Malaria: Understanding Symptoms, Causes, Pathophysiology and Prevention Strategies

What is Malaria

It is a disease caused by one of the four types of plasmodium parasites. It is an acute infection of the blood caused by plasmodium parasites. There are four types of plasmodium parasites responsible for malaria. Plasmodium parasites are protozoa. They include Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale. Plasmodium falciparum is the commonest and forms about 90% of infections in Ghana. Female anopheles mosquito is the host of the plasmodium parasites. The anopheles mosquito usually hides in dark places during the day and bites late in the night. It does not breed in dirty water but in clean stagnant water. The incubation period is 12 days for falciparum, 14 days for vivax and ovale, and 30 days for malariae.

Pathophysiology of Malaria

When an infected female anopheles mosquito bites man during feeding, it injects sporozoites through its proboscis into the bloodstream. The sporozoites migrate to the liver cells and multiply asexually by to become schizonts which also develop into merozoites. The merozoites rupture the liver cells and re-enter the blood stream and invade or attack red blood cells. Some re-enter the liver cells and multiply and destroy the liver cells. This is when the signs and symptoms show in the infected person.
The multiplication and destruction of the liver cells and attack on the red blood cells continue until treatment is sought. When an infected female anopheles mosquito bites man during feeding, it injects sporozoites through its proboscis into the bloodstream.The sporozoites migrate to the liver cells and multiply asexually by to become schizonts which also develop into merozoites.
The merozoites rupture the liver cells and re-enter the blood stream and invade or attack red blood cells. Some re-enter the liver cells and multiply and destroy the liver cells. This is when the signs and symptoms show in the infected person. The multiplication and destruction of the liver cells and attack on the red blood cells continue until treatment is sought.

Signs & Symptoms of Malaria

• Chills
• Headache
• General body weakness
• Joint pain and weakness
• Fever
• Anorexia
• Anaemia
• Diarrhoea
• Vomiting
• Nonproductive cough

Treatment of Malaria

Antimalarial drugs

• Treat uncomplicated cases with Artesunate – Amodiaquine (drug of choice).
• Artesunate 4mg/kg body weight and Amodiaquine 10mg/kg body weight for 3 days.
• For complicated malaria, intravenous and intramuscular Quinine, followed by oral Quinine.
• For pregnant women, Sulphadoxine Pyrimethamine

Analgesics and antipyretics for headache and fever

Hematinic for anaemia

Nursing Management of Malaria

The following are the measures to put in place in the care of patient's with Malaria

• The patient should be given complete bed rest in the phase of high temperature, joint pains and anaemia.
• If they are wet, the sweat and the bed should be cleaned.
• The linen should be changed to promote comfort and rest.
• The patient should be nursed in a highly ventilated room and on a comfortable bed.
• The patient should be given highly nutritious diet.
• The patient is given fruit juice to enhance appetite.
• Fluid intake is also increased and if possible forced fluids are enhanced.
• The forced fluids can be IV or oral.
• Monitor vital signs 4 hourly but more especially temperature should be monitored closely.
• Observe for signs of dehydration.
• Monitor intake and output.
• Observe for jaundice and signs of anaemia.
• Assist patient to take care of his/her personal hygiene.
• Monitor patient closely and ensure that all sharp objects are away from reach of patient.
• Ensure that side rails are well fixed and in good use.

Preventions of Malaria

• Wear protective clothing.
• Kidney failure
• Premature delivery
• Brain damage or encephalitis. Use of mosquito repellent.
• Wire screening of the house or room.
• The use of insecticides.
• Burning all used cans.
• Clearing all bushes around the house.
• Distil all gutters.
• Prophylaxis using daraprim - a prophylactic drug for malaria especially in pregnant women. If you are in school, it should be taken every weeks.
• Early reporting for treatment.
• Sleep in treated mosquito nets.
• Cover all cans carrying water in the house.