Prepared by:

ALINGAN, MUAMIR A.
BSN-4A
WHAT IS MALARIA
• A vector-borne infectious disease caused by protozoan
parasites.
• The term MALARIA originates from MEDIEVAL ITALIAN: MALA
ARIA – “BAD AIR”; and the disease was formerly called
ague or marsh fever due to its association with swamps.
• It is widespread in tropical and subtropical regions,
including parts of the Americas, Asia, and Africa.
• Historical records suggest malaria has infected humans
since the beginning of mankind.
• It has been infected humans for over 50,000 years, and
may have been a human pathogen for the entire history
of our species.
1880
 A French army doctor
working in the military
hospital of Constantine
Algeria named Charles
Louise Alphonse Laveran
observed parasites for the
first time, inside the red
blood cells of people
suffering from malaria. He
therefore proposed that
malaria was caused by this
protozoan, the first time
protozoa were identified
as causing disease.
1884
 Ettore Marchiafava and
Angelo Celli, while
studying wet blood
smears from malarious
patients with the new
oil-immersion lens,
looked at unstained
blood and saw an
active amoeboid ring
in the red blood
cells. They then
published this finding
and named it Plasmodium.
A year later
 Carlos Finlay, a Cuban
doctor treating patients
with yellow fever in
Havana, first suggested
that mosquitoes were
transmitting disease to
and from humans.

1898
 It was Britain's Sir
Ronald Ross working in
India who finally proved
in 1898 that malaria is
transmitted by mosquitoes
NORMAL ANATOMY AND
PHYSIOLOGY
Blood
is a specialized bodily fluid that delivers necessary substances to the
body's cells – such as nutrients and oxygen – and transports waste
products away from those same cells.In vertebrates, it is composed of
blood cells suspended in a liquid called blood plasma. Plasma, which
constitutes 55% of blood fluid, is mostly water (90% by volume), [1] and
contains dissolved proteins, glucose, mineral ions, hormones,
carbon dioxide (plasma being the main medium for excretory product
transportation), platelets and blood cells themselves. The blood cells
present in blood are mainly red blood cells (also called RBCs or
erythrocytes) and white blood cells, including leukocytes and platelets.
The most abundant cells in vertebrate blood are red blood cells. These
contain hemoglobin, an iron-containing protein, which facilitates
transportation of oxygen by reversibly binding to this respiratory gas
and greatly increasing its solubility in blood. In contrast, carbon
dioxide is almost entirely transported extracellularly dissolved in
plasma as bicarbonate ion.

Vertebrate blood is bright red when its hemoglobin is oxygenated. Some an

imals, such as
crustaceans and mollusks, use hemocyanin
to carry oxygen, instead of hemoglobin. Insects and some molluscs
use a fluid called hemolymph
instead of blood, the difference being that hemolymph
is not contained in a closed circulatory system
. In most insects, this "blood" does not contain oxygen-carrying molecule
s such as hemoglobin because their bodies are small enough for their
tracheal system to suffice for supplying oxygen.
Jawed vertebrates have an adaptive immune system
, based largely on white blood cells
. White blood cells help to resist infections and parasites.
Platelets are important in the clotting of blood.[2]
Arthropods, using hemolymph, have hemocytes as part of their
immune system.

Blood is circulated around the body through blood vessels

by the pumping action of the heart. In animals with lungs,
arterial
blood carries oxygen from inhaled air to the tissues of the
body, and
venous blood carries carbon dioxide, a waste product of
metabolism produced by cells, from the tissues to the lungs
to be exhaled.

Medical terms related to blood often begin with hemo- or hemato

- (also spelled haemo- and haemato-) from the Ancient Greek
word αἷμα (haima) for "blood". In terms of anatomy and
histology, blood is considered a specialized form of
connective tissue
, given its origin in the bones and the presence of potential
molecular fibers in the form of
fibrinogen.
 Functions
•Blood performs many important functions within the body
including:
•Supply of oxygen to tissues (bound to hemoglobin, which is
carried in red cells)
•Supply of nutrients such as glucose, amino acids, and
fatty acids (dissolved in the blood or bound to
plasma proteins (e.g., blood lipids)
•Removal of waste such as carbon dioxide, urea, and
lactic acid
•Immunological functions, including circulation of
white blood cells, and detection of foreign material by
antibodies
•Coagulation, which is one part of the body's self-repair
mechanism (the act of blood clotting when one gets cut to
stop the bleeding.)
•Messenger functions, including the transport of hormones
and the signaling of tissue damage
•Regulation of body pH
•Regulation of core body temperature
•Hydraulic functions
Constituents of human blood

