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Department of Public Health & Preventive
Medicine |
MALARIA
1. Migration of population for various
reasons.
2. Rapid urbanisation.
3. Tremendous developmental activities especially construction of
buildings, overbridges etc.
WHAT IS
MALARIA?
-
Malaria is known as a disease of "High
fever".
-
It is caused by the infection of a tiny organism known as Malaria
parasite.
-
The Malaria parasite is transmitted from a person suffering from
Malaria to another healthy person by certain variety of
mosquitoes.
-
All mosquitoes are not capable of transmitting
malaria.
-
Infection occurs following a bite of an injected female anopheles
mosquito which contains the malaria parasite in the salivary
glands.
-
The parasite spends a part of its life in man and a part in
mosquito.
-
When a female anopheles mosquito bites a sick person, it picks up
malaria parasite.
-
These parasites enter into the stomach of mosquito which become
infective for malaria.
-
When this infective mosquito bites a healthy person malaria
parasites are injected in his blood.
-
The man within 14-21 days gets the fever. One malaria
patient give rise to large number of cases.
-
SYMPTOM OF MALARIA
A typical attack of malaria comprises of three distinct
stages.
1.
COLD STAGE:
Begins with the feeling of cold, shivering and headache.
The individual covers himself with quilts the blankets. Fingers
and lips become bluish with dry skin. Hairs on skin are
raised. It may continue for 15 minutes to 1
hour.
2. HOT
STAGE:
The fever rises very high so the patient feels burning
heat. He takes off the cloths. The patient feels intense
headache with nausea and vomiting. This stage lasts from 2-6
hours. Pulse is heavy and bounding, feels intense
thirsty.
3.
SWEATING STAGE:
In this stage, fever comes down with profuse sweating.
Patient normally goes into deep sleep, on awaking feels weak. This
stage lasts 2-4 hours.
-
There are four types of malaria existing in the world.
Usually we found three types in our
country.
-
Out of three, two major varieties causes concern to
us.
-
They are vivax malaria (a common variety of malaria) and
falciparum malaria (severe form of malaria).
-
The later variety is also known as general malaria which is a
dangerous one. If prompt treatment is not given the patient will
die within 2-3 days.
HOW TO
TREAT MALARIA
-
According to National Anti Malaria Programme, all fever cases
should be considered as Malaria cases unless otherwise diagnosed by
medical person. Accordingly we must administer the tablet
chloroquine as per the following schedule mentioned under suspected
cases.
-
When a malaria is confirmed after blood examination a complete
treatment with another drug "Primaquine" is necessary in addition to the
chloroquine.
-
The following table is given for the drug schedule as per the age
group.
TREATMENT SCHEDULE – MALARIA POSITIVES
RADICAL TREATMENT
Plasmodium vivax (14 days Treatment)*
Age years |
Chloroquine(mg )
(150mg base) |
Primaquine(mg)( 2.5mg)
Daily dose for14 days |
|
DayI |
DayII |
DayIII |
Mg base |
No.of tablets |
0-1 |
75 |
75 |
37.5 |
nil |
nil |
1-4 |
150 |
150 |
75 |
2.5 |
1 |
4-8 |
300 |
300 |
150 |
5.0 |
2 |
9-14 |
450 |
450 |
225 |
10.0 |
4 |
15&above |
600 |
600 |
300 |
15.0 |
6 |
Plasmodium falciparum (One day treatment only)
Age years |
Chloroquine
150mg base) |
Primaquine (7.5 mg base)
|
|
DayI |
DayII |
Day III |
I Day |
No.of tablets |
0-1 |
75 |
75 |
37.5 |
nil |
0 |
1-4 |
150 |
150 |
75 |
7.5 |
1 |
4-8 |
300 |
300 |
150 |
15.0 |
2 |
9-14 |
450 |
450 |
225 |
30.0 |
4 |
15&above |
600 |
600 |
300 |
45.0 |
6 |
No primaquine for infants and pregnant women
Chloroquine Resistant P.falciparum Areas
(Ramanathapuram and Chennai only)
Artesunate(50mg tablet+Sulpha – pyrimethamine (525mg tablet) (ACT)combination
Age (yrs) |
Iday (number of tablets) |
IIday (number of tablets) |
IIIday (number of tablets) |
<1year |
AS
SP |
½
¼ |
½
nil |
½
nil |
1-4 |
AS
SP |
1
1 |
1
nil |
1
nil |
5-8 |
AS
SP |
2
1 ½ |
2
nil |
2
nil |
9-14 |
AS
SP |
3
2 |
3
nil |
3
nil |
15 & above |
AS
SP |
4
3 |
4
nil |
4
nil |
Primaquine should be given with the consultation of a Medical
Officer.
