The Causes and Management Issues of Malaria

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Introduction

Malaria is a mosquito-borne communicable illness caused by a eukaryotic protist referred to as plasmodium. The disease is prevalent in tropical and subtropical areas and other parts of Asia, America and Africa. Every year approximately 350- 500 million cases of the disease are recorded. Out of this number around one to two million people die every year with the majority of them being young children in sub-Saharan Africa. Ninety percent of all malaria-related deaths are registered in sub-Saharan Africa. The high cases are associated with a high level of poverty which affects social-economic factors in sub-Saharan Africa. This region is unable to meet the cost of both and curatives measures supposed to be in place so as to curb the disease. Malaria is considered to be a major hindrance to economic development as the disease requires large sums of money for preventive and management practices. Five species of plasmodium that can infect people with malaria exist.

They include plasmodium falciparum, plasmodium vivax, plasmodium ovale, plasmodium malariae, and plasmodium knowlesi. Out of these five species, Plasmodium falciparum causes the most severe kind of malaria. Malaria is transmitted by a mosquito bite from a female anopheles mosquito. When the mosquito bites an infected person, it takes a small amount of blood containing the parasite that causes malaria. When the same mosquito bites a second person it injects the malaria parasites which later multiply in the red blood cells causing symptoms such as fever and headache. Currently, a range of antimalarial drugs is used to manage the disease, in sub-Saharan Africa where the disease is endemic a mixture of drugs having an artemisinin derivative is used. The essay addresses factors that influence the causes and management issues of malaria (WHO, 2010, p. 29).

Model

The use of a conceptual model to show physiological, social and environmental factors related to the disease provides a clear understanding of the disease. This understanding helps both the community and health professionals to adequately manage the disease. The model goes beyond the health results it explores the fundamental factors that produce the health results observed by the wider community. It also aids in checking these factors as it is a fundamental public health function. Field model of health that shows the social environment, the physical environment and genetic environment gives a wide notion of health and factors that influence health. The model gives an explanation of how social, physical and genetic environment influences the occurrence and management of malarial. The social environment entails the practices of a particular community that either increase or reduces the risks of malaria. Some communities do not believe in the use of mosquito nets, others are ignorant and when given the mosquito nets they use them like windows and door curtains.

Some religions do not believe in taking drugs so when a member of this religion suffers from malaria, they may end up dying or cause the disease to spread further. Social determinants indicate whether an individual leads a healthy or unhealthy life. Positive social determinants influence the health and functioning of an individual and eventually his/her wellbeing. The physical environment involves the climatic factors that may encourage or discourage the breeding of mosquitoes that transmit malaria. It influences the occurrence of diseases and injuries in human beings. Regions, whereby the climatic conditions encourage the breeding of mosquitoes, are likely to register many cases of malaria as compared to regions where the mosquitoes do not multiply in large numbers. The physiological/ genetic environment influences the health and medical situation of an individual related to malaria. Some individuals are more resistant to malaria parasites than others; they rarely or never get sick with malaria. The field model with the three factors explains how the prosperity and wellbeing of individuals are influenced by the individual response to the three factors (Torres, 2003, p.89).

The use of a conceptual model to show physiological, social and environmental factors related to the disease provides a clear understanding of the disease. The social environment entails the practices of a particular community that either increase or reduces the risks of malaria. Some communities do not believe in the use of mosquito nets, others are ignorant and when given the mosquito nets they use them like windows and door curtains. The physical environment involves the climatic factors that may encourage or discourage the breeding of mosquitoes that transmit malaria. The physiological/ genetic environment influences the health and medical situation of an individual related to malaria.

