Malaria

Why it is important ?

• Malaria is a serious disease spread through mosquito bites. The World Health Organization estimates that around 250 million malaria episodes occurred in 2006, resulting in nearly 1 million deaths. About 90 per cent of all malaria deaths occur in sub-Saharan Africa, most among children under age 5.
• Malaria is found in many regions of the world. In sub-Saharan Africa, it is a leading cause of death, illness, and poor growth and development among young children. It is estimated that a child dies of malaria every 30 seconds in this area.
• Malaria is particularly dangerous for pregnant women. Some 50 million pregnant women are exposed to malaria each year. Malaria during pregnancy contributes to nearly 20 per cent of low-birth weight babies in endemic areas, plus anaemia, stillbirth and even maternal deaths.
• Malaria is spread by the bite of an Anopheles mosquito. The mosquito transfers the malaria parasite, Plasmodium, from person to person. People get very sick with high fevers, diarrhoea, vomiting, headache, chills and flu-like illness. Especially in children, the disease can worsen rapidly, causing coma and death. Children under 5 years old are most susceptible to malaria because they have very little acquired immunity to resist it.
• Many lives can be saved by preventing malaria and treating it early. Children and their family members have the right to quality health care for prompt and effective treatment and malaria prevention.
• Governments, in collaboration with communities and non-governmental and community-based organizations, can minimize the number of malaria cases. They need to support preventive actions, such as distributing long-lasting insecticide-treated mosquito nets for families to sleep under.

What every family and community has a right to know ?

1. Malaria is transmitted through the bites of some mosquitoes. Sleeping under an insecticide-treated mosquito net is the best way to prevent mosquito bites.
2. Wherever malaria is present, children are in danger. A child with a fever should be examined immediately by a trained health worker and receive an appropriate antimalarial treatment as soon as possible if diagnosed with malaria. Artemisinin-based combination therapies (ACTs) are recommended by WHO for treatment of Plasmodium falciparum malaria. It is the most serious type of malaria and causes nearly all malaria deaths.
3. Malaria is very dangerous for pregnant women. Wherever malaria is common, they should prevent malaria by taking antimalarial tablets recommended by a trained health worker and by sleeping under an insecticide-treated mosquito net.
4. A child suffering or recovering from malaria needs plenty of liquids and foods.

Supporting information

Key Messages - Malaria is transmitted through the bites of some mosquitoes. Sleeping under an insecticide-treated mosquito net is the best way to prevent mosquito bites.

All members of the community should be protected against mosquito bites, particularly young children and pregnant women. Protection is needed after sunset and before sunrise, when malaria mosquitoes bite.

Long-lasting insecticide-treated mosquito nets last for at least three years and do not require re-treatment with insecticide. These nets are distributed by malaria control programmes and can be obtained through health facilities or during child health days or integrated campaigns. Most mosquito nets are distributed free of charge, especially to pregnant women and young children. They can also be purchased in the marketplace or through social marketing programmes, mainly in urban areas. In the few cases where untreated nets might still be in use, trained health workers can advise on safe insecticides and re-treatment.

Insecticide-treated mosquito nets should be used throughout the year, even when there are fewer mosquitoes, such as during the dry season.

Some countries operate programmes to spray the walls of houses with long-lasting insecticides to kill resting mosquitoes. Communities should cooperate with spray teams to ensure that all houses are sprayed.

In addition to using insecticide-treated mosquito nets, or if mosquito nets are not available or used, other actions can help, but they are not nearly as effective as using mosquito nets:

• Putting screens on doors and windows; these are mostly used in urban settings and are not very effective in traditional rural housing
• Using mosquito coils; these are used to repel but not kill mosquitoes – they have no lasting effect
• Wearing clothing that covers the arms and legs (long sleeves and long trousers or skirts); these can help reduce mosquito bites if worn when malaria mosquitoes are most active – from dusk until dawn.

Key Messages - Wherever malaria is present, children are in danger. A child with a fever should be examined immediately by a trained health worker and receive an appropriate antimalarial treatment as soon as possible if diagnosed with malaria.

Malaria should be suspected if anyone in the family has a fever, or if young children refuse to eat or have vomiting, diarrhoea, drowsiness or fits.

A child with a fever believed to be caused by malaria needs immediate antimalarial treatment as recommended by a trained health worker. If possible, the child should be tested with a Rapid Diagnostic Test (RDT) or microscopy (laboratory diagnosis involving the examination of the person's blood under a microscope) to confirm the malaria infection. RDTs are inexpensive and increasingly available.

If a child with a malarial fever is not treated within a day, she or he might die. ACTs are recommended by WHO for treatment of Plasmodium falciparum malaria. A trained health worker can advise on what type of ACT treatment is best and how long it should be taken in accordance with national guidelines.

Malaria usually causes a high fever and chills. A child with a high fever should be kept cool for as long as the fever persists by:

• Sponging or bathing the child with tepid water (cool, not cold)
• Providing treatment with antipyretics (medication that prevents or reduces fever), such as paracetemol or ibuprofen, but not aspirin.

Keeping the fever from going too high is important to prevent convulsions, which could lead to disabilities.

A child with malaria needs to take the full course of treatment, even if the fever disappears rapidly. If the treatment is not completed, the malaria could become more severe and difficult to cure. Incomplete treatment regimens can also lead to the development of drug resistance among people in the local area.

If the malaria symptoms continue after treatment, the child should be taken to a health centre or hospital. The problem may be:

• The child is not receiving enough medicine
• The child has an illness other than malaria
• The malaria is resistant to the medicine, and another medicine is needed.

Health-care providers have the responsibility to ensure that parents and caregivers are well informed about ways to prevent malaria and the best practices for caring for a child with malaria

Key Messages - Malaria is very dangerous for pregnant women. Wherever malaria is common, they should prevent malaria by taking antimalarial tablets recommended by a trained health worker and by sleeping under an insecticide-treated mosquito net.

• Pregnant women are more likely to suffer from malaria than other women. The disease is more dangerous during pregnancy, especially during the first pregnancy. This is due to changes in a woman's body that lower her previous level of resistance to malaria. Malaria can cause severe anaemia ('thin blood'), miscarriage, premature birth or stillbirth.
• Babies born to mothers who have had malaria during pregnancy are often underweight. This makes them more vulnerable to infection or death during their first year.
• Women in their first pregnancy in areas where malaria is prevalent often do not show the typical signs of malaria.
• As preventive treatment, pregnant women in malarial areas, especially those in their first pregnancy, who can be asymptomatic (without symptoms), should take antimalarial tablets in the second and third trimesters, as recommended by a trained health worker. The health worker will know which antimalarial tablets are best to take.
• It is also very important that pregnant women sleep under insecticide-treated mosquito nets.
• Pregnant women with signs and symptoms of Plasmodium falciparum malaria must be treated immediately by a trained health worker with quinine in the first trimester and ACTs in the second and third trimesters.

Key Messages - A child suffering or recovering from malaria needs plenty of liquids and food.

• A girl or boy suffering from malaria should be offered liquids and foods frequently to help prevent dehydration and malnutrition.
• Frequent breastfeeding prevents dehydration and helps the child fight infections, including malaria. Children who are breastfeeding and suffering from malaria should be breastfed as often as possible.
• Frequent malarial infection can cause anaemia. A child who has had malaria several times should be checked for anaemia.

Source: UNICEF