Blood accounts for 8% of the human body weight, [3] with an

average density of approximately 1060 kg/m3, very close to
pure water's density of 1000 kg/m3.[4] The average adult has
a blood volume of roughly 5 liters (1.3 gal), composed of
plasma and several kinds of cells (occasionally called
corpuscles); these formed elements of the blood are
erythrocytes (red blood cells), leukocytes (white blood cells
), and thrombocytes (platelets). By volume, the red blood
cells constitute about 45% of whole blood, the plasma about
54.3%, and white cells about 0.7%.

Whole blood (plasma and cells) exhibits non-Newtonian fluid

dynamics; its flow properties are adapted to flow effectively
through tiny capillary blood vessels with less resistance
than plasma by itself. In addition, if all human hemoglobin
were free in the plasma rather than being contained in RBCs,
the circulatory fluid would be too viscous for the
cardiovascular system to function effectively.
 Constituents of human blood

Parameter Value

Hematocrit 45 ± 7 (38–52%) for males

42 ± 5 (37–47%) for
females
pH 7.35–7.45

base excess −3 to +3

PO2 10–13 kPa (80–100 mm Hg)

PCO2 4.8–5.8 kPa (35–45 mm Hg)

HCO3− 21–27 Mm

Oxygen saturation Oxygenated: 98–99%

Deoxygenated: 75%
Cells

 4.7 to 6.1 million (male), 4.2 to 5.4 million (female)

erythrocytes:[5] In most mammals, mature red blood cells
lack a nucleus and organelles. They contain the blood's
hemoglobin and distribute oxygen. The red blood cells
(together with endothelial vessel cells and other cells)
are also marked by glycoproteins that define the
different blood types. The proportion of blood occupied
by red blood cells is referred to as the hematocrit, and
is normally about 45%. The combined surface area of all
red blood cells of the human body would be roughly 2,000
times as great as the body's exterior surface.[6]
 4,000–11,000 leukocytes:[7] White blood cells are part of
the immune system; they destroy and remove old or
aberrant cells and cellular debris, as well as attack
infectious agents (pathogens) and foreign substances. The
cancer of leukocytes is called leukemia.
 200,000–500,000 thrombocytes:[7] thrombocytes, also
called platelets, are responsible for blood clotting (
coagulation). They change fibrinogen into fibrin. This
fibrin creates a mesh onto which red blood cells collect
and clot, which then stops more blood from leaving the
body and also helps to prevent bacteria from entering the
body.
Plasma
About 55% of whole blood is blood plasma, a fluid that
is the blood's liquid medium, which by itself is straw-yellow
in color. The blood plasma volume totals of 2.7–3.0 litres
(2.8–3.2 quarts) in an average human. It is essentially an
aqueous solution containing 92% water, 8% blood plasma
proteins, and trace amounts of other materials. Plasma
circulates dissolved nutrients, such as glucose, amino acids,
and fatty acids (dissolved in the blood or bound to plasma
proteins), and removes waste products, such as carbon dioxide
, urea, and lactic acid.

Other important components include:

 Serum albumin
 Blood-clotting factors (to facilitate coagulation)
 Immunoglobulins (antibodies)
 lipoprotein particles
 Various other proteins
 Various electrolytes (mainly sodium and chloride)
 The term serum refers to plasma from which the clotting
proteins have been removed. Most of the proteins remaining
are albumin and immunoglobulins.
Narrow range of pH values

 Blood pH is regulated to stay within the narrow range

of 7.35 to 7.45, making it slightly alkaline.[8][9]
Blood that has a pH below 7.35 is too acidic, whereas
blood pH above 7.45 is too alkaline. Blood pH,
partial pressure of oxygen (pO2), partial pressure of
carbon dioxide (pCO2), and HCO3 are carefully
regulated by a number of homeostatic mechanisms, which
exert their influence principally through the
respiratory system and the urinary system in order to
control the acid-base balance and respiration. An
arterial blood gas will measure these. Plasma also
circulates hormones transmitting their messages to
various tissues. The list of normal reference ranges
for various blood electrolytes is extensive.

