MALARIA – The Greatest Killer of Childeren in the World Today

What Is Malaria?

• Malaria is caused by four species of parasitic protozoa that infect human red blood cells. Protozoa are one-celled organisms that are as sophisticated as a human cell. Malaria parasites feed on red blood cells for a living.
• Malaria parasites have a complex life cycle. In order to live, they need to have both a human and a mosquito host. The mosquito host can’t be just “any” mosquito. It has to be a female mosquito of the genus Anopheles.
  The mosquito picks up the malaria parasites from the blood of an infected human when it feeds. The parasite reproduces itself in the gut of the Anopheles mosquito, forming a sac with thousands of new malaria parasites. The parasites need the mosquito to continue their life cycle. In order to infect an individual, the infected mosquito has to live 15 days at which point the parasites burst out of their sac and reach the salivary gland of the mosquito. Then, the mosquito passes the malaria parasites to the human through its salivary glands.
• There are four different species of malaria parasites causing types of malaria that are somewhat different from each other. These species are Plasmodium falciparum, vivax, malariae and ovale.
• The worst type is caused by Plasmodium falciparum.
• Infection with Plasmodium falciparum kills approximately 1-2% of those who come down with it.
• Falciparum malaria is a serious illness characterized by fever, headache, and weakness.
• Complications of falciparum malaria include cerebral malaria, in which the brain is infected, severe malaria, in which the parasitic infection essentially “runs out of control,” and placental malaria, in which falciparum is a grave complication of pregnancy, and coma.
• Each of these complications is very serious and often fatal.
• Falciparum malaria is the major type found in sub Saharan Africa, where 90% of the world’s malaria cases occur.
• Unfortunately, falciparum malaria is also frequently resistant to drugs and is becoming more common in high elevation areas of Africa, and in portions of Asia.
• The other species of malaria cause a debilitating illness characterized by spells of chills, fever and weakness. This illness generally lasts 10-14 days, and is self-limiting in nature. The malaria caused by these species is rarely fatal.

A World Wide Problem

Malaria is preventable and curable, yet at endemic levels in the worlds poorest countries.
Around 2.5 billion people (at least 40% of the worlds population) are at risk of malaria in over 90 countries. Malaria causes or contributes to 3 million deaths and up to 500 million acute clinical cases each year. In other words, almost as many deaths per annum as the AIDS death total in the last 15 years.
The majority of deaths are children. Our worlds children are dying at a rate of 4 per minute, 5,000 a day and 35,000 a week.
Other high risk groups include pregnant women, refugees, migrant workers, and non-immune travelers .
Malaria is one of leading causes of morbidity and mortality in the developing world (along with TB, acute respiratory syndrome, diarrhoea and HIV) but still not recognised in developed countries as a disaster such as AIDS.

Malaria kills more people today than three decades ago. Reasons for the spread include: increasing drug resistance, increased migration and immigration, decreased mosquito control efforts (insecticide spraying), deforestation and mining (development activities)
Over 35 years ago malaria had been eradicated or dramatically reduced in 37 countries through the WHO insecticide spraying programme, but this situation is rapidly reversing. The reversal is largely due to the cost of sustaining programmes, loss of motivation in the face of a seemingly declining threat, and the development of insecticide and drug resistance.

Malaria exacts an enormous toll in lives, medical costs and days of labour lost.
Educational systems also suffer as large numbers of children miss several weeks of school each year in endemic regions.

Malaria and Africa

Malaria is Africa’s leading cause of under-five mortality and constitutes 10% of the continent’s overall disease burden. It accounts for 40% of public health expenditure, 30-50% of inpatient admissions, and up to 50% of outpatient visits in areas with high malaria transmission.
There are several reasons why Africa bears an overwhelming proportion of the malaria burden. Most malaria infections in Africa south of the Sahara are caused by Plasmodium falciparum, the most severe and life-threatening form of the disease. This region is also home to the most efficient, and therefore deadly, species of the mosquitoes which transmit the disease. Moreover, many countries in Africa lack the infrastructures and resources necessary to mount sustainable campaigns against malaria and as a result few benefited from historical efforts to eradicate malaria.
In Africa today, malaria is understood to be both a disease of poverty and a cause of poverty. Annual economic growth in countries with high malaria transmission has historically been lower than in countries without malaria.
Malaria also has a direct impact on Africa’s human resources. Not only does malaria result in lost life and lost productivity due to illness and premature death, but malaria also hampers children’s schooling and social development through both absenteeism and permanent neurological and other damage associated with severe episodes of the disease.

