THESIS STATEMENT

We know a lot about the communicable disease, Malaria and its prevalence in the society. What is the biochemistry behind this protozoal disease and how can we take simple steps to make people around us aware of the prevention measures that can be taken to combat Malaria?

ABSTRACT
This project, the biochemical story of Malaria was undertaken by a group of three people, namely, me, Siddharth and Dhruvi. We had to focus mainly on how to bring this disease, with its symptoms and prevention measures in the eyes of the general public in our city, Rajkot. I, being a research-loving person, took up the task of gathering the statistics depicting the prevalence of the disease in Rajkot and visiting various doctors like G.U.Mehta in our city. I also took up the task of compressing the large data available to us into a point-wise pattern. This enabled our entire group to create a precise movie as well as a concise report regarding the project. Finally, we came up with a movie that stresses on spreading awareness regarding the Malarial disease in Rajkot. In the process of this project-making, I maintained a daily Process Journal in which I recorded everything I did regarding the project on a particular day. From this project, I learnt how to skim through various sources of information like Internet, books,etc. and extract the best information available. Putting this information in the form of brief points was what I learnt when I prepared this project report. Teamwork, authentic and field research that happens when you actually visit hospitals, was what I would always remember as a cherished part of my project journey.

INDEX
1. 2. 3. 4. AN INSIGHT STATISTICS HISTORY OF MALARIA MALARIA-BRIEF DESCRIPTION OF THE DISEASE AND LIFE CYCLE IN 2 DIFFERENT HOSTS 5. LIFE CYCLE OF Plasmodium IN THE HUMAN BODY 6. MORPHOLOGY OF THE MALARIAN PARASITE 7. STAINING METHOD, CULTIVATION AND MODE OF TRANSMISSION 8. PATHOGENICITY AND CLINICAL FEATURES 9. RELAPSES IN MALARIA AND CLINICAL PATHOLOGY 10. LABORATORY DIAGNOSIS AND TREATMENT 11. STRATEGIES TO CONTROL MALARIA IN RAJKOT, MALARIA VACCINE AND MEASUREMENT OF MALARIA

AN INSIGHT
The story of communicable diseases, Malaria, is a part of PBL, Project based learning which is an integration of studying Physics, Chemistry and Biology behind the understanding of various communicable diseases. This report focuses on the biological aspect of understanding and treating the diseaseMalaria. All the research pertaining to the project was done as part of a group and this is the final individual project report. This project has been submitted to SN KANSAGRA school, Rajkot on 8th June, 2013.

Statistics

The above monthly comparison report, provided by the Government depicts on an average, 300 cases every year of Malaria caused by Plasmodium vivaxin Rajkot. From the above data, it is evident that cases of malaria caused by P.vivax have always been more as compared to those caused by P. falciparum from 2008 to 2013. It is also a general observation from the data that the maximum cases of malaria caused by P.vivax have been repoted in the monsoon months of June and July when the mosquitoes are more prevalent. The early winter months of Jan- Apr have fewer reported cases in all the 5 years. The data clearly demonstates the need to combat Malaria in Rajkot.