 Bones are especially affected by blood pH as they tend

to be used as a mineral source for pH buffering.
Consuming a high ratio of animal protein to vegetable
protein is implicated in bone loss in women.[
Blood in non-human vertebrates

 Human blood is typical of that of mammals,

although the precise details concerning cell
numbers, size, protein structure, and so on, vary
somewhat between species. In non-mammalian
vertebrates, however, there are some key
differences:[11]
 Red blood cells of non-mammalian vertebrates are
flattened and ovoid in form, and retain their
cell nuclei
 There is considerable variation in the types and
proportions of white blood cells; for example,
acidophils are generally more common than in
humans
 Platelets are unique to mammals; in other
vertebrates, small, nucleated, spindle cells are
responsible for blood clotting instead
Physiology

 Cardiovascular system

 Blood is circulated around the body through blood vessels

by the pumping action of the heart. In humans, blood is
pumped from the strong left ventricle of the heart through
arteries to peripheral tissues and returns to the right
atrium of the heart through veins. It then enters the
right ventricle and is pumped through the pulmonary artery
to the lungs and returns to the left atrium through the
pulmonary veins. Blood then enters the left ventricle to
be circulated again. Arterial blood carries oxygen from
inhaled air to all of the cells of the body, and
venous blood carries carbon dioxide, a waste product of
metabolism by cells, to the lungs to be exhaled. However,
one exception includes pulmonary arteries, which contain
the most deoxygenated blood in the body, while the
pulmonary veins contain oxygenated blood.
 Additional return flow may be generated by the movement of
skeletal muscles, which can compress veins and push blood
through the valves in veins toward the right atrium.
 The blood circulation was famously described by
William Harvey in 1628
Production and degradation of blood cells

 In vertebrates, the various cells of blood are made in

the bone marrow in a process called hematopoiesis,
which includes erythropoiesis, the production of red
blood cells; and myelopoiesis, the production of white
blood cells and platelets. During childhood, almost
every human bone produces red blood cells; as adults,
red blood cell production is limited to the larger
bones: the bodies of the vertebrae, the breastbone
(sternum), the ribcage, the pelvic bones, and the bones
of the upper arms and legs. In addition, during
childhood, the thymus gland, found in the mediastinum,
is an important source of lymphocytes.[13] The
proteinaceous component of blood (including clotting
proteins) is produced predominantly by the liver, while
hormones are produced by the endocrine glands and the
watery fraction is regulated by the hypothalamus and
maintained by the kidney.
 Healthy erythrocytes have a plasma life of about 120
days before they are degraded by the spleen, and the
Kupffer cells in the liver. The liver also clears some
proteins, lipids, and amino acids. The kidney actively
secretes waste products into the urine.
Oxygen transport

 About 98.5% of the oxygen in a sample of arterial blood

in a healthy human breathing air at sea-level pressure is
chemically combined with the Hgb. About 1.5% is
physically dissolved in the other blood liquids and not
connected to Hgb. The hemoglobin molecule is the primary
transporter of oxygen in mammals and many other species
(for exceptions, see below). Hemoglobin has an oxygen
binding capacity of between 1.36 and 1.37 ml O2 per gram
Hemoglobin,[14] which increases the total
blood oxygen capacity seventyfold,[15] compared to if
oxygen solely was carried by its solubility of 0.03 mL O2
per litre blood per mmHg partial pressure of oxygen
(approximately 100 mmHg in arteries).[15]
 With the exception of pulmonary and umbilical arteries
and their corresponding veins, arteries carry oxygenated
blood away from the heart and deliver it to the body via
arterioles and capillaries, where the oxygen is consumed;
afterwards, venules, and veins carry deoxygenated blood
back to the heart.
 Under normal conditions in humans at rest,
hemoglobin in blood leaving the lungs is about 98–
99% saturated with oxygen. In a healthy adult at
rest, deoxygenated blood returning to the lungs is
still approximately 75% saturated.[16][17]
Increased oxygen consumption during sustained
exercise reduces the oxygen saturation of venous
blood, which can reach less than 15% in a trained
athlete; although breathing rate and blood flow
increase to compensate, oxygen saturation in
arterial blood can drop to 95% or less under these
conditions.[18] Oxygen saturation this low is
considered dangerous in an individual at rest (for
instance, during surgery under anesthesia.
Sustained hypoxia (oxygenation of less than 90%),
is dangerous to health, and severe hypoxia
(saturations of less than 30%) may be rapidly
fatal.[19]
 A fetus, receiving oxygen via the placenta, is
exposed to much lower oxygen pressures (about 21%
of the level found in an adult's lungs), and, so,
fetuses produce another form of hemoglobin with a
much higher affinity for oxygen (hemoglobin F) in
order to function under these conditions
Carbon dioxide transport

