AN estimated 228 million malaria cases were recorded in 2018, with approximately 405 000 people succumbing to the disease worldwide, according to the World Health Organisation.

Sadly, children under five years of age accounted for 272 000 of malaria deaths. And Africa is the malaria epicentre accounting for 94 percent of malaria deaths in 2018.

Overall, around 24 million children in sub-Saharan Africa were reportedly infected with plasmodium falciparum in 2018.

Plasmodium falciparum is “the most deadly of the human malaria parasites”, having the ability to subvert the physiology of its host.

Malaria is a life-threatening blood disease that is transmitted to humans by the female anopheles mosquito.

Biologically, parasites that cause the spread of malaria belong to the plasmodium genus. And more than 100 types of plasmodium parasites can possibly infect a variety of species.

Plasmodium falciparum, plasmodium malariae, plasmodium vivax, plasmodium ovale and plasmodium knowlesi parasites are commonly transmitted through mosquitoes in humans.

A mosquito becomes infected by feeding on a person who has malaria. And if the mosquito bites the next person, it can effectively transmit malaria parasites.

As the infected mosquito bites a human, parasites eventually multiply in the host’s liver before infecting and destroying the red blood cells.

And at this stage, patients typically develop malaria symptoms.

While some types of the plasmodium genus are responsible for frequently causing severe malaria symptoms, others lie dormant for as long as a year.

Since malaria parasites affect the red blood cells, people can similarly contract the disease from infected blood.

In this context, mother-to-child transmission, unsafe blood transfusions and the sharing of injection needles are essentially common means of malaria transmission.

Crucially, early diagnosis is very important in the control and treatment of malaria. But poor countries generally lack sufficient resources to carry out effective screening of malaria cases.

Though a malaria vaccine has been licensed in Europe, no other vaccines have been specifically developed for other continents.

Nevertheless, advances in malaria treatment have immensely helped in easing the perennial health burden.

Clinically, malaria symptoms can be divided into two categories – uncomplicated and severe malaria.

Uncomplicated malaria symptoms typically last between six and eight hours. Though symptoms usually recur after every 48 hours, some strains of the parasite can have a longer cycle.

Malaria infection is generally characterised by fever, chills, headache, nausea, vomiting, muscle pains and fatigue.

Occasionally, the signs and symptoms of malaria may include sweating, chest pains, abdominal pains, and cough.

Some patients with malaria experience cycles of malaria “attacks”. An “attack” usually starts with shivering and chills, followed by high fever and sweating, and a return to normal temperature.

Normally, malaria clinical manifestations begin within a few weeks after being bitten by an infected mosquito.

Since malaria symptoms resemble those of flu, they usually remain undiagnosed or misdiagnosed in the areas where malaria is less common.

As the world battles the devastating Covid-19 pandemic, medical practitioners must thoroughly carry out investigations that timely differentiate malaria from the coronavirus.

Scientifically, malaria diagnosis is specifically confirmed by the presence of malaria parasites in the blood. Also, laboratory tests confirm the type of malaria parasite and any resistance to certain drugs.

Artemisinin-based combination therapies (ACTs) have been widely used in the first line treatment of malaria. These include artemether-lumefantrine (coartem) and artesunate-amodiaquine.

Pharmacologically, each ACT is a combination of two or more drugs that work against the malaria parasite in different ways.

On the other hand, chloroquine phosphate has always been the preferred treatment for any parasite that is sensitive to the drug.

Apparently, the drug has been clinically considered ineffective for malaria treatment. “The deadly malaria parasite” has since become resistant to chloroquine in many parts of the world.

Complicated malaria

Delayed and missed diagnoses have been carefully observed to cause complicated malaria. Clinical and laboratory evidence often show signs of vital organ dysfunction.

Signs and symptoms of complicated malaria include fever, chills, impaired consciousness, multiple convulsions, deep breathing, respiratory distress, abnormal bleeding, anaemia and jaundice.

Essentially, the parenteral administration of the adequate, appropriate and safe anti-malarial drugs has always helped in managing complicated malaria.

Cases of severe malaria must always be treated in a setting of the highest possible level of clinical care, usually in an intensive care unit.

Likewise, supportive management of complications such as coma, convulsions, hypoglycaemia, fluid and electrolyte disturbances, renal failure, bleeding disorders, and anaemia is very important.

Mechanical ventilation has apparently played an important role in reducing the mortality of this life-threatening condition.

Of late, the use of artemisinin derivatives has since been extensively observed as a major breakthrough in the treatment of malaria.

However, it is very important to seriously consider anti-malaria precautions. The risk of developing malaria is often high when one travels to malaria-affected areas.

Crucially, the ABCD approach in malaria control has always been very important in reducing the health burden.

As such, the ABCD approach encourages increased awareness of malaria risk, bite prevention, checking whether one needs malaria prophylaxis and that diagnosis must be made promptly.

With the world religiously following the Covid-19 pandemic protocols, using the ABCD approach will similarly help contain plasmodium falciparum – “the most deadly malaria parasite”.

Everisto Mapfidze is a registered general nurse who holds a Bsc Honours in Sociology (UZ). For feedback: [email protected]