INTRODUTION

•Malaria is protozoal disease caused by

the infection with parasites of the genus
Plasmodium transmitted to man by
certain species of infected female
anopheline mosquito.
• Clinical features:-Mild to severe and
complicated ,according to the species of
parasite, patient’s immune status,
intensity of infection.
History
• Malaria has infected human for over
50,000 years .
• In the beginning of 2700 BC in China
the term Malaria originate from
Medieval Italian: mala aria which
means “bed air”.
• Also called Ague & Mast fever due to
it’s association with swamps.
• Scientific study starts in 1880,
French army doctor Charles Louis
Laveran observed parasite in
side the red blood cells of
people suffering from
malaria & he was awarded
with Nobel Prize for
Physiolgy and medicine.
 CLASS OF MALARIA
According to region
Tribal malaria:-
• found in tribal areas of AP, MP,
Bihar etc.
• Contribute 50% of P. falciparum
case in country.
• Limited infrastructure & lack of
drugs.
 Rural Malaria
• Arid & semiarid plains of Hryana,
Panjab, U.P.,M.P.
• An.culicifacies is main vector & P.
vivax is main causative agent.
Urban Malaria
• 15 major cities & 4 metropolitan
cities contribute 80% of malaria
cases
• Delhi, Mumbai, Chennai, Kolkata,
Banglore, Ahmedabad, Jaipur etc.
• P. vivex & P.falciparum
• Health infrastructure is well devloped
• Low socio-economic group living in
unplanned settlement prone to
periodical epidemic.
Border Malaria
• Due to military conflicts.
• Mixing of population.
• Poor administrative control.
CAUSATIVE AGENT

• P.vivex:- Contribute 70% of malaria

infection.
• P.falciparum:- Contribute about 25-
30% of malaria infection.
• P.malariae:- contribute less than 1%
cases of malaria in India.
• P.ovale:- This is very rare parasite in
man. Mostly found in Africa.
LIFE CYCLE OF PLASMODIM
VECTOR OF MALARIA
Out of 45 species of anapheline
mosquito few are regarded as vector
for the transmition, they are as
follows,
• Anapheline culicifacifacies
• Anapheline fluviatiatilis
• Anapheline stephensi
• Anapheline minimus
• Anapheline pihilippinensis
• Anapheline sundaicus and
• Anapheline maculatus
 Symptoms
• COLD STAGE
-lassitude, headache, nausea, chilling.
• HOT STAGE
-burning sensation, rapid respiration, full
pulse
• SWEATING STAGE
-fever comes down with sweating, temp.
drops to normal & skin is cool & moist,
slower pulse rate, patient feels sleepy.
• FEBRILE PAROXYSMS occurs with definate
period repeating every third or fourth day.
CLASSIFICATION OF ANTIMALARIAL
DRUGS
• 4-Aminoquinoline (chloroquine)
• Quinoline methanol (mefloquine)
• Acridine (mepacrin)
• Cinchona alkaloids (quinine)
• Biguanides (proguanil)
• Diaminopyrimidines (pyrimethamine)
• 8-Aminoquinoline (primaquine)
• Sulfonamides & sulfones (sulfodoxine)
• Tetracycline (tetracycline)
• Sesquiterpine lactone (arthesunate)
• Naphoquinone (atovaquone)
HOW BIG PROBLEM IS? WORLD
WIDE
• About 100 countries in the world are
considered as malarious.
• Out of 300-500 million clinical cases each
year, 90% are from subsaharan africa
caused by p. falciparum.
• Kills 1.1-2.7 million people worldwide/year
of whom 1 million r children under age of
5yrs.
• Means 1 death in every 30sec.
Estimate of mortality & DALYs lost due to
malaria
MORTALITY DALYs
REGION [000] [000]
selected

AFRICA 1136 40855

AMERICAS 1 111
EAST MEDITERRANEAN 59 1196

EUROPE 0 21
SEAR 65 2777
WESTERN PACAFIC 11 371

TOTAL 1272 46481

Malaria incidence & mortality in
SEAR
Malaria Cases Malaria related mortality rate
COUNTRY (per 100,000 (per 100,000 population)
population)
All Ages Children aged
0-4 ages

INDIA 7 3 6
BANGLADESH 40 1 1

BHUTAN 285 5 8
INDONESIA 920 1 0
MYANMAR 224 20 3
NEPAL 33 8 11
SRI LANKA 1110 9 4
 IN INDIA

• During 2003 abot 1.65 million cases

were reported with 943 deaths, 0.7
million cases of p.falciparum.
• Prevalence of malarial vector sever
in north eastern states due to
geography, climate condition.
 DIAGNOSIS
• Depends on demonstration of parasites in
blood.
• Thin & Thick blood flims are prepared on
same slide.
• Thick flim is more relable in searching of
parasite.
• Thin slide is more valuable for identifying
species of parasite.
• Malaria Fluorescent antibody test.
• Dipstick antigen capture test.
MEASUREMENT OF MALARIA
• TWO CLASSES
1.Pre-Eradication
- Spleen rate
- Average enlarged spleen
- Parasite rate
- Parasite density index
- Infant parasite rate
2. Eradicatin era
- Annual parasite incidence (API)
- Annual blood examination rate
(ABER)
- Annual falciparum rate (AFR)
- Slide possitive rate
- Slide falciparum rate
WORK DONE IN PAST FOR
ERADICATION

• ROLL BACK MALARIA initiative was launched by

WHO, UNICEF, UNDP and the WORLD BANK in
1998.

