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Jessica Dawson
Dr. Arneson
Why Aren’t We Dead Yet GNED 150
December 11, 2012
Malaria and Health Education
Malaria is a deadly disease caused by parasites that are transmitted to people
through the bites of infected mosquitoes. The main symptoms of malaria include high
fevers, shaking chills, flu-like symptoms, and anemia1. The symptoms of malaria were
first recorded more than 4,000 years ago in ancient China. Malaria became widely
recognized in Greece by the 4th century B.C.E. and was responsible for multiple
population decreases in many city-states. Hippocrates even noted the main symptoms of
malaria. Numerous Roman writers thought that malaria was caused by exposure to
swamps. In 340 C.E. in China, Qinghao was used as a fever and pain reducer. The active
ingredient in Qinghao is artemisinin which is actually used today as an antimalarial drug.
Additionally, after Spanish missionaries arrived to the New World, they found
indigenous tribal medicine for malaria in Peru. The tribal medicine originated from the
Cinchona tree and contained the active ingredient, quinine. Quinine is still used in
antimalarial drugs today. In 1880, Charles Laveran, a French army surgeon, noticed
parasites in the blood of a patient with malaria. In 1886, Camillo Golgi, an Italian
neurophysiologist, discovered that there were different types of the disease where the
rates of fevers varied. Golgi noted that the different types of malaria depended on the
maturity and release into blood stream of new parasites known as merozoites. In 1890,
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Dugdale, David. Malaria. PubMed Health.
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the first two names for the malaria parasites were given as Plasmodium vivax and
Plasmodium malariae. In 1897, a British officer named Ronald Ross was the first person
to demonstrate that a mosquito could transmit the malaria parasite. The construction of
the Panama Canal from 1905 to 1910 was only made possible after the malaria was
controlled through an insect control program. DDT was used as a malaria control agent
to kill malaria-infected mosquitos but was banned in the U.S. in 1972. The Center of
Disease Control’s mission to combat malaria began in 1946 to reduce malaria
domestically and internationally. There have been eradication efforts by the World Health
Organization that have failed due to lack of funding and decreased community
participation2.
Malaria is transmitted to humans by female mosquitoes from the genus
Anopheles. Female mosquitoes preform blood meals as a means for egg production, and
those blood meals are the link between humans and the mosquito for the parasite’s life
cycle3. Malaria can also be transmitted from a mother to her unborn baby and by blood
transfusions. 4
Malaria is caused by a parasitic protozoan that belongs to the Plasmodium genus.
There are over 400 species belonging to the genus, but typically four specific species
cause malaria in humans: Plasmodium falciparum, Plasmodium vivax, Plasmodium
ovale, and Plasmodium malariae. Despite the genus similarities, each species exhibits
different biological behavior within the human and mosquito host. Additionally, these
species have variation based on their geographic location. P. falciparum is found in most
Center for Disease Control and Prevention. The History of Malaria, an Ancient Disease.
Center of Disease Control and Prevention. Anopheles Mosquitos. Malaria.
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Dugdale, David. Malaria. PubMed Health.
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tropical regions throughout the world and it is the most dangerous because of its lethality
and morbidity. Relapses cannot occur with P. falciparum. However, relapses from P.
vivax can occur due to a latency period, where the parasites in the infected hepatocytes
(liver cells) remain dormant. P. vivax is found in many sub-tropical areas and tropical
areas throughout the world. P. ovale is similar to P. vivax biologically, but it is
prominently located in West Africa. P. malariae is the least studied species of malaria
parasite because of it’s low prevalence and milder symptoms. It is found throughout subSaharan Africa, Southeast Asia, Indonesia, and South America5.
Approximately 3.3 billion people live in areas at risk of malaria transmission in
106 countries. According to the World Health Organization, malaria has caused in 2010
about 216 million clinical episodes and 655,000 deaths6. The vast majority of cases occur
in children under 5 years old because of their lack of immunity. Pregnant women are also
very vulnerable because their immunity is decreased. Although there have been efforts to
reduce the prevalence of malaria, there have been little change in which areas are at risk
for malaria since 1992.7 Malaria is presently considered an endemic in a broad band
around of the equator in the areas of the Americas, parts of Asia, and much of Africa.
