultant physician at Hiranandani Hospitals Thane. He has a wide clinical experience of over 19 years he has been a faculty in various CMEs and conferences. Dr. Krishnan is a part of the senior management team at Hiranandani Hospital and is also involved in quality initiatives like NADH accreditation. Dr. Sundar is also the recipient of many awards and is a member of many prestigious associations. 

Transmission of malaria and important steps to control it

Dr. Sundar Krishnan says, “ Malaria is a widespread disease. It is a disease of the tropical and subtropical regions. There are millions of patients affected by malaria throughout the world. There are 200 million affected by malaria who are infected by this dreaded disease. There is a significant mortality rate associated with malaria. It is a life-threatening disease and we should be aware of its transmission so that we can act in the right way. Malaria spreads by a female mosquito who bites in dusk and dawn. These infected mosquitoes carry a parasite called Plasmodium. There are five types of Plasmodium 

• Plasmodium vivax
• Plasmodium falciparum 
• Plasmodium ovale 
• Plasmodium malaria 
• Plasmodium knowlesi 

In India, Plasmodium vivax and falciparum are very common. When this infected Anopheles mosquito bites the human through the salivary glands of the mosquito, this parasite is injected and enters the bloodstream of the human body. In the reproductive phase, this parasite multiplies in the human body. After a certain period of time, when the other mosquito bites that infected individual, the parasite enters into the mosquito and so on and so forth. The cycle keeps propagating especially in an endemic area, where there is a huge population of malaria cases. This is how malaria is transmitted. It is important to act and control the disease at various steps of transmission. 

Symptoms of malaria 

Dr. Krishanan states, “During this pandemic, one has to keep COVID as the first diagnosis when talking about fever. Do not waste any time in testing for COVID if you have a fever. The early you get tested, the better. Patients with malaria present symptoms like: 

• Fever with chills and rigors 
• Periodicity of fever: Fever with intervals of 48 to 72 hours
• Organ systems get involved like liver 
• Drop-in hemoglobin leading to anemia 
• Low bilirubin count leading to jaundice 
• Low urinary output 
• Cerebral malaria 
• Confusion, disorientation, coma 
• It is important to get the test done for COVIs or malaria to know the exact diagnoses. Some pointers may help you decide the diagnosis of COVID like 
• Sore throat 
• Bodyache 
• Malaise 
• Lungs get involved in COVID

In today’s scenario, it is important to keep COVID in mind. Don’t wait till COVID symptoms develop, you may end up with a drop in oxygen levels. Many patients are facing a scarcity of beds and oxygen cylinders. 

Malaria is preventable 

Dr. Krishanan says, “Malaria is a preventable disease. We need to know the modes to prevent this disease. Here are some steps to prevent malaria :

• Reduce contact between the vector and the human
• Barrier methods like nets coated with insecticides
• Mosquito repellants
• Try and wear full sleeve garments in high prevalent areas
• Minimizing exposure to mosquitoes 
• Avoid stagnant pools and water
• A spray of insecticides and oils can destroy larvae and mosquitoes in vulnerable areas. 
• Biological methods like the gambusia fish 
• Eliminating the causes is very essential to treat the malaria disease
• Treatment of malaria at right time can prevent the transmission of the disease. 
• Chemoprophylaxis: Usage of drugs in endemic situations incases of traveling outside country 
• Chloroquine can be taken once a week to prevent transmission of malaria
• Therapeutic dose of antimalarial drugs in case of infection 
• Preventive therapy 

Treatment of malaria 

Dr. Krishnan says, “Completing the full course of therapy of malaria is very important. There is a tendency when one starts taking medicines and feels better, they stop taking further treatment. We need to educate people about the same. Uncomplicated cases of malaria can be treated at home with oral drugs as prescribed by your doctor. These can be administered safely. 

• Complicated cases of malaria need intravenous drugs which are given intramuscularly. 
• Supportive therapy may also be given. 
• Paracetamol for fever may be needed 
• If the patient has vomiting associated with malaria, IV fluids may be needed as well
• Low hemoglobin is associated with malaria may need a blood transfusion or transmission of platelets. 
• Complications that lead to liver or renal failure need special attention
• Therapies should be targeted as per the need of the patient. 

Radical cure of malaria for complete eradication 

Dr. Krishnan explains, “It is important to ensure that you complete the course of treatment for malaria as prescribed by the doctor. Relapse of malaria is very common if you stop the treatment abruptly. The Plasmodium parasite continues to remain in the liver dormant. You may feel better after a 3 -4 day course. There are higher chances of relapse after 3 -4 weeks of stopping the treatment of malaria. So it is important to eradicate malaria with a radical cure. Radical cure means eliminating the parasite from the liver. This is done by administering drugs as primaquine treatment for 14 days after you get an infection with the plasmodium parasite. An entire course of 14 days is important to eliminate malaria from the body. It is important to monitor your blood parameters during the course of treatment of malaria.”

Vaccine for malaria 

Dr. Krishnan states, “There is no vaccine available for malaria. It is under the developmental stage. At this point, we have no vaccines for malaria. We can take preventative measures for a vulnerable population like pregnant ladies, senior citizens, and children. Controlling and eradicating is very important. Educating people about measures for malaria is very essential. Treatment and preventative measures can help to control malaria.”

(Edited by Dr.Rati Parwani)