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At a time when the world is facing a pandemic as immense in proportions as COVID-19, it might be difficult to even imagine that focus can be divided and attention be paid to any other global issue. Yet, malaria is one of the oldest and deadliest diseases in the history of this world, and nothing about it can be taken for granted. 

The World Health Organization (WHO) has already urged all nations at risk of a malaria outbreak to take this threat seriously and resume preventive measures at the national level. With World Malaria Day 2020 - which is observed on 25 April every year - coming up, the WHO hopes to reignite the fight against malaria, a global threat to health that claims lakhs of lives every year and infects many more.

Read more: Don’t miss the signs of these diseases in the panic around COVID-19

This year’s theme for World Malaria Day is “Zero malaria starts with me”. This is a grassroots campaign that aims to keep the issue of malaria high on the political agenda of all nations, make sure that additional resources are mobilized on a global level to combat malaria, and all communities are empowered enough to take malaria care and prevention into their own hands. This entire campaign is based on the findings in the WHO’s World Malaria Report 2019. 

The report mentions that while there were 251 million malaria cases worldwide in 2010, the number went down to 228 million cases in 2018. This reduction over eight years is not as significant as it could be, and the report concludes that there were no global gains in the reduction of the number of infections between 2014 and 2018. What’s more, the number of deaths due to malaria didn’t change much between 2017 and 2018 either.

Read more: Malaria and COVID-19

This suggests that urgent action against malaria on a global, national and community level is very important. Awareness about malaria, how it spreads, how it can be treated and how to prevent it needs to reach every community and individual at the grassroots level.

  1. Malaria and India: Why elimination is a major goal
  2. Frequently asked questions about malaria
Doctors for 10 most frequently asked questions about malaria

Malaria is a type of parasitic infection which has been around for centuries, especially in the subtropical and tropical areas of Africa, Asia and South and Central America. It’s said to have originated in Africa as far back as the Neolithic age, and gradually spread to other continents. India has had an ancient link with the disease, with malaria even being referred to as the “king of diseases” in Vedic texts.

It was also in India that  Dr Roland Ross of the Indian Medical Service announced in 1897 that the malaria parasite was carried and transmitted by mosquitoes - leading health scientists to figure out ways to prevent and treat malaria in subsequent years.

Malaria outbreaks are common in present-day India, especially due to the tropical climate, heavy monsoons and water-logging. According to India’s National Health Portal, the majority of malaria cases in India are reported in the eastern and central parts of the country as well as states which are predominantly made up of forest, hill or tribal areas. States like Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh, Maharashtra, Tripura, Meghalaya and Mizoram witness the highest number of cases every year.

To reduce the burden of malaria in the nation and to contribute to the world, in 2015, India joined 17 other Asia-Pacific countries to endorse a plan to eliminate malaria from the world by 2030. India further pledged to make this plan a reality by eliminating malaria by 2027 - three years ahead of the regional and global target. The NHP mentions that India was able to control the burden of malaria to a large extent with the number of cases declining from 20.8 lakhs in 2001 to four lakhs in 2018.

This was done through the rigorous pursuit of the National Framework for Malaria Elimination (2016-2030) and the National Strategic Plan (NSP). The government needs to continue to focus on the NSP to completely eliminate malaria from the country.

India is one of the 20 countries that carry 85% of the world's malaria disease burden, according to the WHO Malaria Report 2019 (the other 19 countries are all in Sub-Saharan Africa). Spreading awareness about malaria is one of the best ways to combat its spread in India. The following are some of the most commonly asked questions about malaria:

Can malaria kill you?

Yes, malaria is a disease that can cause death. In fact, malaria causes about four lakh deaths every year globally - a large number of those who die are children below the age of 5 years. According to the WHO, kids below 5 years of age accounted for 67% of all deaths due to malaria in 2018.

Malaria is caused by a parasite called Plasmodium and its different varieties, which are carried by the female Anopheles mosquito. Once it enters the body, Plasmodium affects the red blood cells and their circulation, which affects all the major organs of the body including the liver, kidneys and lungs. Cerebral malaria, which is caused by the Plasmodium falciparum parasite, can affect the brain and lead to its failure.

Anaemia, or low levels of red blood cells in the body, also sets in and affects all the organs of the body and impairs their function very quickly. This can lead to failure of multiple organs of the body. This type of multi-organ failure, especially in the absence of any treatment or intervention, can cause death due to malaria.

What causes malaria?

Malaria is caused by Plasmodium parasites. When the female Anopheles mosquito bites someone with malaria, it picks up the parasites. When this same mosquito bites another human being (or other animals as well), the parasite enters their body and mixes with the bloodstream to multiply quickly. 

