Malaria

It is an infection caused by the female Anopheles mosquito. It is a major health problem having
an annual incidence of 5.1/1000 population. It is produced by intraethrocytic parasites of the genus
Plasmodium. The severity and characteristics of the disease are governed by the infecting species, the
magnitude of the parasitemia, the metabolic effects of the parasite, the cytokines released as a result of
the infection.
Signs and Symptoms
• Recurrent chills
• Fever
• Profuse sweating
• Anemia
• Malaise
• Hepatomegaly
• Spleenomegaly
Early Diagnosis and Prompt Treatment
• Identification of a patient with malaria as soon as he/she is seen, through clinical or microscopic
method.
• Clinical Method is based on the signs and symptoms of the patient and the history of his/her
having visited a malaria-endemic area.
• Microscopic method is based on the examination of the blood smear of the patient through
microscope.
• This should be done by Medical Technologist at the Health Center where there are microscopic
facilities during regular consultations. She/he should take smear of patients with fever with one
month and are residing in malaria-endemic areas and of patients who did not respond to
appropriate anti-malaria treatment.
Chemoprophylaxis
Only Chloroquine drug should be given. It must be taken at weekly intervals, starting from 1-2
weeks before entering the endemic area. In pregnant women, it is given throughout the duration of
pregnancy.
Sustainable Preventive and Vector Control Measures
a. Insecticide- Treatment of Mosquito Net
This involves the soaking of the mosquito net in an insecticide solution and allowed to
dry. It is used as a protective measure against the vector mosquito during night.
b. House Spraying
This is the application of insecticide of the indoor surfaces of the house through spraying.
c. On stream seeding
 This involves the construction of bio-ponds for fish propagation which shall be the
responsibility of the LGUs and their corresponding communities. About 2-4 fish per sq. m
is needed for an immediate impact and about 200-400 fish per ha. Is needed for a
delayed effect.
d. On stream clearing
This is the cutting of the Vegetation overhanging along stream banks to expose the
breeding stream to sunlight, rendering it unsuitable for mosquito vector habituation.
Recommended Anti-Malaria Drugs
Blood Schizonticides – drugs acting on sexual blood stages of the parasites which are responsible for
clinical manifestations.
• Chloroquine phosphate 250 mg
• Sulfadoxine 50 mg-pyrimethamine 25 mg/tablet
• Quinine sulfate 300 mg tablet
• Quinine hydrochloride 300 mg/ml, 2 ml ampule
• Tetracycline hydrochloride 250 mg/capsule
• Quinidine sulfate 200 mg/durules
• Quinidine glucolate 80 mg/ml, 1ml vial
Other Preventive Measures
• Wearing of clothing that covers arms and legs in the evening.
• Avoidance of outdoor night activities, particularly during the vector’s peak biting hours from 9pm
to 3am.
• Use mosquito repellants
• Planting of Neem tree
• Zooprophylaxis- the typing of domestic animals to deviate mosquito bites from man to these
animals.
Nursing Responsibilities
1. Participates in the implementation of the following:
a. Treatment policies
b. Provision of drugs
c. Laboratory confirmation of diagnosis
d. Training of BHW and volunteers on the diagnosis and treatment of malaria.
e. Supervision of malaria control activities of all health personnel in the area
f. Collection, analysis and submission of required reports
2. Recognition of early signs and symptoms for management and further referrals.
3. Educate the individual/families/communities of the importance of the following:
a. Taking of chemoprophylaxis
b. Wearing of long-sleeved clothing and trousers when going out at night.
 c. Application of insect repellent to skin
d. Use of mosquito net
e. Use of screen in doors and windows. If no screen, close windows and doors during night
time.
f. Use of insecticide aerosols and pyrethroid mosquito coils
g. Clearing of hanging branches of trees along the stream
4. Availability of anti-malarial drugs and chemoprophylaxis drugs.