 When blood flows through capillaries, carbon dioxide diffuses

from the tissues into the blood. Some carbon dioxide is
dissolved in the blood. A part of CO2 reacts with hemoglobin
and other proteins to form carbamino compounds. The remaining
carbon dioxide is converted to bicarbonate and hydrogen ions
through the action of RBC carbonic anhydrase. Most carbon
dioxide is transported through the blood in the form of
bicarbonate ions.
 Carbon dioxide (CO2), the main cellular waste product is
carried in blood mainly dissolved in plasma, in equilibrium
with bicarbonate (HCO3-) and carbonic acid (H2CO3). 86–90% of
CO2 in the body is converted into carbonic acid, which can
quickly turn into bicarbonate, the chemical equilibrium being
important in the pH buffering of plasma.[21] Blood pH is kept
in a narrow range (pH between 7.35 and 7.45
 Transport of hydrogen ions
 Some oxyhemoglobin loses oxygen and becomes deoxyhemoglobin.
Deoxyhemoglobin binds most of the hydrogen ions as it has a
much greater affinity for more hydrogen than does
oxyhemoglobin.Lymphatic system
 In mammals, blood is in equilibrium with lymph, which is
continuously formed in tissues from blood by capillary
ultrafiltration. Lymph is collected by a system of small
lymphatic vessels and directed to the thoracic duct, which
drains into the left subclavian vein where lymph rejoins the
systemic blood circulation.
Thermoregulation

 Blood circulation transports heat throughout the body,

and adjustments to this flow are an important part of
thermoregulation. Increasing blood flow to the surface
(e.g., during warm weather or strenuous exercise)
causes warmer skin, resulting in faster heat loss. In
contrast, when the external temperature is low, blood
flow to the extremities and surface of the skin is
reduced and to prevent heat loss and is circulated to
the important organs of the body,
preferentially.Hydraulic functions
 The restriction of blood flow can also be used in
specialized tissues to cause engorgement, resulting in
an erection of that tissue; examples are the
erectile tissue in the penis and clitoris.
 Another example of a hydraulic function is the
jumping spider, in which blood forced into the legs
under pressure causes them to straighten for a
powerful jump, without the need for bulky muscular
legs
Color

 Hemoglobin

Hemoglobin is the principal determinant of the color of blood

in vertebrates. Each molecule has four heme groups, and their
interaction with various molecules alters the exact color. In
vertebrates and other hemoglobin-using creatures, arterial
blood and capillary blood are bright red, as oxygen imparts a
strong red color to the heme group. Deoxygenated blood is a
darker shade of red; this is present in veins, and can be seen
during blood donation and when venous blood samples are taken.
Blood in carbon monoxide poisoning is bright red, because
carbon monoxide causes the formation of carboxyhemoglobin. In
cyanide poisoning, the body cannot utilize oxygen, so the
venous blood remains oxygenated, increasing the redness. While
hemoglobin-containing blood is never blue, there are several
conditions and diseases wherein the color of the heme groups
make the skin appear blue. If the heme is oxidized,
methaemoglobin, which is more brownish and cannot transport
oxygen, is formed. In the rare condition sulfhemoglobinemia,
arterial hemoglobin is partially oxygenated, and appears dark
red with a bluish hue (cyanosis).
 Veins in the skin appear blue for a variety of reasons only
weakly dependent on the color of the blood. Light scattering in
the skin, and the visual processing of color play roles as
well.[23]
 Skinks in the genus Prasinohaema have green blood due to a
buildup of the waste product biliverdin.
 Hemocyanin

The blood of most mollusks – including

cephalopods and gastropods – as well as some
arthropods, such as horseshoe crabs, is blue, as
it contains the copper-containing protein
hemocyanin at concentrations of about 50 grams
per litre.[25] Hemocyanin is colorless when
deoxygenated and dark blue when oxygenated. The
blood in the circulation of these creatures,
which generally live in cold environments with
low oxygen tensions, is grey-white to pale
yellow,[25] and it turns dark blue when exposed
to the oxygen in the air, as seen when they
bleed.[25] This is due to change in color of
hemocyanin when it is oxidized.[25] Hemocyanin
carries oxygen in extracellular fluid, which is
in contrast to the intracellular oxygen transport
in mammals by hemoglobin in RBCs.[25]
ETIOLOGY

• Malaria is caused by protozoan parasites of the

genus Plasmodium (phylum apicomplexa).
• There are several species of Plasmodium
Parasites but only four of them are significant
to the cause of malaria diseases to humans. Some
of these are in to animals. Like birds,reptiles,
monkeys, chimpanzees, and rodents.
 PATHOPHYSIOLOGY

A female Anopheles mosquito bites, injecting saliva containing sporozoites,

the infective form of malaria parasite.

