The Aspects Of Treatment Of Malaria
I have decided to investigate malaria in Africa. I chose Africa as it accounts for the highest global malarial burden (World Health Organization, 2019). In 2017, this region was home to “92% of malarial cases, and 93% of malarial deaths” (WHO, 2019).
The vector-borne disease is transmitted through the bite of infected female Anopheles mosquitoes (WHO, 2019). Although transmission through needle sharing is possible, it is extremely rare WHO, 2017). Malaria is caused by a class of parasites called Plasmodium –with the falciparum type causing 99.7% of the cases in the African Region (WHO, 2019).
Reword This is why as a health promotion officer, it is so important to have a prompt and effective diagnosis and treatment (Sambo, Ki-Zerbo & Kirigia, 2011). From there we can implement strategies for prevention and control, but also strong surveillance programs for future outbreaks (Kureya, Ndamimani, Mhlanga, 2017).
Outline of steps
I will have three main phases for my outbreak investigation –which are classified into the identification phase, hypothesis-generating phases, and then the confirmation phase.
Firstly, I will need to identify the surge in cases in the regions that have reported the outbreak (Banik, 2019). Then I will conduct diagnostic tests to ensure these cases are valid. During this identification phase, we will also determine vulnerable groups in Africa (Banik, 2019). Further investigation of these reported cases will require barriers in the implementation of the strategies that will be listed below. I will then ensure appropriate parties are involved when communicating findings and disseminating data (Banik, 2019). Then there must be the execution of control and prevention measures after considering these barriers (Banik, 2019).
Establish validity in case increase
Upon being notified of an outbreak, we must then visit the regions in Africa that have reported an increase in cases (Malaria Consortium & Montrose, 2019). To make sure the quality of data and validity of the reported increase in cases is accurate, specific diagnostic tests will be conducted (Malaria Consortium & Montrose, 2019).
When reporting cases of malaria, it is important we do not confuse malaria with conditions (i.e influenza) that have a similar clinical criterion. The clinical diagnosis includes “headaches, fever, chills, nausea/vomiting, muscle pain and fatigue” (Lillie et al., 2012).
However, because of the high prevalence of malaria in Africa, we must not disregard signs and symptoms as it could possibly be linked to the condition (WHO, 2019).
The laboratory criteria for case classification must include one of the following:
- Rapid diagnostic test (RDT) to determine if there are any malarial antigens present in the blood (WHO, 2015) or
- A polymerase chain reaction test or (WHO, 2015)
- Detection of the parasite through blood (WHO, 2015)
The case is only then confirmed if it meets one of these criteria:
- Microscopy test to identify the specific malarial parasite or (WHO, 2015)
- The nucleic acid test to detect specific of plasmodium or (WHO, 2015)
- Analyzing blood films under a microscope in a lab (WHO, 2015)
However, due to Africa’s has limited resources, it heavily relies on as it doesn’t require removes reliance on extra laboratory equipment such as microscopes (Rosenthal, 2012). Furthermore, it is important to distinguish new cases from existing cases for accurate case reports (CDC, 2014). A patient already diagnosed with malaria previously does not count as a new case. However, if the cause of malaria was from a different species of parasite, then it is classified as a new case (CDC, 2014).
We must also be more vigilant around vulnerable groups who present with the clinical criteria. Children under the age of 5, pregnant women, and HIV/AIDs (especially as this is also highly prevalent in Africa) (WHO, 2019), also carry a higher risk of developing deadly malaria, due to their compromised/under-developed immunity (Ricci, 2012).
- Every two minutes a child in Africa is killed by malaria
- over 70% of malarial deaths are from this age group (WHO, 2017).
The unclear symptomology, and long incubation period (anywhere from 7 days to a year) it can make it difficult to detect malaria. Additionally, because there are no vaccines or cures for malaria, there should be an extra emphasis on bite prevention through vector control (WHO, 2016).
