Malaria is a serious and often fatal vector-borne disease. Despite the disease being both preventable and treatable, hundreds of thousands of people die annually due to malaria. In this final article of the series, key take-aways will be reiterated; to be shared with others.

The University of Pretoria Institute for Sustainable Malaria Control creates a platform for diverse experts to bring their unique skills and knowledge to the table and join forces to address malaria holistically.

Know your foe

Malaria is caused by Plasmodium parasites transmitted from one person to another through the bites of infected female Anopheles mosquitoes. Only female mosquitoes bite to obtain a blood meal for egg development.

When an infected mosquito bites a human, parasites are injected into the bloodstream. They travel to the liver, multiply, and mature. Re-entering the bloodstream, they infect red blood cells, where they multiply and damage the blood cells. This triggers an immune response, leading to the characteristic flu-like symptoms. The time from infection to onset is usually within 10 to 14 days.

Ambient humidity and temperature, influence malaria transmission. There is year-round risk of malaria in areas where Anopheles mosquitoes thrive, peaking in the rainy season with increased breeding sites. Despite global successes in reducing cases over the past decades, challenges like drug- and insecticide resistance, and climate change is helping malaria fight back. 

The A,B,C,Ds of malaria prevention

Malaria can be avoided. Understanding the causes, recognising common symptoms, and adopting effective prevention strategies are critical steps in the fight towards malaria elimination.

A is for AWARENESS (and symptoms)

Malaria symptoms can vary in severity, but the most common ones include:

• Fever: A high fever is often the first sign of malaria. It can be intermittent, coming and going in cycles, and is often accompanied by chills and sweating.
• Chills and sweating: Chills often accompany fever and may alternate with periods of intense heat, giving rise to intense sweating, which can lead to significant discomfort.
• Fatigue: Malaria can cause extreme tiredness and weakness, making it difficult for individuals to carry out their daily activities.
• Headaches: Many people with malaria experience severe headaches, which can be accompanied by nausea and vomiting.
• Muscle and joint pain: Malaria often leads to muscle and joint pain, which can be quite debilitating and contribute to the overall discomfort experienced by malaria sufferers.

Uncomplicated malaria displays mild flu-like symptoms, causing delayed treatment due to its resemblance to common illness. Severe symptoms include cerebral issues, anaemia, respiratory distress, organ dysfunction, coma, and death. Immunity may result in milder symptoms, while those without immunity face severe forms. Weakened immune systems, like in young children, pregnant women, elderly people, or travellers, heighten disease risk. Recognising symptoms is crucial for timely diagnosis and treatment.

B is for BITE PREVENTION

Prevention is better than cure. The first line of defence is protection against mosquito bites. Various strategies can be applied:

• Stay indoors at night: Avoid outdoor activities from dusk to dawn when Anopheles mosquitoes are most active. If possible, schedule daytime activities to reduce mosquito exposure.
• Personal bite protection: Using insect repellent properly applied to skin and clothing. Wearing long-sleeved shirts, long trousers, and shoes with socks can minimise mosquito exposure. Dark colours often attract mosquitoes.
• Bed net usage: In areas where malaria is prevalent, sleep under insecticide-treated bed nets to reduce the risk of bites. The installation of screens on windows and doors provides an effective means to prevent transmission.
• Mosquito repellent usage: Prevent mosquito bites by using anti-mosquito sprays, insecticide dispensers, and the burning of mosquito coils for continuous indoor protection at night. indoors.
• Eliminate mosquito breeding sites: Mosquitoes breed in stagnant water. Reducing mosquito breeding sites, such as stagnant water in containers, can help control mosquito populations.

If you are in a malaria area, take appropriate precautions to protect yourself.

C is for CHEMOPROPHYLAXIS
When traveling to malaria-endemic areas, consider taking antimalarial chemoprophylaxis for protection. Consult a healthcare provider for the best prophylaxis options based on health, destination, malaria species prevalence and anti-malarial drug resistance in the area, duration of stay, and personal factors. Correct and consistent use reduces severe malaria risk, though breakthrough infections may occur.

Prophylaxis doesn't mask symptoms but lessens disease severity and prevents complications and death. It does not guarantee 100% protection, but early symptoms are milder. To enhance protection, take precautions against mosquito bites and promptly seek medical attention for any malaria symptoms during or after a trip.

Pregnant women or those planning pregnancy are advised to avoid malaria-endemic areas due to increased severity and potential pregnancy risks. Similarly, it is recommended not to include young children under five in travels, as they are highly susceptible to malaria.

D is for DIAGNOSIS and rapid treatment

If malaria symptoms start, especially after recent travel to or residing in a malaria-endemic area, seek immediate medical attention. Inform healthcare providers of symptoms, travel history, and potential malaria exposure. Malaria diagnosis involves a combination of clinical assessments and laboratory tests.

Upon malaria confirmation, the healthcare provider will prescribe antimalarial medication based on factors like parasite species, drug resistance, and infection severity. Follow the instructions precisely and complete the full treatment course to ensure the removal of all parasites from the body. Prompt and accurate diagnosis and timely treatment can prevent severe complications and are vital for a full recovery while breaking the transmission cycle.

Malaria can cause considerable fatigue; therefore, prioritise rest, stay hydrated to manage fever, and report symptom changes to your healthcare provider. Maintain measures to prevent mosquito bites.

Research towards malaria elimination

Malaria elimination relies on thorough research to comprehend the complexity and evolving nature of the disease. Understanding vector and parasite biology guides the development and implementation of effective, evidence-based, and targeted interventions, optimising resource allocation.

Malaria research sets an example of the impact of collaborative, sustained efforts. It demonstrates that with strategic investments, relentless innovation, thoughtful implementation, and perseverance, humanity can ultimately conquer this formidable foe.

For more information, visit the webpage of the University of Pretoria Institute for Sustainable Malaria Control, a multi-disciplinary research institute making a substantial contribution towards the creation of a malaria-free Africa.

Read more from the Malaria 101 series