The sporozoites enter the liver and multiply

In the liver, the sporozoites change into merozoites,

another form of the parasite.
 Merozoites are released from the liver and
enter the bloodstream.

Merozoites attack Red Blood Cells.

Red Blood cells burst and release the merozoites

which invade other red blood cells
and cause recurring chills and fever.
(At this point the infected person becomes a reservoir of malaria that infects
any mosquito that feeds on him.)
PLASMODIUM
FALCIPARUM

PLASMODIUM
VIVAX
• P. Vivax is the most common
cause of infection, responsible
for about 80% of all malaria
cases.
PLASMODIUM
MALARIAE • However, P. Falciparum is the
most important cause of disease,
and responsible for about 15% of
infections and 90% of deaths.

PLASMODIUM
OVALE
 The Parasite’s primary hosts and
transmission vectors are female
mosquitoes of the Anopheles genus.

 The disease is transmitted to

humans when an infected Anopheles
mosquito bites a person and injects
the malaria parasites (sporozoites)
into the blood.
 Mosquito injects the  Sporozoites enter the liver
infective plasmodial cells, and transform into
sporozoites. merozoites which penetrate RBC.

 Once in RBC,
merozoites reproduce
rapidly, producing
many more
merozoites, which
burst out of the RBC
& penetrate new
cells.
 Some of these
merozoites form male
& female
gametocytes, which
can be picked up by
another mosquito.
 Inside the gut of
the mosquito,
gametocytes will
 The zygote then develops into an fertilize creating
 Ready for
oocyst and ruptures to release
another cycle. zygote.
thousands of sporozoites.
  Only female mosquitoes feed on
blood, thus males do not
transmit the disease. The
females of the Anopheles genus
of mosquito prefer to feed at
night. They usually start
searching for a meal at dusk,
and will continue throughout
the night until taking a meal.
 Malaria parasites can also be
transmitted by blood
transfusion, although this is
rare.
 SIGNS & SYMPTOMS
 The symptoms characteristic of malaria include
flu-like illness with fever, chills, muscle
aches, joint pain (athralgia), vomiting, anemia
caused by hemolysis, hemoglobinuria, convulsions,
and headache.
 The classical symptom of malaria is cyclical
occurrence of sudden coldness followed by rigor
and then fever and sweating lasting four to six
hours, occurring every two days in P. vivax and
P. ovale infections, while every three for P.
malariae. P. falciparum can have recurrent fever
every 36-48 hours or a less pronounced and almost
continuous fever.
 People with severe P.
falciparum malaria can develop
bleeding problems, shock,
liver or kidney failure,
central nervous system
problems, coma, and can die
from the infection or its
complications.

 Cerebral malaria (coma, or

altered mental status or
seizures) can occur with
severe P. falciparum
infection. It is lethal if not
treated quickly; even with
treatment, about 15%-20% die.
INCUBATION PERIOD

