2. 1. Management of malaria cases in the
community.
2. Active intervention to control/interrupt
malaria transmission with community
participation.

3.  Should be given first priority.
 Healthy guides and multipurpose workers are
fully trained to detect and treat malaria cases at
community level with support from referral
system.
 Govt have also established drug distribution
centres and fever depot all over the country.

4.  National Drug Policy on Malaria was first formulated
in 1982 and has subsequently been reviewed and
revised periodically.

5.  Emphasis on complete treatment in diagnosed
cases of malaria rather then one single dose
presumptive treatment to suspect the case of
malaria to avoid choloroquine resistance in
P.falciparum.
 The first line of treatment is choloroquine

6.  Providing complete cure (clinical and
parasitological) of malaria cases
 Prevention of progression of uncomplicated
malaria into severe malaria and thereby
reduce malaria mortality.
 Prevention of relapses by administration of
radical treatment
 Interruption of transmission of malaria by use
of gametocytocidal drugs
 Preventing development of drug resistance
by rational treatment of malaria cases.

8.  Avoid starting Rx on empty stomach.,
 1st dose given under observation.,
 Dose repeated if vomiting within 30 minutes
 Patient should report back if no improvement
after 48 hrs.
 Patient should be examined for concomitant
illness.

9.  All fever cases suspected to be malaria
should be investigated by microscopy or RDT

10.  All mixed infections should be treated with
full course of ACT and Primaquine 0.25 mg
per kg body weight daily for 14 days

11.  P.vivax cases should be treated with chloroquine
for three days and Primaquine for 14 days
 Chloroquine: 25 mg/kg body weight divided over
three days i.e. 10mg/kg on day 1, 10mg/kg on
day 2 and 5mg/kg on day 3.
 2. Primaquine: 0.25 mg/kg body weight daily for
14 days.

12.  Primaquine is used to prevent relapse.
 Contraindicated in pregnant women, infants
and individuals with G6PD deficiency

13.  Patients should be instructed to report back
in case of haematuria or high colored urine
/cyanosis or blue coloration of lips and
Primaquine should be stopped in such cases.
 Care should be taken in patients with
anaemia

14.  Chloroquine first drug of choice
 If chloroquine resistant, then Artesunate combined
therapy(ACT)
 ACT consists of Artesunate combined with a long
acting antimalarial like sulfadoxine and
pyrimethamine
 Artesunate 4 mg/kg body weight daily for 3 days
 Sulfadoxine (25 mg/kg body weight) – Pyrimethamine
(1.25 mg/kg body weight) on first day
 Primaquine 0.75 mg/Kg body weight on Day 2
 

15.  Patient resistant to ACT-quinine is drug of
choice.

17.  :-
a)impaired conciousness/coma
b)repeated generalized convulsions
c)renal failure(serum creatinine >3mg/dl)
d)jaundice(serum bilirubin >3mg/dl)
e)severe anaemia(Hb <5mg/dl)
f)pulmonary edema/ARDS
g)hypoglycaemia(plasma glucose<40mg/dl)
h)metabolic acidosis
i)circulatory shock(systolic BP<80mmHg)
j)abnormal bleeding and DIC
k)haemoglobinuria,hyperthermia
(temp>104degree F)&hyperparasitaemia

18.  Choice of antimalarial is quinine injection
 10mg/kg body wt.
 I.V drip in 5% dextrose saline to be runover 4hrs
 Total duration of treatment is of 7 days
 Injectable form of artemisinine derivatives
may be used for the management of the
sever complicated malaria in adult and non-
pregnant women only

19.  Artesunate
 2.4mg/kg bw
 IM or IV followed by 1.2mg/kg bw once daily for 4
days
 Total duration is 5 days
 Artemether
 1.6mg/kg bw
 IM followed by 1.6mg/kg bw daily for total 6
injection or twice for 3 days
 Artether
 150mg daily IM for 3 days
 Only for adult
 Artemisinine
 10mg/kg bw at 0 and 4 hours followed by 7mg/kg bw
at 24,36,48 and 60 hours

20.  Choloroquine has few side effects like nausea, vomiting,
blurring of vision and headache.
 Cases of retinal damage has been reported but only in a
person exposed to large cumulative dose over many years
 Choloroquine should not given to empty stomach.

