MALARIA IN GHANA

Anaclare Cobb, RN, BS, MSN, FNP

 

The World Health Organization (WHO) reports that malaria affects at least 85 countries in the world.  They estimate that in 2021, there were over 240 million cases of malaria, with 624,000 individuals succumbing to the illness worldwide.  Children are most affected by the illness, with the largest number of deaths being from the pediatric population.  Complete immunity to the disease does not occur, but children, who have had the least amount of exposure to the disease, are most vulnerable to the potential severity of the illness.

 

Malaria is transmitted by the female Anopheles mosquito.  It is caused by five species of the parasite Plasmodium, with P. falciparum being the most common in Ghana. P. falciparum also causes the most serious illness of the five species. The malaria parasite is transmitted to the human host when the person is bitten by the disease-carrying mosquito. It takes 7 to 30 days for the infected person to show signs of illness. Once introduced into the bloodstream, the parasites travel to the liver, where they grow, multiply and then travel to the red blood cells. There, the parasites continue to grow and eventually rupture through the red blood cells, leading to anemia for the host. Disease is caused by the sheer number of the parasites as they multiply.

 

Symptoms of malaria may vary, but are categorized as uncomplicated or severe.

 

UNCOMPLICATED

  •     Fever
  •     Chills/sensation of feeling cold
  •     Body aches
  •     Headache
  •     Nausea, vomiting and/or diarrhea.
  •     Weakness

 

     SEVERE

  •     All of the above
  •     Abdominal pain
  •     Impaired consciousness
  •     seizures
  •     abnormal behavior
  •     Anemia
  •     Respiratory distress
  •     Kidney disease
  •     Low blood sugar
  •     Jaundice
  •     Bleeding (nose, gingiva, bowels)

    

Symptoms of severe malaria are considered a medical emergency.  Medical care must be sought immediately.

 

Treatment is guided by whether the person has symptoms of uncomplicated or severe malaria.

Uncomplicated malaria is treated with oral antimalarial medications, antipyretics, and antiemetics. In Ghana, a combination of drugs is typically given for uncomplicated malaria:  artesunate and lumefantrine. These medications are generally well tolerated and are taken for a total of three days. Adults are given a standard dose of four tablets, twice a day. and a Children’s dosage will vary, depending on the child’s weight. Pregnant women in the first trimester may be treated with seven days of quinine and clindamycin. During the second and third trimesters of pregnancy, they are given artesunate and lumefantrine for uncomplicated malaria.

 

For cases of severe malaria, hospital treatment is essential.  An intravenous artemisinin derivative is given for at least 24 hours. Once stable, the person may be started on oral medications. Underlying complications such as anemia, respiratory distress, kidney injury and hypoglycemia are managed accordingly.

 

Women who are pregnant are more likely to experience severe malaria.  The malaria parasites attack the placenta, which can cause advanced anemia, low birth weight, premature labor and even fetal death.  Therefore, pregnant women must be treated more aggressively. The WHO recommends prophylactic antimalarial medications to be given at predetermined intervals throughout the pregnancy, along with discussions on home precautions to prevent mosquito bites.  These include, but are not limited to, the use of treated mosquito netting.

 

As the world battles the ravages of malaria, hope is on the horizon. In October 2021, the WHO released its position paper and recommendation for the RTS,S vaccine for children. The vaccine targets the malaria-causing parasite Plasmodium falciparum.  The WHO recommends a 4-5 series immunization schedule before the age of one. It is estimated that the vaccine will prevent tens of thousands of deaths each year. The WHO has initiated the RTS,S vaccine program in three counties: Ghana, Kenya and Malawi. Over 1.7 million doses have been given and the vaccine has proven to be safe and effective.

 

With continued advances, malaria may become a disease of the past. Until then, we must all be vigilant in maintaining preventive measures and seeking treatment with the onset of any potential symptoms.

 

Works Cited

 

World malaria report 2021. Geneva: World Health Organization; 2021. License: CC BY-NC-SA 3.0 IGO.

“Fact Sheet about Malaria.” World Health Organization, World Health Organization, 29 Mar. 2023, www.who.int/news-room/fact-sheets/detail/malaria.