About 85 to 90 percent of malaria fatalities occur in sub-Saharan Africa. The geographic
distribution of malaria within large areas is complex because often places with malaria
and place free of malaria will be found relatively close. In drier geographical areas,
White, Jason. Malaria. Medical Ecology
World Health Organization. Malaria: Key Facts. Malaria.
7 Pearson, Richard. Malaria. The Merck Manual.
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outbreaks can be predicted by mapping the amount of rainfall. Malaria is more common
in rural areas than cities due to the distribution of the mosquito vector. 8
All species of Plasmodium go through asexual and sexual reproduction. During
the asexual stage, the protozoan enters the bloodstream of the host through the bite of an
infected female anophelene mosquito. At this stage, the Plasmodium is spindle shaped
and motile and known as a sporozite. The sporozite travels through the bloodstream to
the liver, penetrates a liver cell called a hepatocyte, and undergoes asexual multiplication.
In the P. vivax and P. ovale species specifically, some sporozoites transform to into a
dormant sporozoite known as a hypnozoite. The latency stage with the hypnozoite can
last up to five years and is responsible for relapses when it re-enters its developmental
cycle. Then, depending if the parasite underwent a latency stage, it will enter a
developmental stage where the division occurs and thousands of new parasites known as
merozoites are created. Then the host liver cell containing these parasites bursts releasing
the parasites back into the blood steam. The merozoites can no longer enter the liver and
infect hepatocytes, so it must infect red blood cells in order to survive9.
The merozoites attach to red blood cells and digest hemoglobin. Anemia results
from the destruction of the red blood cells. There are also large amounts of free
hemoglobin that is released into circulation after the red blood cells break open. The free
hemoglobin accounts for the malarial pigment that is visible underneath a microscope10.
Plasmodia also sexually reproduce within the mosquito. Merozoites in the human
bloodstream differentiate into microgametocytes (male) and macrogametocytes (female)
World Health Organization. Malaria: Key Facts. Malaria.
White, Jason. Malaria. Medical Ecology
10 Pearson, Richard. Malaria. The Merck Manual.
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and are ingested by the mosquito. Within the mosquito’s stomach, haploid male gametes
fuse with female gametes to form a diploid zygote that becomes an ookinete. The
ookinete penetrates the mosquito’s stomach wall and turns into an oocyst. The oocyst
creates thousands of haploid sporozoites that make its way to the mosquitos salivary
glands. The mosquito’s next blood meal then is injected with the diploid sporozoites and
the cycle starts over again11.
Most symptoms of malaria are caused specifically by the release of merozoites
into the bloodstream, anemia caused by the destruction of red blood cells, and the free
hemoglobin that is released after the red blood cells lyse. The first symptoms occur 10
days to 4 weeks after infection from the mosquito. Additionally, symptoms can appear as
early as 8 days or as long as a year after infection. The symptoms occur in cycles of 48 to
72 hours. Symptoms of malaria include: anemia, bloody stools, chills, coma, convulsion,
fever, headache, jaundice, muscle pain, nausea, sweating, and vomiting. If infected
people do not receive treatment than ultimate complications that lead to death from
malaria include: brain infection (cerebritis), destruction of blood cells, kidney failure,
liver failure, meningitis, respiratory failure from fluid in the lungs, and rupture of the
spleen that leads to hemorrhaging12.
Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis of the
patient. A complete blood count can identify if anemia is present. Deciding what type of
medication to give a patient with malaria depends on the species of the infecting parasite,
the area where the infection was required, the clinical status of the patient, any
accompanying illness or condition, pregnancy, and drug allergies. With all those factors
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White, Jason. Malaria. Medical Ecology.
Dugdale, David. Malaria. PubMed Health.
