Malaria I : What You Should Know

Malaria Overview; what is malaria?;  malaria in children;; severe malaria; malaria in pregnant women
Medical Tutors Limited
February 26, 2023

11:41 AM

Malaria, is a parasitic infection that is spread to humans through the bites of infected mosquitoes, causes fever, headaches, and several chills, and once it is left untreated can become severe and cause complications.

What is Malaria?

Malaria is a mosquito-borne disease caused by a parasite called the plasmodium parasite. It is spread to humans through bites from an infected female Anopheles mosquito. It tends to be a serious illness, and sometimes can be life-threatening if it is left untreated, especially in children, pregnant women, and visitors from Europe or America.

It is an illness quite common in Nigeria, a tropical country whose climate permits mosquitoes to live and thrive for a long time, especially in marshy areas and open gutters.

Each year, malaria infects nearly 290 million people worldwide, with more than 400,000 people dying from the disease, especially children ranging from ages 0 – 5 years and pregnant women. Though it is preventable and curable, people with malaria tend to feel very sick with chills, high fever, and flu-like illness. When these symptoms are left untreated, they develop into more severe complications that may lead to death in children or pregnant women.

In the quest to make the environment a malaria-free society, the World Health Organization in partnership with health institutions, and health ministries of various countries have: (1) provided various health programs that have helped to sensitize individuals on how to recognize persons with malaria; (2) preventive methods such as insecticide-treated bed nets; (3) approved anti-malaria drugs for children and adults who live in countries with high numbers of malaria cases.

How Can We Recognize Someone with Malaria?

After an individual has been bitten by an infected mosquito, it takes about 10 – 15 days for the symptoms of malaria to start kicking in. Apart from high fever, chills, or flu-like symptoms, one can recognize an individual infected with malaria with the following symptoms:

  • High temperature of 38OC or above
  • Constant headache, body aches, or muscular pains
  • Diarrhea
  • Abdominal pains
  • Cough, nausea, and vomiting
  • Jaundice
  • Convulsions
  • Difficulty breathing and bloody stools

What Causes Malaria?

Malaria is caused by a parasite called the plasmodium which is then transmitted to humans through the female Anopheles mosquito. Mosquitoes can become infected when they feed on a person who has malaria, and when these mosquitoes bite an uninfected person, the person contracts the malaria parasites. Once these parasites enter the body, they travel to the liver; then infect the red blood cells, which then causes individuals to develop malaria symptoms.

Who Is at Risk of Contracting Malaria?

For malaria especially in countries like Nigeria with high cases of malaria, where good health facilities or preventive measures are lacking, everybody is at risk of getting infected with malaria. However, certain people are at higher risk of contracting severe malaria, and they include:

  • Young children between the ages of 0 – 5 years
  • Pregnant women and their unborn children
  • People who are visiting from locations with very low cases of malaria e.g., Europe

When Should You Visit a Doctor?

Due to how life-threatening malaria can be, it is important for any individual who develops malaria symptoms to seek medical care immediately, especially pregnant women and infants/young children who are at more risk of severe malaria.

How Can You Manage People With Malaria?

Malaria can be well managed through proper diagnoses, treatment, and preventive measures used. The World Health Organization recommends that the use of early diagnosis and treatment of malaria can help reduce the effect of the disease, deaths, or further transmission. It also recommends that all suspected cases of malaria be confirmed using parasite-based diagnostic testing (through either microscopy or rapid diagnostic test). This can be done using the (1) blood smear test; (2) Fyodor Urine Malaria Test (UMT) which can be done in the comfort of the patient without visiting a hospital.

The best treatment for malaria according to WHO, particularly for p. falciparum malaria, is artemisinin-based combination therapy (ACT). This treatment is done to ensure the rapid and total elimination of plasmodium patients from the patient’s bloodstreams and also prevent any complications from malaria treatment.

