Southern African Development Community          (SADC) Malaria week (Part 1)

What is malaria?

According to Luo (2019), malaria is a life-threatening disease. It’s typically transmitted through the bite of an infected Anopheles mosquito and infected mosquitoes carry the Plasmodium parasite. When this mosquito bites a person, the parasite is released into the bloodstream.

Once the parasites are inside the body, they travel to the liver, where they mature. After several days, the mature parasites enter the bloodstream and begin to infect red blood cells. Within 48 to 72 hours, the parasites inside the red blood cells multiply, causing the infected cells to burst open. The parasites then continue to infect red blood cells, resulting in symptoms that occur in cycles that last two to three days at a time.

People with malaria often experience fever, chills, and flu-like illness and if left untreated, they may develop severe complications and die. In 2018, an estimated 228 million cases of malaria occurred worldwide, and 405 000 people died, mostly children in the African region. About 2 000 cases of malaria are diagnosed in the United States each year and the vast majority of cases in the United States are in travellers and immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa and South Asia  (CDC: https://www.cdc.gov/parasites/malaria/index.html. Accessed 6 October 2020).

Malaria is typically found in tropical and subtropical climates where the parasites can live. The World Health Organization (WHO) trusted source stated that, in 2016, there were an estimated 216 million cases of malaria in 91 countries. According to the Western Cape Government’s homepage, the annual malaria season starts and typically increases in the South African summer months from September until the end of May. The high-risk areas in South Africa include:

• The far north of KwaZulu-Natal Province bordering Mozambique
• The low-Veld areas of Mpumalanga Province including the Kruger National Park but excluding Nelspruit and White River
• The north-eastern parts of Limpopo Province

6 Key facts to know

• Malaria is preventable and curable.
• Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission.
• Malaria isn’t contagious and can’t be spread from person to person like a cold or the flu.
• Climate conditions influence transmission as it may affect the number and survival of mosquitoes, such as rainfall patterns, temperature, and humidity.
• A person’s immunity is a very important factor, especially if he/she lives in an area of moderate or intense transmission conditions.
• Transmission is more intense in places where the vector mosquito lifespan is longer and where the females of local vector species bite several times in one night. A vector is any agent (person, animal, or microorganism) that carries and transmits an infectious pathogen into another living organism – in this case, it’s the mosquito.
  (https://www.westerncape.gov.za/general -publication/key-facts-about-malaria. Accessed 6 October 2020).

Symptoms of malaria can develop in as quickly as 7 days after being bitten by an infected mosquito

Typically, the time between being infected and when symptoms start (incubation period) is 7 to 18 days,

depending on the specific parasite. However, in some cases, it can take up to a year for symptoms to develop.

The initial symptoms of malaria are flu-like and include:

• A high temperature of 38°C or above
• Feeling hot and shivery
• Headaches
• Vomiting
• Muscle pains
• Diarrhoea
• Generally feeling unwell

These symptoms are often mild and can sometimes be difficult to identify as malaria. With some types of malaria, the symptoms occur in 48-hour cycles. During these cycles, the person feels cold at first with shivering. He or she then develops a high temperature, accompanied by severe sweating and fatigue and these symptoms usually last between 6 and 12 hours.

The most serious type of malaria is caused by the Plasmodium falciparum parasite. Without prompt treatment, this type could lead to quickly developing severe and life-threatening complications, such as breathing problems and organ failure.

Prevention

There’s a significant risk of getting malaria when travelling to an affected area. It’s very important to take precautions to prevent the disease. Malaria can often be avoided using the ABCD approach to prevention, which stands for:

Awareness of risk – find out whether you’re at risk of getting malaria.

Bite prevention – use insect repellent, covering arms and legs, and using a mosquito net.

Check whether the need to take malaria prevention tablets – make sure to take the right antimalarial tablets at the right dose and finish the course.

Diagnosis – seek immediate medical advice if you are experiencing malaria symptoms, up to a year after your travels.

Preventing bites

It’s not possible to avoid mosquito bites completely, but the less you’re bitten, the less likely you are to get malaria.

To avoid being bitten:

• Stay somewhere that has effective air conditioning and screening on doors and windows. If this isn’t possible, make sure doors and windows close properly.
• When not sleeping in an air-conditioned room, sleep under an intact mosquito net that’s been treated with insecticide.
• Use insect repellent on your skin and in sleeping environments. Remember to reapply it frequently. The most effective repellents contain diethyltoluamide (DEET) and are available in sprays, roll-ons, sticks and creams.
• Wear light, loose-fitting trousers rather than shorts, and wear shirts with long sleeves. This is particularly important during early evening and at night, when mosquitoes prefer to feed.

There’s currently no vaccine available that offers protection against malaria, so it’s very important to take antimalarial medication to reduce your chances of getting the disease.

However, antimalarials only reduce the risk of infection by about 90%, so taking steps to avoid bites is also important. When taking antimalarial medication:

• Make sure to get the right antimalarial tablets before you go – check with your GP or pharmacist if you’re unsure.
• Follow the instructions included with your tablets carefully.
• Depending on the type you’re taking, continue to take your tablets for up to 4 weeks after returning from your trip to cover the incubation period of the disease.

The first part of his blog focused on malaria, how it is transmitted, and the clinical manifestations, while the latter part provided an account of preventative measures.

Part two will focus on the National Department of Health (NDOH) presentation of the Malaria Elimination Strategic Plan 2019-2023 for the Republic of South Africa. The strategy comes at an important time as the Southern African Development Community (SADC) heads of state have recently renewed the commitment to eliminate malaria in Botswana, Eswatini, Namibia and South Africa by 2020 and in the whole SADC region by 2030, with the target of zero local malaria cases and deaths (Malaria Elimination Strategic Plan 2019-2023 for the Republic of South Africa. Mkhize).

For the first time, we have the genetic sequences of all three of the players in the global malaria debacle: the parasite, the anopheles mosquito and the human. It’s a very important milestone (Anthony Fauci)