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considered, drugs are typically used in treatment and can fight the disease causing
parasites in the blood. Some examples of drugs used are chloroquine, atovaquoneproguanil, artemether-lumefantrine, mefloquine, quinine, and quinidine. Additionally,
primaquine prevents relapses and is active against the dormant parasite liver types called
hypnozoites. The prognosis is expected to be good in most cases of malaria with
treatment, but poor in P. falciparum infections with complications due to its antibiotic
resistant properties.13
Most people that live in areas where malaria is prevalent have received some
types of immunity from the parasitic disease. An example of some immunity would be
the sickle cell trait where individuals are carriers for the sickle cell disease with one
sickle gene and one normal hemoglobin gene. Because of the protective advantage of the
sickle cell trait, it is expected that more people in a malaria endemic area would have the
sickle cell trait. Visitor to areas where malaria is common will not have immunity;
therefore preventive measures must be taken. The first step is to see a health provider
well in advance before the trip because malarial medication should be taken two weeks
before the trip and one month after the trip. The type of anti-malarial drug depends on the
area that the traveler visits. People that are taking anti-malarial medications can still
become infected.14 This is why visitors and people that are from an area where malaria is
common should wear protective clothing over the arms and legs, use screens or mosquito
nets, and use insect repellent to avoid mosquito bites. Insecticide-Treated bed nets and
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White, Jason. Malaria. Medical Ecology.
Center for Disease Control and Prevention. Choosing a Drug to Prevent Malaria.
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indoor residual spraying of insecticide are also beneficial preventive measures15. Another
really important of prevention is called intermittent preventive treatment of malaria in
pregnant women (IPTp). IPTp is a method that requires the administration of a
antimalarial drug to all pregnant women whether or not they are infected with malaria
starting the second trimester. This helps decrease the chance of malaria in the mother and
baby16.
This disease is very important public health issue due to the wide distribution and
high frequency of cases throughout the world. In many of the countries affected by
malaria, it is a leading cause of illness and death. The cost of malaria is enormous to
individuals, families, communities, and nations. When many people in a population are
affected with malaria than it results in higher health care costs for an entire society as
well17.
A very important aspect of public health that can be used to combat malaria is
health education. “Health education is any combination of learning experiences designed
to help individuals and communities improve their health, by increasing their knowledge
or influencing their attitudes”18. Health education can be preformed by a variety of
different methods. This information could be spread by religious leaders, mothers,
medical professionals, community leaders, school teachers, NGO’s such as the Red
Cross, health campaigns, media, and many more. A very important part of public health
is the prevention of the disease and illness. With knowledge comes the power to change
World Health Organization. Malaria: Key Facts. Malaria.
Center for Disease Control and Prevention. Intermittent Preventive Treatment of
Malaria
17 Center for Disease Control and Prevention. Malaria Worldwide.
18 World Health Organization. Health Education.
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one’s health, use preventative health measures, and make better life choices to ensure a
longer disease and illness free life. The impact of health education is normally decreased
mortality and morbidity rates throughout a population. With health education, the
aggregate health of a community could be greatly improved.
Health education can combat malaria by providing education to societies, nations,
and individuals on how to prevent malaria. Malaria can be preventable through
insecticide bug nets, bug sprays, and clothing that covers the arms and legs. By
distributing this information around through health education, the incidence of malaria
could be significantly decreased. Health education also addresses the dangers of DDT—a
once-commonly used pesticide used to kill malarial mosquitos—and encourages nations
to find alternative methods to deal with malaria such as insecticide bug nets. For
example, DDT is now illegal in the United States due to health education measures to
warn the public of the harmful effects it has to humans and the environment. DDT is still
used to day in some third world countries such as India to prevent malaria. If there was
more health education about the problems associated with DDT then there would be a
decrease in the spread of additional diseases and complications associated with DDT.
Health education also extends to governmental health education about the benefits of
investing in preventative measures such as free insecticide bug nets for citizens. A major
benefit of investing in preventative measures would be an overall decrease in the
aggregate health care costs to society. Subsequently, increased governmental education
and a cost break down of the amount of money saved from health care costs by investing
in preventative methods and research would help in the global effort to eradicate malaria.
In the past, a worldwide eradication effort was not possible because of the lack of
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monetary funding and transnational support. With health education, malarial eradication
could become a reality. In that particular example, health education is tied with health
economics, another aspect of public health. Health economics is concerned with the
issues related to scarcity in the allocation of health and health care. Because health
education and health economics are so intertwined in that example, it illustrates the
interdisciplinary nature of public health.