Epidemiology

Malaria is a globally devastating disease that causes approximately 500 million new infections presented by the occurrence of fever and one million deaths each year. Large numbers of individuals who suffer from the disease are young children under the age of five years and pregnant women. This number is mostly observed in the sub- Saharan region where climatic conditions encourage the breeding of mosquitoes. There have been great efforts to reduce the incidences of malaria through reduction of transmission and increased treatment. However, very little change has been realized especially in the prone areas. It is feared that if the occurrence of malaria remains on its current upward track death rates of malaria may double in the coming twenty years. These statistics have shortcomings as cases of malaria in some rural settings are not documented due to a lack of necessary facilities and inadequate manpower. Co-infection with HIV/AIDS and malaria usually increases the mortality rate though not as much as in the case of co-infection with tuberculosis and HIV/AIDS. HIV/AIDS infection increases the susceptibility of an individual to malaria infection as opposed to persons who are HIV/AIDS negative.

Currently, malaria is endemic in a wide region of the equator, places such as America, much of Africa and many regions of Asia. The worst-hit region is sub-Saharan Africa where 85-90% of malaria deaths occur. In dry places, outbreaks of malaria can be monitored by accurate mapping of rainfall seasons. Many cases of malaria occur in rural regions as opposed to urban regions. However, in Africa, many cases are registered both in a rural and urban setting though urban regions are at a lower risk. Malaria is caused by a protozoan known as plasmodium, five species of plasmodium exist but Plasmodium falciparum accounts for the great percentage of malaria cases and mortality internationally. The malaria parasites are transmitted by bites of female anopheles’ mosquitoes. When this mosquito bites an infected individual, it sucks a small amount of blood which contains the malaria parasites and is injected into a second individual upon biting. Many cases of mortality linked with malaria are caused by the bursting of infected red blood cells at their reproductive stage (CDC, 2009, p.110).

Diagnosis

Malaria is majorly diagnosed by microscopic testing of blood films, this is considered a major method since 1880 when Charles Laveran first identified malaria parasites in the blood. This method is economical and hence the most preferred. Each species of plasmodium is identified with its distinguishing characteristics. Two forms of blood films are used, thin blood film which is the same as the normal blood film and allows easy identification of malaria parasites since their appearance is well preserved during preparation. Thick films allow the screening of a large volume of blood and they are approximately eleven times sensitive as compared to thin films. By the use of thick films, health professionals are able to detect even low levels of infections easily. However, the appearance of parasites in the thick film is slightly distorted thus it becomes difficult to distinguish the various species of plasmodium. Health professionals combine both thick and thin-film methods when making a definitive diagnosis. Symptomatic diagnosis is used in areas where even simple laboratories can not be found.

The diagnosis is on the history of fever as an indicator to treat malaria; this can also be combined with taking of rectal temperature and checking for splenomegaly. This combination increases chances of correct diagnosis from 21% to 41% as opposed to the use of symptoms only, this significantly decreased unnecessary treatment of malaria. However, fever and septic shock have been highly misdiagnosed as malaria especially in Africa resulting in the failure in the treatment of life-threatening sicknesses. In places where microscopy is unavailable or laboratory technicians are not experienced in malaria diagnosis antigen tests can be carried out. The test only requires one drop of blood, dipsticks are used and the outcomes are interpreted by the presence or absence of colored bars on the dipstick. Dipstick only tests whether there is the presence of malaria parasite in the blood but not the amount which is a disadvantage of the test. The molecular method of diagnosis is also used in testing for malaria, it is more precise than microscopy and only it is only found in a few clinical laboratories. However, the method is very expensive and needs a specialized laboratory (Farnet, 2008, p. 234).

Signs and symptoms

Signs and symptoms of malaria mostly include fever, joint pains, convulsions, anemia, retinal damage and hemoglobinuria. The major symptom of malaria is a recurring sudden onset of coldness and later fever followed by sweating. This lasts for at least six hours and occur every two days in plasmodium vivax and plasmodium ovale, every three days in plasmodium malariae in plasmodium falciparum the fever may recur after every 36- 48 hours. Malaria also causes cognitive impairment mostly in young children and extensive anemia at a time of brain development which may eventually lead to direct brain damage. Brain damage comes as a result of cerebral malaria infection whereby children are more prone, cerebral malaria is also linked with retinal whitening. Serious malaria which is almost exclusively caused by plasmodium falciparum may lead to a coma and eventually death if no treatment is given children under the age of five years and expectant women are more vulnerable. Other symptoms include renal failure, stillbirth, low birth weight and hypoglycemia (Esse, 2008, p. 224).