Because every part of the body needs blood to function, the parasite quickly spreads all over and affects the functioning of the body. The parasite particularly weakens the liver, kidneys, lungs and brain. Without proper treatment and intervention, a malaria patient’s condition can deteriorate very quickly.

What is the malaria protozoa?

Contrary to popular belief, malaria is not caused by a virus, and is therefore not a viral infection. It is, in fact, a parasitic infection caused by the Plasmodium parasites. These parasites were first discovered in the blood of malaria patients by Charles Louis Alphonse Laveran in 1880. 

Inspired by Laveran’s hypothesis about the Plasmodium parasites, Ronald Ross in 1897 (in Secunderabad) discovered the existence of said parasites in the stomach tissues of a female Anopheles mosquito, thereby not only proving that malaria is caused by this parasite but also that this particular type of mosquito is the vector (carrier) for the disease. Ross was awarded the Nobel Prize for Medicine in 1902 because of this discovery.

Currently, we know of five protozoan parasites of the Plasmodium genus that cause malaria globally:

  • Plasmodium falciparum, which is responsible for the majority of deaths globally and especially affects the sub-Saharan African continent.
  • Plasmodium vivax, which affects Asian and Latin American nations and causes the predominant type of malaria in India as well.
  • Plasmodium ovale, which has an added devastating effect on the liver because it can stay dormant for years without getting activated.
  • Plasmodium malariae, which causes a very small number of malaria infections worldwide. 
  • Plasmodium knowlesi, which predominantly affects primates but can also be transmitted to humans.

Why is malaria so deadly?

Malaria is a disease that is categorized as an acute febrile illness - which means it is characterized by a rapid onset of fever accompanied by chills, headache, body aches and joint pain. But this is not the only reason why it’s considered to be one of the deadliest diseases humankind has ever faced. 

Certain types of malaria, especially P. falciparum, can progress to severe illness and cause death if not treated within 24 hours. This becomes a very difficult task to complete if the healthcare system of the affected countries is not up to the task or if the outbreak occurs in poverty-ridden sections of cities, nations or societies. 

If you take a look at the most affected nations, you’ll find that all of these are developing countries in Africa, Asia and Latin America. Because malaria is linked to hygiene, waterlogging and water safety, the poorest of the poor get affected by this disease. Such affected communities might not even have adequate access to healthcare to get treatment and recover from malaria - and this is what makes malaria so deadly.

What are the first signs of malaria?

The incubation period of the Plasmodium parasite is seven to 30 days. This means that if you get bitten by a vector female Anopheles mosquito today, you are likely to show the symptoms of malaria at least a week later. 

The first symptoms of malaria, according to the WHO, are fever, chills and headache. It’s very easy to mistake these primary symptoms to be those of the flu or common cold, but if you live or work in an area where mosquitoes and mosquito bites are common, then you should get tested for malaria immediately because prompt diagnosis and treatment play a key role in recovery.

The secondary symptoms of malaria include muscle pain, joint pain, nausea and vomiting, and diarrhoea. As malaria progresses, it also causes jaundice and anaemia. Further progression can lead to kidney failure, seizures, liver failure, mental confusion, coma and death.

How do you test for malaria?

There is only one way to test for malaria and identify exactly which type of Plasmodium caused the disease - finding out the latter is important to get proper treatment - and that is by getting a drop of the patient’s blood and checking it under a microscope for the parasites.

If you are sick, have the symptoms of malaria, and either live or have recently travelled to an area with a malaria outbreak, you should contact a doctor immediately and get a blood test done to confirm your diagnosis and get adequate and timely treatment. In areas where malaria outbreaks are frequent, malaria Rapid Diagnostic Tests (RDTs) are made available by government agencies, the WHO and healthcare providers.

All RDTs are equipped to detect the specific antigens or proteins produced by malaria parasites, although variations can occur in these products. Some RDTs can detect only one species of Plasmodium, while others are equipped to detect multiple species. The best part about RDTs is that the blood of the patient is drawn through a simple finger prick, which means that these can be used at home or while travelling as well.

For how long can you have malaria?

With proper and timely treatment, malaria can be cured pretty quickly. The expected duration of complete remission of all symptoms is two weeks. Relapses do occur in some cases, but they’re extremely rare.

However, without proper treatment, malaria can progress very quickly and cause coma or even death. In milder cases, malaria episodes can return periodically. This is the reason why people who have travelled to areas with malaria outbreaks are asked to give their travel for up to a year during doctor’s appointments.

Repeated exposure to the Plasmodium parasites can make patients partially immune to malaria and cause only milder forms of the disease to come up periodically. This has been noticed especially in some sub-Saharan African communities.

What should you eat in malaria?