One of the greatest challenges facing Africa in the fight against malaria is drug resistance. Resistance to chloroquine, the cheapest and most widely used antimalarial, is common throughout Africa. Resistance to sulfadoxine-pyrimethamine, often seen as the first and least expensive alternative to chloroquine, is also increasing in east and southern Africa. As a result of these trends, many countries are having to change their treatment policies and use drugs which are more expensive, including combinations of drugs, which it is hoped will slow the development of resistance.

Malaria and HIV/AIDS

Malaria and HIV are two of the most devastating global health problems of our time. Together they cause more than 4 million deaths a year. Both are diseases of poverty, and both are causes of poverty. To a considerable extent, both are concentrated in the same geographical regions. The resulting co-infection and interaction between the two diseases have major public health implications.
HIV-infected people must be considered particularly vulnerable to malaria.

Where both diseases occur, more attention must be given to specific diagnosis for febrile patients. In HIV-infected individuals, a malaria case definition based on fever alone can result in a febrile illness due to a wide range of ordinary, virulent and opportunistic infections being misdiagnosed and treated as malaria. This may lead to inappropriate care of HIV-infected adults with severe febrile illnesses due to causes other than malaria.

Evidence of interactions between malaria and HIV in non- pregnant adults is accumulating. In areas with stable malaria, HIV increases the risk of malaria infection and clinical malaria in adults, especially in those with advanced immunosuppression. In settings with unstable malaria, HIV-infected adults are at increased risk of complicated and severe malaria and death.

Additional research is needed to investigate the impact of malaria on the natural history of HIV, potential therapeutic implications, and interactions at a cellular and molecular level.

Acute malaria episodes cause a temporary increase in viral replication of HIV and hence plasma viral load. However, there is no evidence that malaria has a substantial effect on clinical progression of HIV, HIV transmission or response to antiretroviral treatment in areas where malaria and HIV overlap.

Few studies have examined the interaction of malaria and HIV in children. In areas of stable malaria, HIV-infected children may be at increased risk of clinical malaria compared to children not infected with HIV. Advanced immunosuppression in HIV- infected children results in more episodes of clinical malaria and higher parasite densities compared with HIV-infected children whose immune status is less compromised. In areas of unstable malaria HIV-infected children may be at increased risk of severe disease and death.

The effects of interactions between malaria and HIV are particularly deleterious to maternal and infant health. HIV infection impairs the ability of pregnant women to control P. falciparum infection. They are more likely to develop clinical and placental malaria, more often have detectable malaria parasitaemia and have higher malaria parasite densities.

Compared to women with either malaria or HIV infection, co-infected pregnant women are at increased risk of anaemia, preterm birth and intrauterine growth retardation. As a result, a considerable proportion of children born to women with dual malaria and HIV infection have low birth weight and are more likely to die during infancy.

Children and Malaria

• Children are especially vulnerable to malaria.
• Malaria kills one child every 30 seconds in the world today.
• Children aged one to four are the most vulnerable to infection and death. Malaria is responsible for as many as half the deaths of African children under the age of five.
• The disease kills more than one million children – 2,800 per day – each year in Africa alone.
• In regions of intense transmission, 40% of toddlers may die of acute malaria.

Anaemia, low birth-weight, epilepsy, and neurological problems, all frequent consequences of malaria, compromise the health and development of millions of children throughout the tropical world. Yet much of the impact of malaria on the worlds children could be prevented with currently available interventions.
Of the more than 500,000 African children who develop cerebral malaria (a severe form of the disease that affects the brain) each year, 10-20% die and approximately 7% are left with permanent neurological damage. Children with malaria typically develop fever, vomiting, headache and flu-like symptoms. If untreated, the disease may progress rapidly (often within 24 hours) to convulsions, coma, and death.

Malaria is a major cause of anaemia in many parts of the world. Chronic anaemia may adversely affect a childs growth and intellectual development. Repeated episodes of malaria may lead to severe, life-threatening anaemia. Blood transfusions may save lives in these circumstances, but also expose the child to the risk of HIV and other blood-borne infections.

A reduction of illness and death in young children can be achieved through:

• Prevention: Children must be protected from the mosquitoes that transmit malaria. The best way to do this is to ensure that they sleep under insecticide-treated nets (ITNs). Studies in Africa have shown that ITNs can reduce deaths among under-fives by up to one-third.
• Prompt recognition and effective treatment: There is an urgent need to ensure that effective and affordable antimalarial drugs or drug combinations are widely available to all individuals living in malaria-endemic areas.
• Anaemia: Parents and healthcare workers must be trained to recognize the clinical signs of anaemia, and to seek treatment. Malaria, nutritional iron deficiency and intestinal parasites (such as hookworm) are the most common and preventable causes of anaemia in much of the developing world.
• Prevention of malaria-related low birth weight: Pregnant mothers must be encouraged to use ITNs and take advantage of Intermittent Preventive Treatment. This has been shown to increase birth weight, a major determinant of child survival.