Course of malaria

Currently, many countries are putting great effort to control malaria by reducing transmission and increasing treatment of infected diseases. However, the course of malaria continues to progress upward especially in Africa. Morbidity and mortality rates are on the rise especially among the vulnerable groups of young children under the age of five years and pregnant women. Climatic changes continue to affect the trend of malaria globally, in the past decades highland temperatures continually increase the temperatures have actually increased by at least four degrees compared to the normal temperatures. These high temperatures favor the breeding of mosquitoes and have resulted in increased incidences of malaria in the affected regions. Individuals have also developed resistance to antimalarial drugs which are in the market making the management of malaria difficult as the disease continues to spread and cause more mortality cases Every year malaria normally affects 500 million people globally mostly in Africa whereby one out of five deaths in children is as a result of malaria infection. mostly in Africa whereby one out of five deaths in children is as a result of malaria infection.

The possibility that the climatic changes are interfering with the trend of the disease may indicate that tools used to foretell when an outbreak may occur could become invaluable. Malaria starts developing in humans when a female anopheles mosquito carrying malaria parasites bites them. The development is in two phases, exoerythrocytic and erythrocytic. The exoerythrocytic phase entails infection of the hepatic structure or liver while the erythrocytic phase entails infection of the red blood cells. When infected female anopheles mosquito bites to have a blood meal, sporozoites which are in the saliva of the mosquito are injected into the bloodstream. In at least 30 minutes the sporozoites infect the hepatocytes and multiply asexually and asymptomatically for a duration of 6 to 15 days. In the liver, sporozoites differentiate to form many merozoites which upon rapture escape into the blood cells and the erythrocytic phase begins. In the red blood cells, the parasites multiply further asexually and invade new blood cells. At this stage waves of fever are experienced; the parasites are shielded from the immune system as for the most time it resides in the liver and red blood cells which are invisible to immune surveillance. Nevertheless, infected blood cells in the circulation system are damaged in the spleen. Plasmodium evades this destruction by exhibiting adhesive proteins which glue the infected red blood cells on blood vessels. This sequesters the parasites from passing the normal blood circulation system and the spleen. The adhesiveness results in the hemorrhagic problems associated with malaria, blockage of these vessels cause placental and cerebral malaria (Easmon, 2009, p.13)

Acceptance of disease

Medical professionals have accepted that malaria is a global disaster that needs immediate intervention in order to reverse the trend of its incidences. Scientists are even teaming up to develop a vaccine against malaria. Professionals are actively involved in the development of a strategic plan to control and manage malaria. Elaborate education is also been offered to health professionals in order to increase their knowledge and skills of managing malaria. Health professionals trained in regions where malaria is not found must get official training on tropical diseases if they want to practice in malaria-prone areas like sub-Saharan Africa (cooper, 2010, p. 78).

Treatment

Active malaria infection caused by plasmodium falciparum is considered a medical emergency that requires hospitalization. Infections by other species of plasmodium are mostly mild and can be managed at the outpatient level. Management of malaria involves supportive measures and administering antimalarial drugs. Early detection of plasmodium species before they cause a lot of destruction to both red blood cells and liver cells is important in improving the management of malaria. Antimalarial drugs can be manufactured in industries but their cost is quite high and some people may opt for herbal forms of treatment such as Artemisia annua tea. However, counterfeit drugs have been found in several Asian countries such as Cambodia, Indonesia, Thailand, Vietnam, China and Laos. Relevant authorities in these countries are doing everything possible to eliminate counterfeit drugs in order to eliminate avoidable deaths. Professions have managed to reduce the incidences of malaria by administering drugs that cure malaria and thus avoid the further spread of the disease. Health education and promotion offered by health professionals to the public help them to change their behavior in order to curb the disease; they are encouraged to use mosquito nets. This has also reduced the mortality levels as the disease can be treated before it gets too severe levels. However, management of malaria is faced with a problem of resistance to drugs, health is faced with a dilemma of choosing the kind of drugs to administer to patients especially those who have developed resistance (Charles, 2005, p.98).