 The period between the mosquito bite and the onset of the
malarial illness is usually one to three weeks (seven to
21 days). This initial time period is highly variable as
reports suggest that the range of incubation periods may
range from four days to one year.
 The usual incubation period may be increased when a person
has taken an inadequate course of malaria prevention
medications.
 Certain types of malaria (P. vivax and P. ovale) parasites
can also take much longer, as long as eight to 10 months,
to cause symptoms. These parasites remain dormant
(inactive or hibernating) in the liver cells during this
time. Unfortunately, some of these dormant parasites can
remain even after a patient recovers from malaria, so the
patient can get sick again. This situation is termed
relapsing malaria.
TREATMENT
 Malaria can be a severe, potentially fatal disease
(especially when caused by P. Falciparum) and
treatment should be initiated as soon as possible.
 The Word Health Organization recommends that those
in endemic areas, treatment should be started
within 24 hours after the first symptoms appear.
Treatment of patients with uncomplicated malaria
can be conducted on an ambulatory basis (without
hospitalization) but patients with severe malaria
should be hospitalized if possible.
 In areas where malaria is not endemic, all patients
with malaria (uncomplicated or severe) should be
kept under clinical observation if possible.
 Drug Treatment
 The first effective treatment for malaria
was the bark of cinchona tree, which
contains QUININE. It was first used by the
inhabitants of Peru, where these trees
mainly grow.
 Today, there are several antimalarial
drugs available for treatment:
 Chloroquine
 sulfadoxine-pyrimethamine (Fansidar®)
 mefloquine (Lariam®)
 atovaquone-proguanil (Malarone®)
 quinine
 doxycycline
 artemisin derivatives
 primaquine
 But, drug treatment of malaria is not
always easy. You have to consider some
factors in treating different conditions
of patients having malaria.
There are three main factors in determining
treatment
1. The infecting species of Plasmodium parasites.
 Different species of Plasmodium parasites may vary in
treating patients.
2. The clinical situation of the patient.
 Mild malaria can be treated with oral medication.
 Severe malaria (having one or more symptoms of either
coma, severe anemia, renal failure, shock, etc.)
requires intravenous (IV) drug treatment and fluids.
 Malaria may pose a serious threat to a pregnant women
and her pregnancy. Infection may be more severe than
those women who are not pregnant.
3. The drug susceptibility of the infecting parasites.
 Determined by the geographic area where the infection
was acquired.
 Different areas of the world have malaria types that
are resistant to certain medications.
 Correct drug must be prescribed by the doctor who is
familiar with malaria treatment protocol.
PUBLIC HEALTH PREVENTION
& NURSING MANAGEMENTS
MALARIA CONTROL
 The goal of malaria control in
malaria-endemic countries is to reduce
as much as possible the health impact
of malaria on a population, using the
resources available, and taking into
account other health priorities.
 Malaria control does not aim to
eliminate malaria totally. Complete
elimination of the malaria parasite
(and thus the disease) would
constitute eradication. While
eradication is more desirable, it is
not currently a realistic goal for
most of the countries where malaria
is endemic.
 Malaria control is carried out through the following
interventions, which are often combined:

 Case Management (diagnosis and treatment) of patients

suffering from malaria.
 Persons who are sick should be treated promptly
and correctly. It eliminates an essential
component of the cycle (the parasite) and thus
interrupts the transmission cycle.
 WHO recommends that anyone suspected of having
malaria should receive diagnosis and treatment
with an effective drug within 24 hours of the
onset of symptoms.
 Prevention of Infection through vector control.
 Infection is prevented when malaria-carrying
Anopheles mosquitoes are prevented from
biting humans.
 Vector control aims to reduce contacts
between mosquitoes and humans.
 Some vector control measures like
(destruction of larval breeding sites,
insecticide spraying inside houses) may
require organized teams and resources that
are not always available.
 Insecticide-treated bed nets could also be an
alternative in vector control and personal
protection. It could be conducted by the
community themselves and become a major
intervention in malaria control.
 Prevention of Disease by administration of
antimalarial drugs to particularly vulnerable
population groups such as pregnant women and
infants.
 Administration of antimalarial drugs to
vulnerable population groups does not prevent
infection, which happens through mosquito
bites. But drugs can prevent disease by
eliminating the parasites that are in the
blood, which are the forms that cause disease.
 Pregnant women are the vulnerable group most
frequently targeted. They may receive, for
example, "intermittent preventive treatment"
(IPT) with antimalarial drugs given most often
at antenatal consultations during the second
and third trimesters of pregnancy.
MALARIA IN THE
PHILIPPINES
PHILIPPINE SCENARIO

The Philippines is one of the Southeast Asian

countries plagued with malaria. Although the country
does not contribute significantly to the global
mortality attributed to malaria, the disease remains
to be a major cause of “healthy days of life lost”
(HDLL) in the endemic areas of the country. Malaria
affects the socioeconomic well-being of the affected
population, and the different socioeconomic
activities affect transmission, prevention, and
control of the disease. Thus, this situation not only
generates an enormous economic, social and health
burden to these people per se, but also poses a huge
and persistent challenge to the health deliverers of
the Malaria Control Program.
MALARIA AS A HEALTH PROBLEM
 It is the eighth leading cause of morbidity in the
Philippines. (HIS 2000)
 According to DOH Secretary Reynaldo Duque, “an
average of three Filipinos die daily due to malaria
despite the government’s intensified efforts to
control the occurrence of the ailment”.
 Malaria has become a health threat.
 Although malaria endemicity is now generally moderate
to low, the disease continues to be a major
impediment to human and economic development in areas
where it persists
 This disease is still endemic in 65 of the 79
provinces in the country, and around 10 million
people who live in these areas are at risk of getting
the disease.
 Morbidity trend suggest that there might be a cause
and effect relationship between the activities which
aim to eradicate malaria and its incidence
 There is a decreasing number of deaths caused by
malaria
 Chloroquine, the cheapest medicine against malaria is
losing its effectiveness
Malaria as a Health Services Problem
 It poses challenges of access to health care for prompt
and effective treatment
 There are shortages of antimalarial drug supplies,
especially in peripheral health centers
 The disease still costs the Philippine economy to spend
over Php 100 million in order to sustain control
efforts
 Failures in treatment still occur despite the
preventability of malaria.
 Causes of Malaria Treatment Failure in the Philippines
 Drug resistance
 Non-compliance of patients in the treatment regimen
 Deficient drug absorption
 Self-medication
 Resorting to herbal remedies
 Seeking help when the disease is severe (Malaria is
fatal only when it is seen in its later stages.)