Ugandan Children

In Uganda, malaria has historically been a very serious health problem and currently poses the most significant threat to the health of the population.

Malaria currently accounts for:

• 25% – 40% 0f all out-patient visits at health facilities.
• 20% of hospital admissions.
• 23.4% of total discounted life years lost.
• 9 – 14% of in-patient deaths.

Malaria is the main killer of Ugandan children:

• 720,000 under fives and over one million fives and over are reported to have clinical malaria.
• 43% of deaths of under fives, in Uganda, are attributed to malaria and malaria accounts for 70,000 110,000 child deaths annually.
• With acute disease a child may die within 24 hours.

Malaria kills children often in combination with other diseases, including HIV.

Malaria also causes:

• Childhood anaemia
• Reduced growth (stunting)
• Mental retardation
• An average of 6 episodes of malaria each year
• Severe malarial anaemia resulting in a case fatality rate of 8-25% among paediatric admissions
• Up to 70% of out-patient attendances and over 50% of in-patient admissions in the under 5s.

In pregnancy, malaria may cause:

• Maternal anaemia (particularly in prime gravidae)
• Intra-uterine growth retardation
• Premature births
• Low-weight babies which is the principal contributor to infant mortality
• Still births
• Abortions/miscarriages – malaria is responsible for nearly 60% of miscarriages
• Pregnant women are 4 times as likely to suffer malaria attacks during pregnancy than when not.

Malaria does not only cause ill health and death but also has a great impact on the economic and social development of the family and the individual child.

• Expenditure on treatment and prevention. A poor malaria-stricken family may spend up to 25% of its income on malaria treatment and prevention.
• Malaria affects families most during the rainy season when families least afford to be sick, malaria interferes with their farm activities thus causing poverty in families.
• Loss of household incomes through absenteeism from work.
• Malaria causes absenteeism from school, thus affecting school performance. It is estimated that in endemic areas like Uganda, malaria may impair as much as 60% of the school childrens learning ability.
• Frequent illness or deaths of children due to malaria can lead to misunderstandings within families and between families. Those with sickly or dying children often are likely to accuse others whose children do not fall sick or die of bewitching their children which leads to hatred within and between families.

Wellspring Childrens Medical Centre

Malaria is a leading cause of ill health, poverty and death in Uganda with the children being the most vulnerable to this disease and its consequences.
It is inevitable that a great proportion of the children attending the Wellspring Medical Centre will be suffering from either acute attacks of malaria or the consequences of the disease. To be able to deal adequately and efficiently with such a work load Just Care plans to provide a specialised day care facility for malaria victims alone. This is addition, to malaria care provided in the general health clinics and outreach work. With the prospect of AIDS and other serious diseases causing problems with a definitive diagnosis of malaria, it is important that staff are trained to use laboratory equipment efficiently to ensure an accurate and prompt diagnosis of the disease. Advice regarding appropriate treatment regimes is to be sought from Kitovu Hospital. Any child who is at increased risk due to, for example, age, signs of cerebral malaria, anaemia etc, will be immediately referred to a more specialised unit.

One of the aims of the Wellspring Medical Centre is to reduce the mortality and morbidity rates for those children in the villages suffering from an acute malaria attack by ensuring prompt treatment and urgent referral to a paediatric unit when necessary. In addition, as part of the health education programme, advice will be given with regard to prevention of the disease with the use of mosquito nets, insect repellents and clearance of any areas of stagnant water etc.. Practical provision of mosquito nets will be given to those at greatest risk and with low incomes. Essential follow clinics will also be available for those children diagnosed with acute or chronic malaria.

Just Care is aware that the opening of an acute malaria unit will require dedication and expertise of the part of the staff and a huge financial undertaking with regard to medication, laboratory equipment and staffing, and referral costs. However, with so many children at risk of sickness and death as a result of this killer disease we cannot ignore the problem and will continue to appeal for assistance with regard to expert advice and funding to enable this unit to eventually open and develop.

One mosquito net can be purchased at the cost of £4!

£10 will provide 100 children with anti malarial medication!

Every child in the world is priceless.

No task is too vast, no price is too high to save the life of a child.

Just Care believes that God wants the very best for the neglected children of Uganda but He relies on those with much to provide for those who have nothing.

1. Mortgage Rates says:

   July 30, 2010 at 1:09 pm

   Hey really wonderful blog!!