Prevention of malaria

Different levels of prevention for malaria.

1. Prevention Of Malaria:- Why so important? Aim: -Zero malaria cases – that is the aim of India’s National Vector Borne Disease Control Programme. Since 2000, the country has more than halved the number of malaria cases, down from 2 million to 882 000 in 2013. And, the trend is continuing. DR PIYUSH KUMAR M.B.B.S., E.M.O.C., PGDPHM (STUDENT). GENERAL MEDICAL OFFICER ADHAURA PHC KAIMUR DISTRICT ON DEPUTATION REFERRAL HOSPITAL RAMGARH KAIMUR DISTRICT BIHAR . BIHAR HEALTH SERVICES , GOVERNMENT OF BIHAR. MOBILE-[phone]/[phone] EMAIL [email protected]

2. Different Levels Of Prevention:- Primordial Prevention Primary Prevention Secondary Prevention Tertiary prevention

3. Primordial Prevention :- Societal & environmental determinants(Etiological Phase)*agent/host/environment Alter societal structure and thereby underlying determinants. Environmental factors such as the presence of bushes and stagnant water around homes, rainfall, low altitude and high temperatures favor the breeding of malaria vectors, as well as parasite reproduction within them. Alter these factors in order to discourage the multiplication of agent mosquito (anopheles). House type & design reduction of the contact between mosquitoes and humans :- destruction of larvae by environmental management and the use of larvicides or mosquito larvae predators, and destruction of adult mosquitoes by indoor residual spraying and insecticide-treated bed nets. Individual & mass education(discouraging harmful lifestyle ). biological control agent against mosquito larvae is the top water minnow or mosquito fish Gambusia affini. DDT , Malathion and different formulations of synthetic pyrethroids. is applied to the inside walls of homes to kill or repel mosquitoes. This intervention, called indoor residual spraying (IRS),

4. Primary Prevention:- Risk & Protective Factors (Etiological Phase) Alter exposure that leads to disease. Apply insect repellent to exposed skin. The recommended repellent contains 20-35% percent N,N-Diethyl-meta- toluamide (DEET ). Wear long-sleeved clothing and long pants if you are outdoors at night. Use a mosquito net over the bed if your bedroom is not air-conditioned or screened. . For additional protection, treat the mosquito net with the insecticide permethrin. Spray an insecticide or repellent on clothing, as mosquitoes may bite through thin clothing. Spray pyrethrin or a similar insecticide in your bedroom before going to bed. Health Education . Chemoprophylaxis is recommended for travelers, migrant labourers and military personnel exposed to malaria in highly endemic areas.

5. Secondary Prevention :- Preclinical & clinical phase(detect & treat pathological process at an earlier stage when treatment can be more effective & prevent complications. Early diagnosis(screening test & case finding programs).Microscopy, Rapid Diagnostic tests, Treatment (clinical medicine). Treatment of P. vivax cases: Positive P. vivax cases should be treated with chloroquine in full therapeutic dose of 25 mg/kg divided over three days. The relapse rate in vivax malaria in India is around 30%. For its prevention, primaquine may be given at a dose of 0.25 mg/kg daily for 14 days under supervision. Treatment of P. falciparum cases:-The treatment of P. falciparum malaria is based on areas identified as chloroquine resistant/ sensitive. Artemisinin Combination Therapy (ACT) should be given in resistant areas.

6. Secondary Prevention :- Preclinical & clinical phase(detect & treat pathological process at an earlier stage when treatment can be more effective & prevent complications . The ACT used in the national programme in India is artesunate + sulfadoxine-pyrimethamine (SP). Presently, Artemether + Lumefantrine fixed dose combination and blister pack of artesunate + mefloquine are also available in the country. According to current WHO guidelines, ACTs can be given in the second and third trimester of pregnancy. The recommended treatment in the first trimester of pregnancy is quinine.

7. Tertiary Prevention:- Post clinical(late pathogenesis phase),prevent relapse & further deterioration by follow up , rehabilitation. All measures & intervention in late pathogenesis phase to reduce mortality, impairment, disability, sufferings, etc. • Parenteral antimalarial, antibiotics, anticonvulsants, antipyretics • Intravenous infusion equipment and fluids • Special nursing for patients in coma • Blood transfusion • Well-equipped laboratory • Oxygen Rehabilitation:-psychosocial, vocational , medical .