HISTORY OF MALARIA
Long before the British colonised India, malaria was a serious problem for the country, imposing enormous economic costs and a great deal of human misery. Malaria epidemics occurred throughout India with varying intensity. In 1852, one malaria epidemic wiped out the entire village of Ula and then spread across the Bhagirathi River to Hooghly and continued to devastate populations for many years in Burdwan. The development of the Indian railways under the British administration contributed to the spread of malaria. While the construction of railway embankments provided a number of breeding sites for the malaria vectors, the labourers probably introduced different strains of the parasite to the areas in which they worked. The city of Bombay suffered greatly from malaria epidemics. The construction of railroads or bridges was often associated with increases in malaria, probably due to imported labour from malarious areas. In the early 1920s, Bengal suffered a severe malaria epidemic which resulted in over 730 000 deaths in 1921 alone. Thereafter, the number of deaths from malaria slowly decreased to within 300 to 400 000 per annum. During the Second World War however malaria deaths rose again, particularly in 1943, when Bengal recorded over 680 000 deaths and in 1944 when there were an appalling 763 220 deaths from the disease. Although quinine was available at the time, its supply was probably inadequate and patients did not seek treatment on time. On the other hand, some of the great successes in controlling the disease were also achieved in India. Formal malaria control programmes were started under British colonial rule and continued after Indian Independence in 1946. Early malaria control efforts invloved removal of breeding sites and later used chemicals such as the larvicides Paris green and kerosene. One of the first formal operations to control the disease was at Mian Mir, near the city of Lahore (now in Pakistan). Mian Mir had an intricate system of irrigation canals which provided excellent breeding grounds for the vectors. The malariologists Drs. J.W.W. Stephens and S.R. Christophers, arrived at Mian Mir in 1901 with ambitious plans to remove all the breeding sites, evacuate the infected people and administer quinine as both a curative and preventative measure. Their programme developed into a massive effort, with between four and five hundred soldiers set to work full time at filling in the irrigation canals. The programme of constantly filling in ditches and removing puddles and any other potential breeding site continued until 1909. During 1909 there was a serious malaria epidemic, as there was in 1908 throughout the Punjab, and the courageous, but ultimately useless control programme was abandoned. DDT was first used in India by the armed forces in 1944 for the control of malaria and other vector borne diseases. In 1945, DDT was made available for civilian use in Bombay to control malaria and produced some remarkable results within a very short period. On 1st July 1945, the first civilian home was sprayed in India with a 5% solution of DDT mixed in kerosene. In 1946, pilot schemes using DDT were set up in several areas, including Karnataka, Maharashtra, West Bengal and Assam. Between 1948 and 1952 the WHO

set up DDT demonstration teams in Uttar Pradesh, Rayagada, Wynad and Malnad. Use of DDT not only helped in the control of mosquitoes and malaria, but also improved the life expectancy. After the spraying in the Kanara district, the population began to grow because of a decrease in the death rate. Prior to DDT being used, the district reported an average of 50,000 malaria cases every year, which was reduced by around 97% to only 1,500 cases after DDT was introduced. By 1959, resistance to DDT began to develop in certain areas and added to the problem. Utilisation of chloroquinone, the integrated National Vector Borne Disease Control Programme (NVBDCP) [2004], National Anti Malaria Programme (NAMP)[1995] were few other steps taken to combat this deadly disease in India.

Malaria
Malaria is a protozoal disease caused by infection withparasites of the genus Plasmodium and transmitted to man by certain species of infected female Anopheline mosquito. A typical attack comprises three distinct stages: Cold stage, hot stage and Sweating stage. The clinical features of malaria vary from mild to severe and complicated according to the species of parasite present, the patients state of immunity, the intensity of the infection and also the presence of concomitant conditions such as malnutrition or other diseases.The febrile paroxysms occur with definiteintermittent periodicity.

Geographical distribution
Malarial parasitesare found in all countries, extending from 40*S to 60*N. The tropical zone is the endemic home of all malarial parasites while P. Malariae is a parasite of sub tropical zone, P vivax is the prevailing species of the temperate zone. The distribution of P. Ovale has mainly been reported from East Africa, West Africa especially Nigeria andPhilippines.

Habitat:The malarial

parasites infecting man, after passing through a developmental phase in the parenchyma cells of the liver, reside inside the red blood corpuscles and are carried by the circulating blood at all the organs.

Life cycle
The malarial parasite passes its life cycle in two different hosts. (1) In Man :- The parasite residing inside the liver cell and the red blood corpuscle reproduces by asexual method [Schizogony ] Hence man represents the intermediate host of the malarial parasite. In Female Anopheline Mosquito:-For the initiation of the mosquito cycle, sexual forms (male and female gametocytes) are first developed inside the human host. These are then transferred to their insect host, where theydevelop further and are transformed into sporozites. These sporozites are infective to man. On account of this sexual method of reproduction, mosquito represents the definitive host of the malarial parasite.

(2)

Human cycle

A Plasmodium in the form that enters humans and other vertebrates from the saliva of female mosquitoes (a sporozoite) Human cycle starts with the introduction of sporozoites (a minute thread-like curved organism, tapering at both ends which measures about 9-12ftm in length, has a central elongated nucleus and does not seem to contain any pigment under the light microscope) by the bite of an infected Anopheline mosquito. It comprises the following stages:(1) PRE-ERYTHROCYTIC OR PRIMARY EXO-ERYTHROCYTIC SCHIZOGONY Sporozoite does not directly enter into a red blood corpuscle to start its erythrocyticschizogony, but undergoes adevelopmental phase inside the tissue of man. This phase of development has been referred to as pre-erythrocyticschizogony and consists of only one generation of pre-erythrocyticschizont, the cycle lasting approximately 8 days in P .vivax, 6 days in P. Falciparum and 9 days in P.ovale. The pre- erythrocyticschizogony occurs inside the parenchyma cells of the liver. The liberated merozoites are called cryptozoites. The smaller ones (micromerozoites) enter the circulation and the larger ones (macromerozites ) reenter the liver cells.