Community practices

Community practices may have positive or negative effects on the health of the entire community. Some religious practices put the entire community at risk of contracting malaria such as those who do not believe in going to the hospital and taking drugs. When an individual from such a community gets sick the disease progress to severe stages, they also increase the transmission of the disease due to continued bites by the mosquitoes. Communities through the opinion leaders mobilize their members to give priority to their health; this helps them to realize positive development especially in the aspect of economic development. Community-based education and service help create awareness of the disease and the community is well equipped with knowledge for the control and management of malaria. Through community-based organizations, the government is able to reach most people at the ground in an attempt to deliver equitable health services. Cultures that are retrogressive and comprise the health of the community should be done away with; this can only be achieved if the community leaders are willing to transform their members for the sake of better health (Malar, 2008, p.67).

Effective management and control of malaria call for integrated practices, policies, and research activities that are practical and sustainable. Practices that would help in the control and management of malaria would include the implementation of preventive measures such as the use of mosquito nets and the spraying of appropriate insecticides. Individuals should be encouraged to seek proper medical attention when they are suffering from the disease. This helps in the reduction of cases and deaths from malaria. For the state to successfully solve threats of malaria policies that increase access and use of available control measures should be set.

Policies requiring pretreatment of travelers to malaria-prone regions should be emphasized to avoid the spread of the disease to malaria-free zones. Researchers should carry out continuous investigations that help in detecting any change of trend in malaria, especially in the most prone regions. They should be able to realize any instances of resistance and develop appropriate drugs to address resistant cases (Wadester, n.d, p 167).

The above practices have helped in the reduction of morbidity and mortality levels globally. However, the change is slight and more is required in order to reverse the trend of the disease especially in sub-Saharan Africa. The major challenge experienced is inadequate funds particularly in the developing countries; some countries cannot afford money to purchase drugs and other preventive materials for the affected people. The process of policymaking has been by the political influence which delays the process for longer than the expected duration. Increasing cases of resistance to available drugs is also a challenge to researchers who have to constantly develop new drugs to manage cases of resistance. This greatly increases the cost of research work which eventually affects the economic development of the particular state (white, 2000, p. 178).

Role of Social Workers

Social workers play a fundamental role in creating awareness about malaria at the local level. They educate the community on health-seeking behaviors and the implementation of adequate preventive measures. They are able to direct individuals on where they can seek proper treatment. They also provide the trend of the disease at the community level to the federal and state management team for proper intervention measures. They also air the opinions of various communities to policy makers for further consideration. Information given by health workers on the trend of malaria is of great importance to researchers as they are able to take the appropriate measures. Social workers act as the watchdog in enhancing the mitigation of malaria to the larger public. Delivery of health services faces the challenge of unequal distribution of resources. The poor and minority groups do not get an adequate supply of resources for the control and management of malaria (Yozoum, 2008, p.62).

Conclusion

Malaria is still a threat to health and continues to cause many deaths globally; measures to control and manage the disease are in place but a lot needs to be done in order to reverse the current upward course of malaria. Control of the disease is greatly influenced by social, political and environmental factors that exist in a particular community. Some environmental factors favor the breeding of mosquitoes, social factors involve the practices which either discourage or encourage incidences of malaria in the community. Political factors influence the process of policymaking and distribution of resources for the purpose of malaria control and management. Social workers act as the watchdog in enhancing the mitigation of malaria to the larger public.

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