-
Children below one year and pregnant women should not be given
this drug. Drugs should not be taken in empty
stomach.
-
In case of severe form of malaria i.e. P.falciparum, the tablet
primaquine should be given as a single dose as per table given along
with chloroquine. A single dose treatment with 600 mg
chloroquine and 45 mg primaquine given for an adult suffering from
P.falciparum malaria. Dosage for chloroquine and primaquine for
the treatment of P.falciparum malaria should be reduced suitable to
lower age group as mentioned in the above
table.
-
For the treatment of Malaria, drugs are available in all
Hospitals, Dispensaries, Primary Health Centres and Sub-centres
throughout the country.
-
Chloroquine tablets are also available with local chemist
shops.
-
Malaria can be cured through proper treatment. There are
several medicines used in treatment of Malaria. In most cases
chloroquine is still useful medicine for
malaria.
MALARIA
SITUATION IN TAMILNADU:
-
In Tamil Nadu State during 90's a total of 1,20,029 cases
were recorded out of which 59.6 % were recorded from the urban
areas and 40.4% in rural.
-
The coastal villages of Ramanathapuram, Paramakudi and
Nagapattinam and riverine villages of Dharmapuri,Krishnagiri and
Tiruvannamalai were endemic for malaria.
-
Due to the intensive control measures like active and
passive surveillance, vector control measures etc. taken up by the
PH dept the malaria case incidence has been drastically brought down to
43053 in 2000.
-
At present the coastal villages of Nagapattinam which were
once endemic are almost free from
malaria.
-
The incidence of malaria in Ramanathapuram and Tiruvannmalai show
a decreasing trend. However, Malaria is emerging as a problem in
Nagerkoil.
-
The factors contributing for the persistence of malaria in rural
areas are
1. Numerous breeding places in the river beds, puddles, rocky pits,
sandy pits casuarina pits etc.
2. Migration of the population for fishing ( Ramanathapuram ), as
labourers for construction and as quary workers to other endemic
states.
3. Non acceptance for indoor residual
spray.
Out of the total malaria cases reported in the State, 74% are
occurring in Chennai City and another 8.4% in Tuticorin, Erode, Vellore,
Dindigul, Salem, Tiruchengode, Tiruvallur and Tiruvottriyur. The
following problems attribute for the increase of malaria in urban
areas.
1. Population migration in search of
employment.
2. Lack of adequate water supply leading to storage of water for
use, creating breeding source of Malaria vector.
3. Developmental activities especially construction of buildings,
overbridges etc.
4. Non closure of wells, cisterns, overhead tanks
etc.
5. Inaccessible overhead tanks causing hindrance to the anti-larval
work.
IMPORTED
CASES:
A total of 145 cases are imported from Kerala during 2000,121 from
Andhra Pradesh and 99 cases from Karnataka. The importation of cases
are due to
1) Migration of Labourers and
fishermen.
2) Pilgrimage population.
3) Movement of people from one place to another seeking
jobs,business,etc.