Following a healthy and easily digestible diet while suffering from malaria is very important. The below-mentioned foods should be prepared properly, while maintaining hygiene, and be consumed by the patient of malaria.

  • Fluids: Drink safe, potable water. If you do not have access to filters that perform reverse osmosis or other purifying methods, boiling the water before drinking is a good thing to do. You can also drink fresh fruit and vegetable juices, coconut water and other detoxifying and immune-boosting drinks. (Read more: How to increase immunity: foods and remedies)
  • Carbohydrates: Easily digestible carbohydrates like rice should be eaten for energy and to relax the stomach.
  • Protein: Thin lentil soups, dal, chicken broth, fish soup, milk, curd, buttermilk and boiled lean chicken are dependable sources of protein while recovering from malaria. Protein is necessary for energy as well as to fight off weakness.
  • Vitamins and minerals: Malaria can deplete the vitamin and mineral levels in your body, which is why it’s very important to replenish them as soon as possible. Opting for fresh fruits and vegetables is a good way to do this, but if your doctor recommends it, you can also opt for vitamin B-complex, vitamin A and vitamin C supplements.

Can you get malaria twice?

Simply put, the answer is yes, you can get malaria twice. The primary reason behind this is the different species of Plasmodium that can cause malaria. You might have, for example, contracted P. vivax once, gone through the entire treatment protocol and recovered completely. This might give you some immunity from P. vivax. But if you are bitten by a mosquito carrying P. falciparum a year later, you could contract malaria again.

People who grow up in areas with a high occurrence of malaria can sometimes develop a partial immunity from the disease. But there is no guarantee for this, and there are very few communities which have developed this type of herd immunity. 

Read more: What is herd immunity and can it help stop COVID-19?

A much graver complication which is posing a problem to healthcare systems around the world is that Plasmodium species are gaining resistance to malaria drugs - which suggests mutation of these parasites and reinfections as well as outbreaks of malaria in communities which might have built even a partial immunity. 

The WHO mentions this resistance to antimalarial drugs is a major and recurring problem which affects malaria control efforts and reverses any progress made in this direction. The WHO has repeatedly launched efforts to counter the spread of drug-resistant malaria parasites in different parts of the world.

Is malaria contagious or infectious?

No, malaria is not contagious or infectious and you cannot catch it by being physically close to somebody who has the disease. Sharing the same space or even kissing an infected person will not transmit malaria to you, because this disease - unlike viral and bacterial infections - is caused by parasites which are activated only once they enter your bloodstream.

Malaria is spread when a female Anopheles mosquito carrying one of the Plasmodium parasites bites a human being and the parasites enter the bloodstream. Since the parasites thrive in the bloodstream, the only way malaria can be transmitted from one person to the next is via blood transfusion or organ transplants. It is also possible for pregnant women to pass the parasite on to their babies during the later stages of pregnancy or during childbirth.

Read more: Checkups during pregnancy: tests and ultrasounds in all three trimesters

Dr. Arun R

Dr. Arun R

Infectious Disease
5 Years of Experience

Dr. Neha Gupta

Dr. Neha Gupta

Infectious Disease
16 Years of Experience

Dr. Lalit Shishara

Dr. Lalit Shishara

Infectious Disease
8 Years of Experience

Dr. Alok Mishra

Dr. Alok Mishra

Infectious Disease
5 Years of Experience

References

  1. World Health Organization [Internet]. Geneva (SUI): World Health Organization; World Malaria Day 2020
  2. National Health Portal [Internet] India; World Malaria Day 2019
  3. Centers for Disease Control and Prevention [Internet], Atlanta (GA): US Department of Health and Human Services; Ross and the Discovery that Mosquitoes Transmit Malaria Parasites
  4. World Health Organization [Internet]. Geneva (SUI): World Health Organization; World malaria report 2019
  5. World Health Organization [Internet]. Geneva (SUI): World Health Organization; World malaria report 2018
  6. Kumar A, Valecha N, Jain T, et al. Burden of Malaria in India: Retrospective and Prospective View. In: Breman JG, Alilio MS, White NJ, editors. Defining and Defeating the Intolerable Burden of Malaria III: Progress and Perspectives: Supplement to Volume 77(6) of American Journal of Tropical Medicine and Hygien
  7. Narain, Jay Prakash and Nath, Lalit M. Eliminating malaria in India by 2027: The countdown begins!. Indian J Med Res. 2018 Aug; 148(2): 123–126. PMID: 30381533
  8. Das, Aparup. et al. Malaria in India: The Center for the Study of Complex Malaria in India. Acta Trop. 2012 Mar; 121(3): 267–273. PMID: 22142788
  9. World Health Organization [Internet]. Geneva (SUI): World Health Organization; How malaria RDTs work
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