An additional example of health education would be encouraging all pregnant
women that live in areas with a high malarial incidence to get treated with the IDTp tests
(intermittent preventive treatment of malaria in pregnant women) to prevent acquiring
malaria and passing it on to the baby. This would be used to affect the spread of the
disease throughout a population. Health education could also be used to educate members
of a community where there is a high malarial incidence of the symptoms of malaria. By
educating people of the symptoms and the deadliness of the disease if they do not receive
medical care, helps people understand the urgency of acquiring immediate medical
assistance. Another example of health education would be the World Health
Organization’s Series on School Health: Malaria Prevention and Control that is translated
and sent to schools all over the world. Schools are a great method of spreading the word
through to children who will grow up with the malaria prevention knowledge19.
Prevention knowledge also helps to decrease the spread of malaria.
Public health principles can be used to decrease the incidence of the malaria.
There should be a health campaign for all travelers to countries where malaria is common
to see their health provider for malarial medication. This particular health campaign
World Health Organization. Malaria Prevention and Control: A Important
Responsibility of a Health-Promoting School.
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would target visitors rather than people that already live in places with a high malaria
incidence. Visitors are more at risk then indigenous people due to their lack of immunity.
The main reason why visitors acquire malaria is because of their lack of education of the
necessity of malarial medication20. As a part of the health campaign, airlines could send
out travel messages with the flight confirmation with health instructions when a traveler
buys a ticket to a place where malaria is prevalent. Additionally, most visitors need to
apply for a visa to visit some countries with high malaria prevalence. When people get
those visas, visa consulates could also distribute malaria health prevention instructions.
This also might help decrease the incidence of malaria for visitors that travel to malaria
prone geographical regions.
Research is another very important public health principle. Researching for new
insights and innovative solutions to health problems is one of the 10 essential public
health services. The research for more cost-effective prevention techniques would be
extremely beneficial in reducing the incidence of malaria. There are many organizations
all over the world that are currently trying to find new innovate solutions to
understanding malaria and solving the problems associated with it such as the World
Health Organization. Finding cost-effective quality medications can help decrease the
cost barrier to medication. By lowering the cost barrier to medication, more people have
access to malarial medication and prevention methods. The research of new malaria
solutions ultimately will bring down the incidence of malaria throughout the world.
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Center for Disease Control and Prevention. Choosing a Drug to Prevent Malaria.
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Works Cited
Center of Disease Control and Prevention. Anopheles Mosquitos. Malaria. 9 Nov 2012.
Web. 9 Dec 2012. <http://www.cdc.gov/malaria/about/biology/mosquitoes/>
Center for Disease Control and Prevention. Choosing a Drug to Prevent Malaria.
Malaria. 9 Nov 2012. Web. 9 Dec 2012.
<http://www.cdc.gov/malaria/malaria_worldwide/index.html>
Center for Disease Control and Prevention. Intermittent Preventive Treatment of Malaria
for Pregnant Women (IPTp). Malaria. 9 Nov 2012. Web. 9 Dec 2012.
<http://www.cdc.gov/malaria/malaria_worldwide/reduction/iptp.html>
Center for Disease Control and Prevention. Malaria Worldwide. Malaria. 9 Nov 2012.
Web. 9 Dec 2012. < http://www.cdc.gov/malaria/malaria_worldwide/index.html>
Center for Disease Control and Prevention. The History of Malaria, an Ancient Disease.
Malaria. 9 Nov 2012. Web. 9 Dec 2012.
<http://www.cdc.gov/malaria/about/history/>
Dugdale, David. Malaria. PubMed Health. 9 June 2011. Web. 9 Dec 2012.
<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001646/>
Pearson, Richard. Malaria. The Merck Manual. 2012. Web. 9 Dec 2012.
<http://www.merckmanuals.com/professional/infectious_diseases/extraintestinal_
protozoa/malaria.html>
White, Jason. Malaria. Medical Ecology. 2004. Web. 9 Dec 2012.
<http://www.medicalecology.org/diseases/malaria/malaria.htm>
World Health Organization. Health Education. 2012. Web. 9 Dec 2012.
<http://www.who.int/topics/health_education/en/>
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World Health Organization. Malaria: Key Facts. Malaria. Apr 2012. Web. 9 Dec 2012.
<http://www.who.int/mediacentre/factsheets/fs094/en/>
World Health Organization. Malaria Prevention and Control: A Important Responsibility
of a Health-Promoting School. 2007. Web. 9 Dec 2012.
<http://www.who.int/chp/topics/healthpromotion/MALARIA_FINAL.pdf>