An environment and place like where we live (in a country like India) are almost perfect for malaria to thrive in. There is humidity that approaches about 90 percent in some parts. There is also fluctuation of temperatures, a total amount of the moisture in the environment, especially if you are living in a city, by the sea, or by any kind of water. All these things make the environment such that the eggs of mosquitoes will thrive and grow and multiply at a speed that is faster than in a cold and dry climate.
To add to this there is a large amount of environmental waste that does not get disposed of as it should be. That means this waste, that is outside your housing complex or on the pavement or the streets where you are walking are breeding grounds for mosquitoes that transmit malaria.
It is important to note that treatment for malaria must be followed thoroughly and not stopped after the initial fever has subsided. It is when treatment is stopped midway that there is a relapse of malaria in the patient as malaria is still present in the body due to not treating it completely. So, it is not a relapse of malaria, but it is simply a fact that the mosquito and the lifecycle of the mosquito are going through several reparations inside the blood of the patient. This happens very frequently, and it is probably one of the biggest causes why people end up taking treatment for malaria time and again.
That is why it is very important to ensure that the duration of the treatment as prescribed by your doctor must get completed so that you don’t have a relapse of malaria or symptoms of malaria, which normally happen in 3 to 6 months of the first instance.
Malaria is itself a ghastly disease, but there is two specific parts of malaria, one of which is malaria in pregnancy. Malaria in pregnancy caries about 30 percent mortality. Hence it is very important for pregnant women that they don’t get the infection and if they get the infection, they treat it as aggressively as they can because it can be detrimental to both the foetus and mother. This is one situation that must be avoided at all costs.
Malaria that grows in the brain of the patient, cerebral malaria, is a fatal condition. It can very easily kill a patient within a few hours’ time.
A parasite index of malaria is how much of the patient's red cells are infected with malarial parasites. If you look at the standard books of medicines. It is anything over 3 percent that is ominous in malaria. In some of the civic hospitals in Mumbai, the malarial parasite index approaches more than 60 percent or 70 percent when the malarial death review committee looks at the outcome of patient deaths.
So, from 3 percent to 60 percent or 70 percent is a huge spectrum that again gives you an idea that such patients need to be treated very aggressively. It is also important to point out here, that in some situations where the risk is high in the malarial parasite test which is the rapid malarial antigen test (RMAT) may be negative on more than one occasion while the patient has malaria. And that is why sometimes if you think that the patient's clinical condition is deteriorating rapidly, or the risk of the complication is high then there is some wisdom in treating such patients even thou the test has come back being negative just so that things don’t get missed and the patient don’t go into complications.
While there are several treatments for malaria, some of them are becoming either resistant or they are not having the same kind of efficacy. There are a few reasons for that, some of the older treatments are also a little bit toxic. They tend to have complications others are very smooth and will have very good outcomes used in carefully selected patients.
And finally, a few quick words about the travellers in malaria, people going to endemic areas where malaria has a rampant offering to take medication so that they are protected from the entire cycle of the malarial parasite, going into adulthood even if they get infected and that is why you take the profile access. It is a good strategy that is being used with good effect for several decades and it should be offered to people who are going to be living in a high-risk situation for a short period of time.
The importance of civic hygiene, civic cleanness, the importance of getting rid of garbage either around the places you live, where you work, or where you are traveling or spending time, cannot be over-emphasized. This is something that is important just not for malaria but for mosquitoks that will spread a few other diseases besides malaria. So, it is very important that as an individual you insist on the area around you being as clean as possible and being as hygienic as possible and that every individual takes that responsibility. Every housing society or working space takes that responsibility and every social structure of the city takes up the responsibility as well.
(Dr Om Shrivastav, Infectious Disease Specialist, Jaslok Hospital and Research Centre)