Drug Treatment

Artemisinin-based combination therapy such as Coartem, Lonart, Amartem, or P-alaxin. Patients should take paracetamol along with these antimalarial drugs to reduce temperature and body pains.

Severe malaria is usually treated in the hospital. Patients are admitted and given an intravenous injection of quinine or artesunate.

Uncomplicated Malaria (Explained with Illustrative Cases)

Malaria can be classified as uncomplicated when a patient has the symptoms of malaria and a microscopy or RDT positive test, but no sign of severe symptoms (breakdown of organs; abnormalities in the bloodstream; low blood sugar, etc.).

The symptoms of uncomplicated malaria include fever; chills; sweats; headaches; nausea and vomiting; body ache; and general malaise. The incubation period of malaria ranges from 10 to 14 days depending on the parasite species.

Treating of uncomplicated malaria is usually done using Artemisinin–based combination therapy. The ACT is a combination in which one of the components is Artemisinin and its derivatives of Artesunate, Artemether, and Dihydroartemisinin. Artemisinin helps to produce a rapid clearance of the malaria parasites in the bloodstream.

Case 1: A five-year-old boy is brought to the hospital’s outpatient department.  The mother says he was well until that morning when he woke up and said he was feeling tired and refused breakfast.  When the mother touched him, he felt hot and she gave him a tablet of Paracetamol. Examination showed a well-nourished 15-kg child, not pale, alert, and with an axillary temperature of 38.50C.  The rest of the examination is normal.

Management: The child has uncomplicated malaria; he had RDT which was positive for malaria parasites. He should be treated with Artemether / Lumefantrine. Artemether is an artemisinin while lumefantrine is combined with it for effectiveness

Case 2: A 22-year-old lady at 26 weeks gestation in her first pregnancy complains of headache, joint aches, and malaise. She had one dose of Sulphadoxine-pyrimethamine (SP) at the early stage of her pregnancy but tests positive for malaria parasites with a rapid diagnostic test (RDT)

Treatment: This patient has uncomplicated malaria which requires immediate treatment using Artemether – Lumefantrine. Artemisinin is not contraindicated in pregnant women in the first trimester.

Severe Malaria (Explained with Illustrative Cases)

Severe malaria is a type of malaria that is caused by the Plasmodium Falciparum, occurring in patients with no strong immunity to malaria e.g., under 5 years children and pregnant women, etc. At this stage, malaria infections are complicated by serious organ failures. And its symptoms include Seizures; Coma (adults: 2 – 4 days, children 1 – 2 days); Respiratory distress; convulsions; hypoglycemia (common in children); jaundice (common in adults); metabolic acidosis, etc.

Severe malaria cases are medical emergencies that should be treated urgently and aggressively once it has been diagnosed.

There are two classes of drugs currently available for severe malaria; cinchona alkaloids (quinine and quinidine) and the Artemisinin derivatives (Artesunate, Artemether, and Artemotil)

Case 1: A 3-year-old boy suddenly started feeling feverish and became breathless. During the examination, he became pale and dyspnoeic with tachypnoea. Pulse is 110/min regular; normal heart sounds but there is a 3rd heart sound; the chest is clear but the abdominal exams showed hepatosplenomegaly.

Diagnosis & Treatment: This patient has malaria which should be confirmed with a blood test for malaria parasites or RDT, and pneumonia which can be confirmed by Chest X-ray. His treatment should include antimalarial drugs and broad-spectrum antibiotics.

Case 2: A 30-year-old woman at 32 weeks gestation in her first pregnancy presents at the accident & emergency with fever, jaundice, coma, and a history of convulsions before the coma.  Her blood film for the Malaria parasite was positive.

Diagnosis & Treatment: The above patient has severe malaria and possibly cerebral malaria. The patient should be treated with intravenous Artesunate in the first 24 hours followed by oral Artemether/Lumefantrine. It is not safe to use Quinine at this stage of pregnancy because it may cause uterine contraction and premature birth.


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