Neither any clinical manifestation nor any pathological damage is produced by the parasite while developing inside the liver. During the pre-erythrocyticschizogony, the parasites are not found in the peripheral blood and inoculation of such blood does not produce any infection, i.e. the blood is sterile. (2) ERYTHROCYTIC SCHIZOGONY:-

During this phase the parasite resides inside the red blood corpuscle and passes through the stages of trophozite, schizonts and merozoite. These asexual forms of parasites can be demonstrated in the thick smears of the peripheral blood 3 to 4 days after the completion of pre-erythrocyticschizogony, i.e. in P.vivax infection about 12 days and in P. falciparum infection about 9 days after exposure. Each cycle of erythrocyticschizogony lasts for 48 to 72 hours. In P.vivax, P.ovaleand P.falciparum it is 48 hours, whereas in P. malariae it is 72 hours. The parasitic multiplication during the erythrocytic phase is responsible for bringing on a clinical attack of malaria.

(3) GAMETOGONY:After the parasites have undergone erythrocyticschizogony for a certain period (which varies with the different species) some of the merozoites, instead of developing into trophozoites and schizonts, give rise to forms which are capable of sexual function after leaving the human host. These are called gametocytes and develop in the red blood cells of the capillaries of internal organs (spleen and bone marrow).Only the mature gametocytes are found in the peripheral blood. The maturation is completed in about96 hours (4 days). (4) LATENT STAGE (HEPATIC):-

After the establishment of blood infection, the initial tissue phase (pre-erythrocytic phase ) disappears completely in P.falciparum, whereas in P.vivax and P.ovale, it persists in the liver cell as dormant form (resting phase ).This resting phase of parasite (latent stage) is known as hypnozoite, which is capable of developing into merozoites. In short,there are mainly two phases of development in the human host:(1) Inside the liver (tissue phase):(i)Pre-erythrocytic [or primary exo-erythrocytic)Schizogony (ii)Hypnozoite stage- cause of relapse Inside the red blood cell (Erythrocytic phase) (i)ErythrocyticSchizogony cause of malarial paroxysm. (ii)Gametogony Infects mosquito The essential difference between the tissue phase and erythrocytic phase of development is that the pigment granules are absent in the former but present in the latter.

(2)

MORPHOLOGY OF MALARIAL PARASITE

The specific name vivax is derived from L.vivere, to live, and indicates the activity of movement. Plasmodium vivax is also called the parasite of benign tertian or vivax malaria. PRE-ERYTHROCYTIC SCHIZOGONY This phase of development occurs inside the parenchyma cells of the liver and the parasite multiplies by the asexual method (schizogony). It comprises a single cycle and lasts approximately 8 days. The fully developed pre-erythrocytic schizont measures 42m in diameter and contains a large number of merozoites (about 12,000). The merozoites consist of a fragment of chromatin with very little of cytoplasmic mass. These merozoites may either enter into a red blood cell to start their erythrocyticschizogony or re-enter into the parenchyma cell of the liver to continue the exo-erythrocytic schizogony. ERYTHROCYTIC SCHIZOGONY The parasite performs various nutritive functions for its growth and development inside a red blood cell. It reproduces by asexual method of multiplication. It is now known that P. Vivax shows a greater tendency to invade younger red blood cells (which are usually of greater diameter) and reticulocytes than mature erythrocytes. During erythrocyticschizogony, the parasite passes through the following stages: trophozoite, schizont and merozoite. The cycle of erythrocyticschizogony lasts approximately 48 hours (2 days) and is completed mainly in the peripheral circulation. Each red blood cell is generally invaded by a single parasite and no more than 1or 2 percent red cells are involved.

