Malaria nonetheless a well being risk – Well being and Way of life
By Henrylito D. Tacio
A professor of medicine at one of the country’s leading universities visited a colleague in the hinterland of Palawan. He stayed for at least two weeks. When he got home, he developed chills and a high fever, which he suspected was caused by either a urinary tract infection or a respiratory infection. Malaria was the next thing on his mind.
A few hours later, the fever and tremors went away – without treatment! He was confused about this strange attack and dismissed it as likely due to an unusual virus. A few days later, while lecturing at a meeting in Pasay City, he suddenly developed another attack of chills and fever. It was so bad that he couldn’t continue his presentation. A close friend who happened to be nearby made the correct diagnosis for malaria, which was confirmed by a blood test.
While the Philippines is still struggling with Coronavirus Disease 2019 (2019), remember that it also has other diseases to defeat like malaria, which is also a life threatening infection.
November is declared Malaria Awareness Month due to Proclamation No. 1168, signed on November 10, 2006 by then President Macapagal-Arroyo. The Ministry of Health (DOH) was commissioned as the lead agency for the implementation of the anti-malaria campaign.
“The Philippines has a history of high levels of malaria disease, but thanks to the tireless efforts of the DOH – National Malaria Control and Elimination Program, cases and deaths have been significantly reduced and the country is now on the path to elimination,” DOH said in an explanation.
The Geneva-based World Health Organization (WHO) said malaria was endemic to the country. Almost 12 million people, or 13% of the population, are at high risk. “Most cases of malaria in the country occur in forested, swampy, hilly and mountainous regions,” he said.
“Malaria is widespread in prevalence, with prevalence varying from area to area,” states a survey of malaria in the Philippines. In 1970, the reported malaria morbidity rate was 77.6 per 100,000, while the death rate was 1.8 per 100,000. Case detection activity found that in 1973 the slide parasite was 7.2%, the annual parasite index was 6.1%, and the annual blood test rate was 8.4%. “
Last year, the health department said only four provinces are endemic to malaria as the country should be declared malaria-free by 2030. “These four provinces are Palawan, Sulu, Occidental Mindoro and Sultan Kudarat,” said Health Minister Francisco T. Duque III, of which a total of 81 provinces have been added, 50 have already been declared malaria-free and the remaining 27 are in the elimination phase.
The health department wants to reduce the malaria incidence rate by 90% by 2022. To achieve this goal, strategies implemented include early diagnosis and full treatment, the use of insecticide-based nets, and indoor insecticide spraying.
According to the United Nations Health Department, a country that has not had malaria cases among indigenous people for at least three consecutive years can apply for WHO certification for malaria-free status.
In Asia, the WHO has certified the following countries as malaria-free: Japan (2012), Brunei (1987), Singapore (1982), Mongolia (since 1963) and Sri Lanka (2016).
The WHO reports that an estimated 228 million cases of malaria occurred worldwide in 2018, with an estimated 405,000 deaths.
Four types of Plasmodium, a unicellular parasite transmitted by Anopheles mosquitoes, cause malaria. Of these, Plasmodium falciparum produces the largest number – and the deadliest – of infections. These parasites enter the body in a thread-like form called a sporozoite when a female mosquito drinks blood (men feed on vegetable juices). These then travel to the liver, where they multiply and transform into another type of spore called a merozoite.
What happens next is not unlike a scene from Alien. In the bloodstream, the parasites penetrate the red blood cells, multiply quickly, and eventually burst, killing the blood cells.
Malaria is curable if caught early. The first symptoms are headache and joint pain, followed by alternating periods of high fever and chills. And because the parasite gobbles up hemoglobin in red blood cells, victims become severely anemic. Over time, the recurring fevers damage the kidneys, liver, and brain, causing coma. Eventually the patient dies.
“Before the cause was understood, malaria was known to be widespread in boggy tropical wetlands,” writes Dr. Isadore Rosenfeld in his book The Best Treatment. The name was given by an Italian scientist who believed that it was caused by “bad air” (mal airia).
In addition to mosquito bites, a person can get malaria from a blood transfusion – if the donor was infected and wasn’t aware of it. “This is entirely possible as it can take up to a year after the mosquito bites for symptoms to appear,” writes Dr. Rosenfeld in his book. “Routine tests for malaria may only detect them if the subject actually has symptoms while the blood is being drawn.”
In the mid-1950s, the WHO predicted that antimalarial drugs and mosquito insecticides would eradicate the disease within 40 years. But a worldwide “eradication” campaign came to an end in 1970 and malaria roared back.
In the past, the best way to prevent malaria was to take one tablet (500 milligrams) of chloroquine (Aralen) per week, starting 14 days before a person embarked on a trip to areas with endemic malaria that continued weekly during their absence and every 7 days for 6 weeks after returning.
In recent years, malaria parasites have become resistant to chloroquine in so many regions of the world that travelers are now better off with a newer drug, mefloquine (Lariam). The dosage is a single 250 milligram tablet, one week before departure, then weekly in the malaria range and 4 weeks after returning home.
“Pregnant women should avoid Lariam because of possible side effects to the fetus, as should people with epilepsy, seizures, or other neurological problems, as this drug can have negative effects on the central nervous system,” warns Dr. Rose field. “Over half of patients given high doses of Lariam complained of nausea, dizziness and fatigue,” wrote NJ White in a study published in the British Medical Journal in January 1994.
In addition to taking anti-malarial drugs, travelers and visitors to a malaria zone are advised to use insect repellants – especially N-diethyl-M-toluamide, better known as deet – on their clothing and body, and to put a mosquito-proof net around their bed. “But the best defense against this disease is not to be bitten by the Anopheles mosquitoes,” writes Anne T. Merriman, a journalist who suffered from malaria while visiting Tanzania a few years ago.
“Despite drug resistance, malaria is a curable disease, not an inevitable burden,” says the WHO. “Although the number of drugs available is limited, malaria disease and deaths can be reduced when used properly and specifically on the most vulnerable, as has been shown in many countries.”
The WHO believes that disease management through early diagnosis and prompt treatment is fundamental to malaria control. “It is a fundamental right of the affected population and must be available wherever malaria occurs,” emphasizes the UN health department. “Children and pregnant women, on whom malaria is the most influential in most parts of the world, are particularly important.”
WHO says malaria control is everyone’s business and “everyone should contribute, including community members and people who work in education, the environment, water, sanitation and community development.
The UN Health Authority urges: “Malaria control must be an integral part of national health development, and community action to combat it must be sustained and supported through cross-sectoral cooperation at all levels, as well as through monitoring, training and evaluation, and operational and basic research.” – ###