21.  Symptoms may be of three types
 Plasmocid types
 Rare toxic manifestation involving the CNS
 Gastrointestinal
 Cramps,nausea and vomiting
 Cardiovascular
 Most serious toxic menifestation

22.  It is recommended for highly infected endemic
areas
 It is not recommended to children under 5 :
 Impossible to achieve continuous suppression in a
significant proportion of the population
 Interfere in the development of promotive immunity
 May accelerate devlopment of drugs resistance
 May increase the risk of retinopathy

23.  Chemoprophylaxis should be administered only in selective
groups in high P.falciparum endemic areas.
 This is recommended for travelers to endemic
areas,soldiers,police and labour forces working in endemic
areas
 Recommendations for dosing are:-
1)dose for children should be based on body weight
2)daily anti malarials should started the day before
travel(eg:-doxycycline)
3)weekly chloroquine started 1 week before arrival

24.  Doxycycline: 100 mg once daily for adults
and 1.5 mg/kg once daily for children
(contraindicated in children below 8 years).
 The drug should be started 2 days before
travel and continued for 4 weeks after
leaving the malarious area.

25.  Mefloquine: 250 mg weekly for adults and
should be administered two weeks
before, during and four weeks after
exposure.
 Mefloquine is contraindicated in individuals
with history of convulsions, neuropsychiatric
problems and cardiac conditions.
Therefore, necessary precautions should be
taken and all should undergo screening
before prescription of the drug

26. 1. Stratification of problem
Essential feature for planning and development
of a sound control strategy to maximise
utilization of available resources.
Provide guidelines as to which strategy could
be most suited.

27. Action For individual and
family protection
For community
protection
Reduction of human-
mosquito contact
Insecticide-treated
nets,repellants,protect
ive clothing,screening
of houses.
Insecticide-treated
nets
Zooprophylaxis
Destruction of adult
mosquitoes
Insecticide-treated
nets,indoor residual
spraying,space
spraying
Destruction of
mosquitoe larvae
Peri-domestic
sanitation
Larviciding of water
surfaces,intermittent
irrigation,sluicing
Source reduction Small scale drainage Environmental
sanitation,water
management,drainage
Social participation Motivation for personal
and family protection
Health
education,community
participation

28. 2. Vector control strategy
 Anti-adult measures
 Residual spray
 Spraying indoor surface of house with
DDT/malathion.
 Discontinuation lead to resurgence of malaria.
 Reduces the longevity of vector.
 Space application
 Major anti-epidemic measure
 Involves application of pestisidesin the form of fug
or mist using special equipments

29.  Individual protection
 Man-vector contact can be reduced by
 Using nets, protecting cloth, coils,
repellents,screening of houses.

30.  Anti-larval measure
Larvicides
 Oiling the collection of standing water or dusting them
with paris green effectively controlled malaria.
 Some moderm larvicides such as temephos which
confer long effect with low toxicity are more widely
used

31.  Source reduction
 Techniques to reduce mosquito breeding sites drainage or
filling.
 Deepening or flushing
 Management of water level
 Changing the salt content of water
 Intermittent irrigation

32.  Integrated control
 In order to reduce too much dependence
residual insecticides, increasing emphasis is
being put on integrated vector control
methodology which includes bio-environmental
and personal protection measure

33.  The Govt of every country affected by malaria has a
National control policy covering prevention and case
management
 Objectives are
 Ensure rapid cure of infection
 Reduce morbidity and mortality, including malarial
related anemia
 Prevent the progression of uncomplicated malaria into
severe disease
 Reduce the impact of malarial infection on the fetus
during pregnancy
 Reduce the reservoir infection
 Prevent the emergence and spreading of drug resistance
and prevent malaria in travellers

34.  Malaria control added impetus as initiative was
launched by WHO,UNICEF,UNDP and world bank
in 1998 .
Aim:-to reduce the Deaths and incidence To 75% by
2015.

35.  Vaccination against malaria is a burning issue
today
 Several vaccine candidates are now being
tested in africa, asia and US
 A vaccine developed in columbia (SPF 66)
advanced to phase 3 trials in africa but failed
to show efficacy in chiildren under 1
 Another vaccine (RTS, S/AS02) with the
potential to prevent infection and ameliorate
disease is being tested by GlaxoSmithKline
and the MVI at PATH in Phase I trial in
Gambia

36.  In phase II in 2002 trials of the vaccine are
being conducted among the children in
Mozambique, which suffers from year-round
malaria transmission offering a better
opportunity to evaluate vaccine performance
 This vaccine has been safely tested in adult
volunteeers in Belgium, Gambia, kenya and
US
 only potential malarial vaccine