TROPHOZITE.
Early trophozite with Leishmans stain appears to consist of a blue cytoplasmic ring, a red nuclear mass and an unstained area called nutrient vacuole. The diameter of the ring is 2.5 to 3m i.e about one-third the size of a red blood cell which is 7.2 m. Oneside of the cytoplasmic ring is thicker than the other and the nucleus is situated on the thinner part of the ring. The trophozoite possesses a very active amoeboid movement and constantly thrusts out pseudopodia inside the red blood cell, giving rise to diverse forms. After a period ofgrowth of about 10 hours, yellowish brown pigment granules appear in the cytoplasm of the parasite. While developing, the parasite induces the following changes in the infected red blood cell : (i)It enlarges and become double its original size. (ii)It becomes greatly distorted in shape becoming rhomboidal or irregular in outline. (iii)It has a washed out appearanceand becomes pale and almost colourless. (iv)The portion of the cytoplasm unoccupied by the parasite shows a dotted or stippled appearance, called Schuffners dots .With Leishmans stain they appear as pinkish granules. According to the stage of growth, the trophozoites have been described as early trophozoites and late or growing trophozoites.

SCHIZONT.
This form appears after a period of growth of about 36 to 40 hours and represents the fullgrown trophozoite, ready to divide. At this stage, the parasite has become rounded in shape and has lost all amoeboid activities. The vacuole has disappeared and the pigment granules are still scattered throughout the cytoplasm. The nucleus is large and lies at the periphery. In size it is larger than red blood cell measuring 9 to 10m in diameter. In next 6 to 8 hours, the nuclear division is completed and about 12 to 24 daughter individuals are produced. These are called merozoites and arrange themselves in the form of rosette(usually in two rows).When the maturation is completed , the red blood cells, unable to hold the parasite bursts. This gives rise to the malarial paroxysm synchronising with the completion of schizogony.

MEROZOITE.
This consists of an oval mass of cytoplasm with a central nucleus and measures about 1.5 to 1.75 m in length and 0.5m in breath. It has no pigment. The free merozoites attack new red blood cells and continue their erythrocyticschizogony repeating the cycle every 48 hours.

GAMETOGONY Certain schizontsbecome modified biologically and the resulting merozoites, instead of undergoing schizogony, are differentiated into sexual forms. Merozoites of a single schizont become either all males (microgametocytes ) or all females (macrogametocytes ).The differences between a microgametocyte and macrogametocyte are as follows : Size: Cytoplasm: Nucleus: Microgametocyte 9 to 10m Stains light blue. Diffuse, large; lies laterally. Macrogametocyte 10 to 12m Stains deep blue. Small, compact; lies peripherally.

Parasites of P.vivax appear in the peripheralblood from the first day of fever i.e 4 to 5 days after the initial appearance of the asexual parasites in thick smears. Gametocytes not taken up by the insect host, do not live for more than a week in the human blood.

LATENT STAGE (HEPATIC) Morphologically hypnozoite (latent parasite in liver) cannot be distinguished from the schizonts leading to first clinical attack. The latent hepatic stage is maintained throughout the course of P.vivax infection independent of erythrocyticschizogony and lasts for several years. Thus, a single infection with P.vivax exists in the human body upto several years and is characterised by short term and long term relapses, after which the infection generally dies out. As long as the hypnozoite (latent stage) persists, it can help to maintain erythrocyticschizogony.

STAINING METHOD
The structural details of malarial parasites are studied by using any of the modifications of the Romanowskysstains such as Leishmans and Gemsas stains. The former is prepared by dissolving the dry powder in acetone-free pure methyl alcohol and is used in strength of 0.15% per cent; whereas the latter is obtained as a readymade watery solution.

CULTIVATION
Culture methods have been evolved to observe the erythrocytic schizogony of malarial parasite as it occurs in man. Bass and Johns technique with a slight modification was used for the cultivation of malaria parasite in artificial culture media.

MODE OF TRANSMISSION
Vector Transmission:
Malaria is transmitted by the bite of certain species of infected female, anopheline mosquitoes. Asingle infected vector, during her life time, may infect several persons. The mosquito is not infective unless the sporozoites are present in its salivary glands. (a) Direct Transmission : Transfusion malaria occurs during the course of blood transfusion when infected persons (having latent malarial infection) are used as donors (screened by indirect immunofluorescent test). Persons who have lived in an endemic area and anyone who has had malaria should not be accepted as blood donor until 3 years afterwards. (b) Congenital Malaria : Transmission of infection to foetus in uterus through some placental defect (a physiologically healthy placenta offers a barrier to the passage of malarial parasites to the foetus).