• Strengthen health system to ensure better

delivery of health care, especially at district and
community level.
• Ensure the proper and expanded use of
insecticide treated mosquito nets.
• Ensure adequate access to basic health care
and training of health care workers.
 SURVEILLANCE
• Active survillance
paid worker, alloted for the
populatuon of 10,000 & for every 4
surv. There is surv. Inspector
Jobs-visit each house under his area
& enquire a) fever cases b) collect
blood & administration of chloroquine
c) make entry in house card &
dispatches bld slide to lab. For
examination d) if test is +ve he
returns to patient & administer a
course of radical treatment for
• Passive surveillance
Search malaria cases in local health
agencies e.g. PHC, hosp.,
dispensaries
Cases of fever which escape the net
of active surveillance workers are
screened by the passive surveillance
agencies & rest
of job is same as active surveillance.
MALARIA CONTROL THROUGH PHC
• This new approach was approved by
WHO in 1978 bcoz antimalarial drug
distribution
is effectively carried out in PHC
• 1045 PHC’s are working
predominantly in 8 states under
enhanced Malaria Control Prog.
 VACCINES
No. of vaccines controlling malaria are
currently under development
• Asexual Blood-stage vaccine
-Antigen derived from the blood stage of
P. falciparum persent in man.
• 2nd type of vaccine is designed to arrest
the development of parastie of mosquito &
thus reduce transmission of disease.
Research supported by UNDP/WORLD
BANK/WHO
• Synthetic cocktail vaccine for
P.falciparum
called SP166 developed by Dr. M
Patarroyo in Colombia.
• ST vaccine - A team backed by the
Gates Foundation and the pharma
giant GlaxoSmithKline have
announced results of a Phase IIb trial
for RTS,S/AS02A, a vaccine which
reduces infection risk by
approximately 30% and severity of
infection by over 50%.
 Countries who have eradicated
malaria & steps they have applied
• Mexico, the third largest country in Latin
America, has made substantial inroads in
decreasing its malaria burden. Has won
the NOBEL PRIZE.
• Intensive surveillance & fouced combined
intervention in areas where transmission is
identified & patients are treated with
antimalarial drugs.
Breeding sites for mosquito larvae are
destroyed or treated; and pyrethroid
insecticides are sprayed as needed, inside
houses and outdoors
 LONDON
• Sterile insect technique is emerging
as a potential mosquito control
method. Progress towards
transgenic, or genetically modified,
insects suggest that wild mosquito
populations could be made malaria-
resistant.
 Work going on currently for the
eradication of Malaria
• APPROACH TO MALARIA ERADICATION

• Case management (diagnosis and

treatment) of patients suffering from
malaria
• Prevention of infection through
vector control
• Prevention of disease by
administration of antimalarial drugs
to population groups such as
pregnant women and infants.
 Case Management
• The clinical management of malaria
cases (i.e diagnosis and treatment)
to reduce morbidity and mortality
ought to be first priority.
• The government have also
established drug distribution centers
and fever treatment depots all over
the country in rural areas to cope
with problem of detecting and
treating malaria cases in endemic
areas.
 Prevention of infection
• Infection is prevented when malaria-
carrying Anopheles mosquitoes are
prevented from biting humans.
• Vector control reduce contact betn.
Mosquitos & humans by destruction
of larval breeding sites & insectiside
spraying inside house.
• Insectiside treated bed nets are also
used for prevention.
 Prevention of Disease

• Antimalarial drugs are used to

prevent the disease by eliminating
the parasite that are in the blood
 Disease control strategies
• Case detection
• Treatment
chloroquine was the antimalarial drug of
choice for many years in most parts of the
world.
There are many drugs which are used for
treatment & prophylaxis.
• Currently available antimalarial drugs
include Artemether-lumefantrine (Therapy
only, commercial name Coartem)
• Artesunate-amodiaquine (Therapy only)
• Artesunate-mefloquine (Therapy only)
• Artesunate-Sulfadoxine/pyrimethamine
(Therapy only)
 Activities for malaria control

• Health education
• Training & supervision of health
workers
• Proper supply of equipment to health
worker to carry out the intervention.
Why it is not possible till today
• Drug resistance in P.falciparum
decreases the efficacy of antimalarial
drug.
• Insecticide resistance decreases the
efficacy on insects such as DDT.
• Inadequate health infrastructure in
country
• Poor socio economic condition & lack
of education
What should be done for effective
eradication
• Indoor residual spraying malathion,
synthetic pyrethnoids.
• Mosquito nets & bed cloths-Mosquito
nets help keep mosquitoes away
from people, and thus greatly reduce
the infection and transmission of
malaria. The nets are not a perfect
barrier, so they are often treated
with an insecticide designed to kill
the mosquito before it has time to
search for a way past the net.
• Conclusion

• Role of pharmacist