MALARIA; THE BUDGET CONSUMER

Malaria illness is causing a lot of economical burden to many household in Nigeria and other African countries, according to Onwujekwe almost $12 billion annually is consumed by malaria treatment, it is also said to take 50% of household budget. The African continent shows the greatest effects of this disease, accounting for more than 90% of DALYs (Disability adjusted life Years) . Although the sequencing of the genomes of Homo sapiens Plasmodium falciparum and Anopheles gambiense raises some hope on elucidating the complex molecular mechanism of the disease.

MALARIA INFECTION;

Malaria is due to blood infection by protozoan parasites of the genus Plasmodium, which are transmitted from one human to another by female Anopheles mosquitoes. Four species of malaria parasite infect humans. "Benign tertian" fevers were so named because they were not associated with the severe and often fatal manifestations of the "subtertian, malignant" periodic fevers (P. falciparum). "Tertian" and "quartan" refers to their characteristic feature of an acute febrile episode, or paroxysm, that returns respectively every third (P. vivax) or fourth (P. malariae) Today,P. vivax and P. falciparum are the most commonly encountered malaria parasites. P. vivax is still found sporadically in some temperate regions, where in the past it was widely prevalent. It remains, however, very common throughout much of the tropics and subtropics. Because of the temperature limitations on its transmission by its mosquitoe vectors, P. falciparum is normally present only in tropical, subtropical, and warm temperate regions. In the tropics today, P. falciparum remains widely prevalent. The fourth human malaria parasite is Plasmodium ovale, which, like P. vivax, is the agent of a tertian malaria and which, also like P. vivax malaria today, carries a very low risk of fatal outcome. P. ovale has the most limited distribution of all the malaria parasites of humans. While it is prevalent throughout most of sub-Saharan Africa, it is otherwise known to be endemic only in New Guinea and the Philippines (Lysenko A. J. and A. E. Beljiev e 1969) The malaria parasites enter and leave the body through mosquito bites, When a mosquito bites a person it sucks up blood. If the person has malaria, some of the parasites in the blood will be sucked into the mosquito. Rarely is malaria transmitted through infected needles or blood transfusion.

·  The malaria parasites multiply and develop in the mosquito. After 10-14 days they are mature and ready to be passed on to someone else.

·  If the mosquito now bites a healthy person, the malaria parasites will enter the body of the healthy person. The parasites quickly enter the liver and mature into tissue schizonts.. Subsequently they release thousands of merozoites which invade the red cells, initiating the erythrocytic phase of the disease. In the red cells they again transform from ring stage to trophozoites and to schizonts which rupture and release more parasites to invade more red cells causing the cycles of fever and chills. Culminating in death or drug treatment. Some of the merozoites differetiate into gametocytes which can be ingested by a female Anopheline mosquito subsequently, resulting in an infective sporozoite. In Plasmodim falciparum, the deadliest of the parasites, the pattern of febrile illness is not synchronized. Infected erythrocytes are sequestered in microvasculature, and parasites appear in peripheral blood later in the day (Delley et. al.2002, Okonkwo et.. al 2004 Unpublished observation)

The symptoms, chronic and acute effects of malaria

There are chronic and acute effects from malaria infections. Acute effects include febrile illness and malaise and in severe cases will include hypoglycaemia, anaemia, respiratory distress, cerebral malaria and possibly death. Chronic effects include Anaemia, neurologic and cognitive deficits resulting in poor development and low school performance in children and poor and erratic leadership and followership.Indeed, European literature is replete with description of natives of malarious environments as lazy, irritable, ignorant unpredictable and prone to maniacal laughter, which probably fueled the racism of the first European visitors to Africa. Children with hemoglobin levels less than 11 gram percent (hematocrit < 33%) are at particular risk and those with hemoglobin levels less than 5 gram percent (hematocrit < 15%) require emergency attention. Crawley J, 2004..draws attention to the myriad causes and consequences of anemia, particularly iron deficiency and malarial anemia, and the need for careful monitoring of children for anemia starting within the first few months of life in areas of intense and stable malaria transmission; the highest prevalence of anemia occurs toward the end of the child’s first year. Awareness of common causes of anemia in Nigeria, such as maternal and childhood nutritional deficiencies (including micronutrients), intestinal helminths, HIV infection, hemoglobinopathies, and malaria, is important to manage patients and prevent the acceleration of severe consequences of, and death from, anemia. The malaria-specific interventions to prevent anemia are Insecticide Treated nets, chemoprophylaxis, and intermittent preventive treatment of pregnant women (IPT), and, possibly for infants (IPTi), and prompt effective treatment of infections. Deworming with mebendazole and albendazole, treatment of HIV/AIDS, including treatment of opportunistic infections, and selective use of iron, vitamin A, zinc, and complementary food supplements should be considered, and attention given to improved agricultural and eating practices. The negative effects of co-infection with HIV and malaria during pregnancy have now been shown definitively by ter Kuile and others 2004 in their review of 11 studies in Africa.pregnant women infected with HIV had "consistently more peripheral and placental malaria, higher parasite densities, and more febrile illnesses, severe anemia, and adverse birth outcomes (low birth weight, prematurity, intrauterine growth retardation) than HIV-uninfected women, particularly in multigravidae." Malaria in pregnancy was increased by 5.5% and 18.8% in populations with 10% and 40% HIV prevalence, respectively. Those pregnant women with malaria had a twofold higher HIV-1 viral concentration. Less clear is whether malaria increased mother-to-child transmission of HIV. These investigators urge more research on interactions between antiretroviral drugs, antimalarials, prophylaxis with cotrimoxazole for opportunistic infections, and IntermittentPreventiveTherapy, including attention to anemia and pharmacovigilance, while strengthening prevention measures for malaria and HIV during pregnancy. The association between malaria and undernutrition is complex, yet improved nutrition lessens the severity of malaria episodes and results in a decrease in malaria deaths. Deficiencies in vitamin A, zinc, iron, folate, and other micronutrients are responsible for a substantial proportion of malaria morbidity and mortality. Important evidence is accruing of the long-term neurocognitive impact of malaria following severe illness. Of 11 well-defined neurocognitive sequelae following malaria (ataxia, hemiparesis/monoparesis, severe motor deficit, dysphasia/dysarthria, behavioral difficulties, severe learning difficulties, visual impairment, hearing impairment, cognitive impairment, language impairment, and epilepsy), children with epilepsy and motor impairment are prone to an early death.