PATHOGENICITY
Each of the four species -causes a characteristic fever and the - disease are designated as follows : P.vivax Vivax malaria (Benign tertian malaria ) P. malariae-Quartian malaria (malariaemalaria ) P .falciparumFalciparum malaria (malignant tertian malaria ), it is alsoresponsible for pernicious malaria -Black water fever. P.ovale Ovale malaria.

Clinical Features Of Malaria

The main clinical features of malaria are a series of febrile paroxysms, followed by anaemia and splenic enlargement .

(1)Febrile Paroxysm
The malarial paroxysm starts generally in the early afternoon but actually it may start at any time. Each paroxysm shows a succession of 3 stages: (i)The cold stage (lasting 20 minutes to an hour ) (ii)The hot stage( lasting 1 to 4 hours ) (iii)The sweating stage (lasting 2 to 3 hours ) Thus the total duration of the febrile cycle is from 6 to 10 hours, varying however with the species of Plasmodia.

Typesof Fever

The febrile paroxysm synchronises with the erythrocyticschizogony of the malarial parasite. (a)With a 48 hour cycle the fever recurs every third day in P.vivax (tertian fever) (b)With a 72 hour cycle the fever recurs every fourth day, quartan fever. In vivax malaria (benign tertian malaria) the characteristic intermittent periodic fever becomes established only in the later stages, the initial pyrexia generally being continuous, quotidian (every four days) or remittent (recurring).

(2)Anaemia

After a few paroxysms, anaemia of a microcytic or a normocytic hypochromic type develops as a result of breaking down of red blood cells during segmentation of parasites.

(3)Splenomegaly

Enlargement of the spleen is one of the important physical signs in malaria. In primary cases, the enlargement is so slight as to escape detection by palpation. After some paroxysms, and usually by the second week it is definitely enlarged and palpable.

Relapses in Malaria
Itis the renewed clinical manifestation or parasitaemia and may result from persistence of hypnozoite forms in the liver in which erythrocyticschizogony commences again. This is recurrence or true relapse and is a feature ofP.vivaxand P.ovale infections.

Clinical Pathology
Changes in Blood:
An individual suffering from an attack of malaria, after a few paroxysmsbecomes temporarily anaemic. The anaemia is due to destruction of infected red blood cells during each cycle of schizogony. It is therefore anexample of haemolytic anaemia. Thereduction in red blood cells is greater in P.falciparum infection than in infections with P.vivax andP.malariae. The red blood cell count may be 2 to 3 million per cubic mm of blood. Anaemia in malaria is of normocytic and hypochromic type.Leucocyte count is increased up to 10 to 20 thousand per cubic mm during the period of rising temperature of the malarial paroxysm but it quickly comes to normal after the paroxysm is over. With recurring paroxysms, leucopenia becomes established, the total count ranging from 3,000 to 5,000 per cubic mm of blood. The neutrophils, granulocytes are diminished, ranging from 50%to 70%; monocytes show an actual increase ranging from 10 to20%. Both the monocytes and neutrophils are often found to contain ingested haematin pigment.

Laboratory Diagnosis of Malaria

A microscopical examination of a blood film forms one of the most important diagnostic procedures in malaria. In majority of cases, a careful examination of thin film will invariably show the plasmodia provided no antimalarial drugs have been administered prior to the taking of blood films. Uses of [QUANTITATIVE BUFFY COAT TEST]is a new method for identification of parasite.

Treatment
The various antimalarial drugs are grouped as follows:

1.Essentially Therapeutic(Clinical Cure):

4-aminoquinolines such as chloroquineartemisinin compounds, quinine and mefloquine. These are potent drugs having action on early erythrocytic phases of the parasite. For radical cure an 8-aminoquinoline, primaquine is used after the clinical cure. It acts on the latent stage of parasites in the liver, hence prevents relapses. It also acts on gametocytes, but has little action on asexual blood parasites.

(2)Protective orProphylactic:
Proguanil (chlorguanide), pyrimethamine and trimethoprim. These are dihydrofolatereductase inhibitors and are mostly used to suppress clinical manifestations. These drugs can destroy pre-erythrocytic phase of the parasite in the liver (causal prophylaxis) and inactivate gametocytes, thereby preventing further development in the mosquitoes. They act on the dividing schizonts.