Epidemiology of malaria is complex, due to

 Variety of ecological conditions observed in different
island groups
 Occurrence of more than one vector species
Malaria Control Program of the Department of
Health

For 2007, The Department of Health has developed a malaria

control program as a measure to help eradicate the spread
of the disease. Some of the program strategies are:

1. Early diagnosis of the disease and prompt treatment.

This was achieved through:

 diagnostic centers which serve as cites of microscopy

 manning by a RDT (Rapid Diagnostic Test) trained
personnel
 promotion of the existence of diagnostic
centers                           
2. Controlling the spread of mosquitoes
This was achieved through:

 giving out insecticide-treated mosquito nets

 indoor spraying which targets houses and not only
communities 

3. Implementation of community-based malaria control

This was achieved through:

 social mobilization
 education sessions
JOURNALS Mosquito Nose Transplants Help Fight Malari
Main Category: Tropical Diseases
Also Included In: Biology / Biochemistry;  Aid / Disasters
Article Date: 16 Feb 2010 - 9:00 PDTIn .

a new approach to combating malaria, a disease that affects half a billion people worlwide, US
scientists successfully transplanted most of the "nose" of the disease-spreading Anopheles
mosquito into frogs' eggs and fruit flies so they could analyse the insect's odorant receptors and find
out how to lure it into traps and even prevent it being able to detect and thereby target humans.
You can read about the two studies by researchers from Yale University in New Haven,
Connecticut, and Vanderbilt University in Nashville, Tennessee, in a report in the 3rd February
online issue of the journal Nature and there is also a complementary article in the Proceedings of
the National Academy of Sciences, PNAS.
The mosquito Anopheles gambiae is the major route through which humans in sub-Saharan Africa
become infected with malaria. While we know that the insect uses its sense of smell to find human
hosts, we know little about the underlying molecular process.
A mosquito's "nose" is in its antennae which carry nerve cells covered with odorant receptors that
react to different chemical compounds in the insect's environment. These receptors are similar to
those that give us our senses of smell and taste in our nose and on our taste buds.
Co-author Dr Laurence Zwiebel, professor of biological sciences at Vanderbilt, told the press
that:"We've successfully expressed about 80 percent of the Anopheles mosquito's odorant
receptors in frog's eggs and in the fruit fly antennae."
Zwiebel's lab at Vanderbilt is where they successfully transplanted the receptors into
frogs' eggs. The transplant into fruit-fly (Drosophila melanogaster) eggs was done at
the laboratory of John Carlson, Eugene Higgins Professor of Molecular, Cellular and
Developmental Biology at Yale and is written up as a complementary study in PNAS.
Scientists have previously used frogs' eggs to study olfactory receptors in moths,
bees and fruit flies. For this study, the researchers injected DNA that codes for the
mosquito's olfactory receptors into a frog egg and waited for it to produce proteins.
Eventually the surface of the egg became covered with mosquito odorant receptors.
They then tested the engineered egg's reaction to being exposed to various odorant
chemicals. They floated the egg in a buffer solution in a voltage clamp (so they could
measure changes in the egg's electrical properties) and dissolved the chemicals one
by one in the solution. They detected a measurable electrical response in the egg.
Guirong Wang, lead author of the PNAS study, and a senior researcher in Zwiebel's
lab, said:"The frog egg system is relatively rapid, highly sensitive and allows us to do
very precise measurements of odorant response."
Wang, who personally conducted several thousand measurements of egg responses
to changes in odorant, described this method as a "medium throughput system",
because although they could set it up quite quickly, they had to make the odorant
solutions by hand, which took much longer.
Antioxidants May Help Prevent Malaria Complications That Damage Brain