- Increasing adherence to anti-malarial drugs for those already infected (SA Health, 2012)
Primary prevention methods include insect repellant, indoor spraying with insecticides, and insecticide-treated nets (ITNs) (SA Health, 2012). Then in pregnant women, intermittent preventive treatment should also be introduced (Sambo, Ki-Zerbo & Kirigia, 2011).
However, these aren’t foreign strategies that haven’t already been implemented (WHO, 2019). This is why we must speculate the causes of increases –especially barriers in the current strategies specific to Africa (Sambo, Ki-Zerbo & Kirigia, 2011).
There are several environmental factors that are out of our control when investigating outbreaks in Africa (CDC, 2019). These include their “warm climate, and existing high prevalence of the parasite” all create a favorable reservoir for malaria to thrive (CDC, 2019). Other factors are their economic instability and poor infrastructure (Sambo, Ki-Zerbo & Kirigia, 2011).
Accessibility, affordability, and poor health literacy all play a role in barriers to malaria prevention and control in Africa (CDC, 2019). These can be divided into financial and non-financial barriers (Sambo, Ki-Zerbo & Kirigia, 2011).
With many regions in Africa being poverty-stricken, the affordability of insecticide-treated nets and antimalarial drugs hamper their access (Sambo, Ki-Zerbo, Kirigia, 2011). Poor health literacy can also explain a decrease in compliance to using prevention measures, thus explain increases in cases (Pleasant, 2013).
We must then disseminate our findings by notifying all appropriate public health authorities in Africa (Kansas, 2018). To then relay this information to African citizens we will freehold educational information sessions that communicate and remind them of protection measures (Malaria Consortium & Montrose, 2019), and the importance of paying attention to any flu-like symptoms and seek medical care immediately (SA Health, 2012) provided by community leaders in their language to educate African citizens, surveillance and outbreak reports. African government parties will also be invited to attend conference presentations.
The outbreak investigation team must also closely monitor the outbreak region to identify the index case (Malaria Consortium & Montrose, 2019). Furthermore, surrounding communities should also be prompted with prevention and control measures (Malaria Consortium & Montrose, 2019). Instead of giving generic advice on using insecticide-treated nets, we must offer tailored interventions that overcome barriers experienced in Africa. To address financial barriers, accessibility to ITN’s and insecticides should be available for everyone (Sambo, Ki-Zerbo, Kirigia, 2011), taking extra consideration that the vulnerable groups are provided with them (WHO, 2016).
Despite these preventive and control measures available in Africa, the actual usage of these mosquito nets are very low (Atieli, Zhou, Afrane, Lee, Mwanzo, Githeko & Yan, 2011). This is why education programs and information sessions that explain the severity of the disease must be reinforced, along with the significance of utilizing these prevention measures (Tizifa et al., 2018). These education programs can act to empower the individuals and address the need for adopting protective behavior change and increase motivation levels to then adhere to them (Tizifa et al., 2018). As for control measures, we must increase the use of diagnostic tests (RDT) to reduce the severity of an outbreaking by having prompt and effective diagnosis and treatment (Sambo, Ki-Zerbo & Kirigia, 2011). If we can diagnosis it sooner, we can reduce the risk of the case developing into serious complications and death (Rosenthai, 2012).
Strategies and methods specifically for people in Africa
- we must take into consideration of the biting preferences (dusk and dawn) and alert citizens to take extra precautions and protection during these times (Banik, 2019).
- Antimalarial drugs –prevent infection from developing into clinical diseases
- Prevention is a key aspect of malaria control, and prompt treatment is considered the most important method of preventing deaths from malaria (Ricci, 2012)
- Active case detection throughout the target area with the expansion of the target area as appropriate if additional cases are identified. This should continue until the caseload falls to normal levels.
Even after the outbreak has subsided we still need to maintain routine surveillance especially due to Africa’s high prevalence of malaria, and “thereby prevent malaria resurgence” (Malaria Consortium & Montrose, 2019). Poverty also increases the risk of malaria but reduces the likelihood that households will adopt appropriate preventive measures (such as sleeping under an insecticide-treated net [ITN]) and curative measures (seeking timely health care for fevers) (Ricci, 2012).