Prophylaxis
For personal prophylaxis: (i)Protection against mosquito bites (ii)Systematic use of antimalarial drugs as a prophylactic measure (chemprophylaxis) For Community Prophylaxis: (1)Prevention of carrier by antimalarial drugs having a destructive effect on the gametocytes, the only drug possessing such action is 8-aminoquinoline. This being a toxic drug cannot be used for mass prophylaxis. (2)Antimosquito measures These may be directed towards adult mosquitoes and their larvae, (a) Destruction of adult mosquitoes can be carried out by spraying with insecticides such as D.D.T or gammexane. (b)Anti-larval measures consist of elimination of breeding places of the mosquitoes and use of larvicides (oil,parishgreen, D.D.T dissolved in oil ). (c) Use of pyrethroid treated bed nets and mosquito repellents are fruitful personal prophylactic measures.

Malaria Vaccine
Research on malaria vaccine is going on. It is hoped that vaccines may prevent death, and infection may be attenuated only, but the disease cannot be prevented.

Measurement of Malaria
The classical malariometric measures are spleen rate, average enlarged spleen, parasite rate etc.They provide the information regarding the trend of the disease.

(a)Spleen Rate:
It is defined as the percentage of children between 2 and 10 years of age showing enlargement of spleen.

(b)Average Enlarged Spleen:

This is a further refinement of spleen rate, denoting the average size of the enlarged spleen. It is a useful malariometric index.

(c)Parasite rate:
It is defined as the percentage of children between 2 and 10 years showing malaria parasites in their blood films.

(d)Parasite density Index:

It indicates the average degree of parasitaemia in a sample of well-defined group of population.

Approaches and Strategies of Malaria Control in Rajkot community:

Basically, there are two different approaches to malaria control: (1)The management of malaria cases in the community, and (2)Active intervention to control or interrupt malaria transmission with community participation.

(A) Management of Malaria cases

The clinical management of malaria cases (i.e., diagnosis and treatment) ought to be first priority. It is well within the capability of the existing primary health care system in Rajkot where institutions like the Civil hospital make healthcare accessible to all classes of people.

Disease Control Strategies

(1) Case Detection All fever cases attending dispensaries /hospitals for treatment should be presumed to be suffering from malaria. (2) Treatment Under the National Malaria Control Programme (1953-1958), antimalarial drugs played little role. The emphasis was on insecticidal spraying. Under the National Malaria Eradication Programme the need for malaria treatment is immense. Great importance is given to the extensive use of antimalarial drugs-to prevent death and to reduce malaria morbidity. In Rajkot, the malaria-active areas should utilise both these practices. (a)Presumptive Treatment Presumptive treatment means that all fever cases are assumed to be due to malaria. This is often the only practical and effective approach in a community based programme, voluntary link workers and laboratory technicians should administer a single dose of chloroquine phosphate in 600mg (4 tablets ) dose for an adult and proportionate dose for children. Concurrently, a blood smear is obtained to confirm the diagnosis and determine the type of malaria. The presumptive treatment is to be given to all age groups. Even pregnant women in any month of pregnancy or during postpartum period should receive presumptive treatment. (b)Radical Treatment If the blood smear is positive for malaria parasite, the laboratory technician should return to the patient and administer radical treatment for malaria. It is to ensure a complete cure from malaria, prevention of relapse, and to make the patient non infective to mosquitoes. The drug schedule is as follows :

(a)

Radical treatment for P.vivax, P.malariae and mixed infections : Asingle dose of 600mg chloroquine and 15 mg primaquine (8-Aminoquinolines ) on the first day followed by 15mg primaquine daily for the next four days (adult dose ).

(b)

Higher chloroquine dose for radical treatment : The radical treatment with 600mg chloroquine along with 15mg primaquine per day for five days has been found to be effective in respect of P.vivax infection. However, WHO recommends a total dose of 1500mg chloroquine adult (i.e 600mg on day 1, +600mg on day 2, +300mg on day 3) which can be followed, wherever feasible.

New drugs in malaria:

Drugs such as mefloquine and halofantrine have been developed and registered. The latest addition to the treatment of severe malaria is injectable derivatives of the traditional Chinese herbal remedy known as artemisinin.