CONTROL
STRATEGY:
The control strategies adopted in the Public Health dept
are:
1) Malaria case detection is being carried out by house to house
visit by collection of blood smears from fever cases and giving treatment
for those who are found positive for malaria.
2) Two rounds of residual insecticidal spray during transmission
period using synthetic pyrethroid in malaria endemic
areas.
3) Passive surveillance and anti-larval work in
urban.
4) Creating awareness among the community for their
participation.
5) Whenever imported cases recorded , the same is cross notified by
the concerned Medical Officer to the respective Health Authorities of
State for further remedial action at their end.
6) Mass and contact Blood survey are being carried out to
prevent the occurrence of secondary cases.
7) Whenever necessary, focal spray is being carried
out.
Active surveillance has become a problem all over the country in
the recent past. In Tamil Nadu, IEC activities have made a great
impact on surveillance, that more number of cases are being identified
under passive surveillance than Active
surveillance.
Geographical Information system (GIS) is being developed in
Tamilnadu for carrying out epidemiological mapping of the villages and for
identifying vulnerable areas and seasonal pattern of disease
outbreak.
In the present scenario in Tamil Nadu, it is feasible to wipe out
malaria if we succeed in bringing out a change in the Perception, Approach
and Practice at large. Malaria is a man-made problem only and
that by the above changes these will be source reduction in mosquito
breeding and complete elimination of parasite from human
circulation.
MALARIA
INCIDENCE IN RURAL AND URBAN AREAS OF TAMILNADU
|
Year |
State
Cases |
Rural
Cases |
Chennai
Cases |
Chennai
% |
Other UMS
Cases |
Other UMS
% |
|
1990 |
120029 |
48478 |
51272 |
42.7 |
20279 |
16.9 |
|
1991 |
144762 |
57403 |
67013 |
46.3 |
20346 |
14.1 |
|
1992 |
151633 |
52298 |
72314 |
47.7 |
27021 |
17.8 |
|
1993 |
148057 |
42908 |
76749 |
51.8 |
28400 |
19.2 |
|
1994 |
104964 |
39736 |
48352 |
46.1 |
16876 |
16.1 |
|
1995 |
92375 |
40739 |
41822 |
45.3 |
9814 |
10.6 |
|
1996 |
80586 |
27249 |
45930 |
57.0 |
7407 |
9.2 |
|
1997 |
72426 |
23429 |
41735 |
57.6 |
7262 |
10.0 |
|
1998 |
63915 |
16023 |
40475 |
63.3 |
7417 |
11.6 |
|
1999 |
56366 |
12141 |
38165 |
67.7 |
6060 |
10.8 |
|
2000 |
43053 |
7574 |
31861 |
74.0 |
3618 |
8.4 |
|
2001
|
31551 |
5121 |
23652 |
75.0 |
2778 |
8.8 |
|
2002 |
34523 |
5490 |
27205 |
78.8 |
1828 |
5.3 |
|
2003 |
43396 |
12233 |
29058 |
67.0 |
2105 |
4.9 |
|
2004 |
41640 |
10841 |
28229 |
67.8 |
2570 |
6.2 |
|
2005 |
40594 |
13560 |
25153 |
62.0 |
1881 |
4.6 |
|
2006 |
26329 |
6529 |
18585 |
70.6 |
1235 |
4.7 |
|
2007 |
22389 |
7104 |
14002 |
62.5 |
1283 |
5.7 |
|
2008 |
20211 |
5737 |
13503 |
66.8 |
971 |
4.8 |
|
2009 |
14920 |
4274 |
8917 |
59.8 |
1729 |
11.6 |
|
2010 |
17086 |
6031 |
9789 |
57.3 |
1266 |
7.4 |
|
2011
|
22171 |
6602 |
14927 |
67.3 |
642 |
2.9 |
2012
(Upto December)
|
18869 |
7133 |
11090 |
58.8 |
646 |
3.4 |
March 2013
|
810 |
335 |
446 |
55.1 |
29 |
3.6 |
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