Malaria still a health threat

By Henrylito D. Tacio

A professor of medicine in one of the country’s leading universities, visited a colleague working in the hinterlands of Palawan.  He stayed for at least two weeks.  On the plane coming home, he developed shaking chills and a high fever, which he assumed were caused by either a urinary or respiratory tract infection.  Malaria was the further thing from his mind.

A few hours, the fever and shakes suddenly disappeared – without any treatment!  He was puzzled by this strange attack, and dismissed it as probably due to some unusual virus.  A couple of days later, while lecturing at a meeting in Pasay City, he suddenly developed another paroxysm of shaking chills and fever.  It was so severe that he was unable to continue his presentation.  A close friend who happened to be around made the right diagnosis of malaria, which was confirmed by a blood test.

Despite battling still with the coronavirus disease 2019 (2019), the Philippines should not forget that it also has other diseases that it needs to beat, such as malaria, also a life-threatening infection.

November is designated as Malaria Awareness Month by virtue of Proclamation No. 1168 signed on November 10, 2006 by then President Macapagal-Arroyo.  The Department of Health (DOH) was tasked as the lead agency in the implementation of the anti-malaria campaign.

“The Philippines carry a high burden of malaria disease in the past but with unrelenting efforts of the DOH – National Malaria Control and Elimination Program, cases and death has been reduced significantly, that the country is now inching towards elimination,” DOH said in a statement.

The Geneva-based World Health Organization (WHO) said malaria is endemic in the country.  Nearly 12 million people, or 13% of the population, are at high risk.  “Most malaria cases in the country occur in forested, swampy, hilly and mountainous regions,” it pointed out.

“Malaria is widespread in distribution with prevalence varying from one area to the other,” said a review of malaria in the Philippines.  “In 1970, the malaria morbidity rate was reported to be 77.6 per 100,000 while the mortality rate was 1.8 per 100,000.  Case detection activities revealed that, in 1973, the slide parasite was 7.2%, the annual parasite index was 6.1% and the annual blood examination rate was 8.4%.”

Last year, the health department said only four provinces remain endemic for malaria as the country races to be declared malaria-free by 2030.  “These four provinces are Palawan, Sulu, Occidental Mindoro, and Sultan Kudarat,” said Health Secretary Francisco T. Duque III, adding that of the total 81 provinces, 50 were already declared malaria-free and the remaining 27 were under elimination phase.

By 2022, the health department aims to reduce malaria incidence rate by 90%.  To realize this goal, the strategies being implemented include early diagnosis and complete treatment, use of insecticide-based nets and indoor residual spraying of insecticide.

According to the United Nations health agency, a country that has achieved at least 3 consecutive years of zero indigenous malaria cases are eligible to apply for a WHO certification of 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 in 2018, an estimated 228 million cases of malaria occurred worldwide, with an estimated 405,000 deaths.

Four types of plasmodium, a single-cell parasite transmitted via Anopheles mosquitoes, cause malaria.  Of these, Plasmodium falciparum produces the greatest number – and the most lethal – of infections.  These parasites enter the body in a threadlike form called sporozoite when a female mosquito gets its drink of blood (males feed on plant juices).  These then travel to the liver, where they multiply and turn into a different kind of spore called merozoite.

What happens next is not unlike a scene from Alien.  In the bloodstream, the parasites penetrate the red corpuscles, reproduce rapidly and eventually burst out, killing the blood cells.

Malaria is curable, if caught early.  The first symptoms are headaches and pain in the joints, followed by alternating periods of high fevers and chills.  And because the parasite gobbles up hemoglobin in red blood cells, victims become severely anemic.  Over time, the recurrent fevers damage the kidneys, liver and brain, causing coma.  Eventually, the patient dies.

“Even before its cause was understood, malaria was known to be prevalent in swampy tropical marshlands,” writes Dr. Isadore Rosenfeld in his book, The Best Treatment.  The name was given by an Italian scientist who believed it to be caused by “bad air” (mal airia).

In addition to mosquito bites, a person can also contract malaria from a blood transfusion – if the donor was infected and unaware of it.  “That’s entirely possible because it may take as long as a year after being bitten by the mosquito before symptoms appear,” Dr. Rosenfeld writes in his book.  “Routine testing for malaria may not detect it unless the subject is actually having symptoms while the blood is being drawn.”

In the mid-1950s, the WHO predicted anti-malarial drugs and anti-mosquito insecticides would wipe out the disease within 40 years.  But a global “eradication” campaign petered out by 1970, and malaria roared back.

In the past, the best way to prevent malaria was to take one tablet (500 milligrams) of chloroquine (Aralen) a week, starting 14 days before a person embarked on a trip to areas where malaria is endemic, continued weekly while he is away, and every 7 days for 6 weeks after coming back.

But in recent years, malaria parasites have become resistant to chloroquine in so many areas 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 leaving, then weekly while in the malaria area and for 4 weeks after returning home.

“Pregnant women should avoid Lariam because of possible adverse effects in the fetus, as should persons with epilepsy, seizures, or other neurological problems because this drug may have adverse effects on the central nervous system,” warns Dr. Rosenfeld.  “Over half of the patients given high doses of Lariam complained of nausea, dizziness, and fatigue,” wrote N.J. White in a study published in the British Medical Journal in January 1994.

In addition to antimalarial drugs, travelers and visitors to a malaria zone are advised to use insect repellent – particularly N-diethyl-M-toluamide, better known as Deet – on their clothes and body and set up a mosquito-proof netting around their bed.  “But the best defense against this disease is to avoid being bitten by the Anopheles mosquitoes,” writes journalist Anne T. Merriman, who suffered malaria while visiting Tanzania some years back.

“In spite of drug resistance, malaria is a curable disease, not an inevitable burden,” assures the WHO.  “Although there are only a limited number of drugs, if these are used properly and targeted to those at greatest risk, malaria disease and deaths can be reduced, 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 basic right of affected populations and needs to be available wherever malaria occurs,” the UN health agency points out. “Children and pregnant women, on whom malaria has its greatest impact in most parts of the world, are especially important.”

The WHO says that malaria control is everybody’s business and “everyone should contribute to it, including community members and people working in education, environment, water supply, sanitation, and community development.

The UN health agency urges: “Malaria control must be an integral part of national health development and community action for control must be sustained and supported by intersectoral collaboration at all levels and by monitoring, training and evaluation, and operational and basic research.” – ###

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