(B) Active Intervention Measures

Neither chemotherapy nor chemprophylaxiswill be able to reduce significantly the malaria prevalence or transmission. (1) Stratification Of The Problem Malaria is a complex disease, and its distribution and intensity vary from place to place. Stratification of the problem has become an essential feature for the planning and development of a sound control strategy to maximise the utilization of available resources. (2) Vector Control Strategies : Vector control is still one of the primary weapons to control malaria in endemic areas of Rajkot. The methods used include: (a) Anti-adult measures (i) Residual Spraying : The spraying of the indoor surfaces of houses with residual insecticides like D.D.T, malathion, fenitrothion is still the most effective measure to kill the adult mosquito (ii).Space Application : This is a major anti-epidemic technique for Mosquito-borne diseases. It involves the Application of pesticides in the form of Fog or mist using equipment. (iii) Individual protection: Man-vector contact can be reduced by other preventive measures such as the use of repellents, protective clothing, bed nets, Mosquito coils, screening of houses etc. (i) (b) Anti-larval measures: Some modern larvicides such as temephoswhich confer long effect with low toxicityare more widely used. However larvicidng must be repeated at frequent intervals and for this reason it is a comparatively costly operation. Source reduction: Techniques to reduce mosquito breeding sites (often called source reduction ) which include drainage or filling, deepening or flushing, management of water level, changing the salt content of water and intermittent irrigation are among the classical methods of malaria control.

(ii)

METHODS TO SPREAD AWARENESS REGARDING MALARIAL PREVENTION MEASURES IN RAJKOT:

(i) Due to the prevalence of media in the society today, the best way to create awareness against the disease malaria would be to publish all the information regarding malaria in bits and pieces every day in popular Gujarati newspapers like Akila, Chitralekha,etc. Advertisements regarding simple preventive measures like applying Odomos, using mosquito nets at night,etc. can be given on popular Gujarati channels. Weekly visits by young doctors or social workers to malaria-prone areas of the city for spraying insecticides or other sprays and encouraging the people not to relapse in their malarial preventive measures may prove to be of great help. People visiting medicine shops, hospitals, etc. can be given pamphlets stating what is malaria, how it transmits and what are its preventive measures. Huge banners can be put up all around Rajkot during seasons of active malaria transmission. Students of all ages in schools should be taught malarial preventive measures as a part of their curriculum every year. Women from government institutions or social workers can individually visit homes and instruct housewives regarding how to combat malaria. Other institutions like banks, laboratories, etc. can induct their employees regarding the disease.

(ii) (iii)

(iv) (v) (vi) (vii) (viii)

CONCLUSION
Malaria is a truly complex disease which is good to prevent rather than to experience. The parasite Plasmodium may remain in the human body for three years with frequent relapses. This disease thus has to be effectively dealt with. After studying the various aspects of this disease and prevention techniques, I realise that the disease can be combated only if the changes are made at a very local level. No doubt doctors can intervene, but to prevent the female anopheles to disable your body with one bite, it is you and only you who can take small but vitally important steps like using mosquito repellents, coils, ointments, mosquito nets ,etc. But many doctors suggest that the most important step to prevent malaria is to keep our surroundings free of garbage or stagnant water which are good breeding grounds of mosquitoes. After successfully spending a good deal of time in understanding the nature of this disease in my city, I feel that a lack of awareness is the main reason for this disease to spread so prevalently. According to a survey in which I asked people regarding what they know about Malaria, they could just narrate incidents around them of malarial victims but the majority of them knew nothing regarding the true nature of the disease or its symptoms. Noticing all this, I mentioned some awareness generating methods in my project report. This message of prevention if reaches people in mediums familiar to them, will play a major role in creating a mass awareness against the disease. After all, I believe prevention is better than cure.

BIBLIOGRAPHY
Any interesting piece of work happens only under sound guidance of teachers and I sincerely thank my Biology teacher, DeepthiMaam to assign such a knowledgeable project to me. I thank my group members, Siddharth and Dhruvi who were always there with me in the entire research done for the project. .I thank my father who is himself a doctor, in guiding me on how to frame my project report. I also thank doctors like G.U. Mehta who gave us their valuable time in helping us with the statistics and also sharing their views regarding malaria and its preventive measures. Other information for the report has been taken from: www.google.com (history of malaria) Book called Parasitology by K.D. Chatterjee Article based on epidemiology of communicable diseases