Using an experimental mouse model for malaria , an international group of scientists has discovered that adding
antioxidant therapy to traditional antimalarial treatment may prevent long-lasting cognitive impairment in cerebral
malaria. Their findings were published online June 24, 2010, in the journal PLoS Pathogens.
Pathogens.
Malaria, an infection caused by parasites that invade liver and red blood cells, is transmitted to humans by the
female Anopheles mosquito. Malaria is one of the leading infectious diseases worldwide, affecting more than
400 million people and causing more than 2 million deaths each year, mainly among African children. Recently,
the U.S. Centers for Disease Control and Prevention (CDC) issued a report on 11 laboratory-confirmed cases of
malaria among U.S. emergency responders and those traveling in the United States from Haiti.
Cerebral malaria is a severe, potentially fatal neurologic complication of infection by the most-feared malarial
parasite, Plasmodium falciparum. Recent studies of children with cerebral malaria indicate that cognitive deficits,
which may impair memory, learning, language, and mathematical abilities, persist in many survivors even after
the infection itself is cured.
"Cerebral malaria and its molecular mechanisms are under intense study, but the cognitive dysfunction that can
persist in survivors in the aftermath of successful treatment has gone unrecognized until recently," says Guy A.
Zimmerman M.D., professor and associate chair for research in the University of Utah School of Medicine's
Department of Internal Medicine and a contributor to the study. "This complication may impose an enormous
social and economic burden because of the number of people at risk for severe malaria worldwide. Our findings
demonstrate that, by using experimental models of cerebral malaria in mice, we can explore mechanisms of
cognitive damage and also examine potential treatments for reducing or preventing neurologic and cognitive
impairment."
Zimmerman and colleagues in Brazil studied the persistence of cognitive damage in mice with documented
cerebral malaria after cure of the acute parasitic disease with chloroquine, an antimalarial therapy. By
administering a battery of behavioral tests to these mice, post-doctoral fellow Patricia Reis, Ph.D., determined
that impairment in memory skills was still present 30 days after the initial malaria infection. Cognitive deficits that
persist for years after the episode of cerebral malaria have also been reported in 11 percent to 28 percent of
children who survive the infection.
"Although we believe that long-term cognitive dysfunction after cerebral malaria is initiated by injury to the brain
during the initial period of untreated infection, it is possible that the mechanisms for persistent cognitive deficits
are independent of those that cause neurological injury and death during acute cerebral malaria," says
Zimmerman. "Future research is aimed at clarifying this point. However, we have been able to demonstrate that
oxidative stress is present in the brains of mice infected with cerebral malaria."
Malaria And Algae Linked To Common Ancestor By 'Little Brown Balls'

Unconspicuous "little brown balls" in the ocean have helped settle a long-standing debate
about the origin of malaria and the algae responsible for toxic red tides, according to a new
study by University of British Columbia researchers.
In an article published this week in the Proceedings of the National Academy of Sciences
Early Edition, UBC Botany Prof. Patrick Keeling describes the genome of Chromera and its
role in definitively linking the evolutionary histories of malaria and dinoflalgellate algae.
"Under the microscope, Chromera looks like boring little brown balls," says Keeling. "In fact,
the ocean is full of little brown and green balls and they're often overlooked in favour of more
glamorous organisms, but this one has proved to be more interesting than its flashier cousins."

First described in the journal Nature in 2008, Chromera is found as a symbiont inside corals.
Although it has a compartment - called a plastid - that carries out photosynthesis like other
algae and plants, Chromera is closely related to apicomplexan parasites - including malaria.
This discovery raised the possibility that Chromera may be a "missing link" between the two.
Now Keeling, along with PhD candidate Jan Janouskovec, postdoctoral fellow Ales Horak and
collaborators from the Czech Republic, has sequenced the plastid genome of Chromera and
found features that were passed down to both apicomplexan and dinoflagellate plastids,
linking the two lineages.
"These tiny organisms have a huge impact on humanity in very different ways," says Keeling.
"The tool used by dinoflagellates and Chromera to do good - symbiosis with corals - at some
point became an infection mechanism for apicomplexans like malaria to infect healthy cells.
"Resolving their evolutionary origins not only settles a long-standing scientific debate but could
ultimately provide crucial information for tackling diseases and environmental concerns."
~ end of presentation ~