malaria

MALARIA

A terrible disease which has cost many lives...

Introduction
We chose the subject malaria for this final assignment project. We chose this subject, because malaria is a disease which still costs many lives. We could also find a lot of information about malaria, so that was a reason to choose malaria as subject too. Suzanne also wanted to, because she went to Sri Lanka once, and she had to take a lot of medicines, so she knew already something about it and had a lot of information about it. In the Geography book was also some information about it about how malaria is spread etc., but in our project we will give more information and details, that is probably the reason why it is a bit long, but we hope not too long!
We hope you enjoy reading it!

Malaria; how, what and where
Malaria is a serious, sometimes fatal, disease caused by a parasite. There are four kinds of malaria that can infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. The World Health Organization estimates that yearly 300-500 million cases of malaria occur and more than 1 million people die of malaria.
Where does malaria occur?
Malaria occurs in over 100 countries and territories. More than 40% of the people in the world are at risk. Large areas of Central and South America, Hispaniola (Haiti and the Dominican Republic), Africa, the Indian subcontinent, Southeast Asia, the Middle East, and Oceania are considered malaria-risk areas (an area of the world that has malaria).
How do you get malaria?
Humans get malaria from the bite of a malaria-infected mosquito. When a mosquito bites an infected person, it ingests microscopic malaria parasites found in the person’s blood. The malaria parasite must grow in the mosquito for a week or more before infection can be passed to another person. If, after a week, the mosquito then bites another person, the parasites go from the mosquito’s mouth into the person’s blood. The parasites then travel to the person’s liver, enter the liver’s cells, grow and multiply. During this time when the parasites are in the liver, the person has not yet felt sick. The parasites leave the liver and enter red blood cells; this may take as little as 8 days or as many as several months. Once inside the red blood cells, the parasites grow and multiply. The red blood cells burst, freeing the parasites to attack other red blood cells. Toxins from the parasite are also released into the blood, making the person feel sick. If a mosquito bites this person while the parasites are in his or her blood, it will ingest the tiny parasites. After a week or more, the mosquito can infect another person.
What are the signs and symptoms of malaria?
Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death.
How soon will a person feel sick after being infected?
For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 8 days or up to 1 year later. Two kinds of malaria, P. vivax and P. ovale, can relapse; some parasites can rest in the liver for several months up to 4 years after a person is bitten by an infected mosquito . When these parasites come out of hibernation and begin invading red blood cells, the person will become sick.

Prevention

Now you know a lot about this disease. More important is, how to prevent yourself. 
Prevention needs A, B, C and D:
à Awareness of risk. 
à Bite avoidance (avoiding mosquito bites, watch out for them). à Chemoprophylaxis (taking prevention medicines if you are traveling to or living in a malaria region). 
à Diagnosis are made immediately with early treatment of an infected case.

So, there are four very important points when we are talking about prevention. After reading about malaria the first point is done, you now what it is and the what the risks are. The other three are not discussed yet, so that is what we are going to do now!

What can you do yourself?
Important to know is that mosquitoes especially bite at in the evening and night, when it is (almost) dark. So, during this time you have to prevent yourself the most. When you are outside after sunset you better wear long trousers, long-sleeved clothing and socks which are thick enough to stop 
them, this is of course hard to follow in a hot climate. Light colors are less attractive to mosquitoes. When you go to bed, it is very important that the bedroom and so you are prevented. Spray the room with an insecticide before entering to kill all the mosquitoes which have entered during the day. The windows and doors must be screened with gauze and no holes in it. 
An air-conditioned room is good too. If the room can not be screened or if there are any other holes in it, you should use an mosquito net. 
To protect yourself from this terrible disease you also can use a special repellant cream. The most effective one is the one which contains diethyl toluamide (DEET). This works on adults, children and pregnant women and is safe as long as the recommendations are not exceeded. 
Other products are less effective but may have some use. Lemon scent was found to protect citrus groves from mosquitoes and refined lemon eucalyptus oil on skin also repels mosquitoes.


Medicines
When you are going to visit a country were there is malaria, it is important to get medicines. That is not easy, there are different kinds and it really can become a problem, there are some points to think of when you are choosing.
1. The type of malaria present in the area you are travelling to.
2. The risk of being bitten by a mosquito.
3. Individual considerations: 
- are you pregnant/breastfeeding/epileptic?
- is the medicine for a child? 
- are you already regularly taking other medicines? 

There are currently six medicines on the market, here are they, with some details:
A few times we have written something about resistance, we'll explain that later on. 
- Chloroquine. 
This is taken weekly
- Proguanil 
This is taken daily 
These two are sometimes combined, e.g. in areas were there is a high chloroquine resistance. 
- Mefloquine (Lariam)
This is taken weekly
This is a medicine which especially is used in areas were there is a high chloroquine-resistance, so in 90% of Africa this is used. 
- Doxycycline
This is taken daily
- Malarone (containing proguanil and atovaquone)
It is taken daily
It is in some ways the same as mefloguine, but it only prevents for Plasmodium falciparum malaria. 
The last two we mentioned, Malarone and Doxycyline, are the first choice in areas were the malaria is resistant to mefloquine and chloroquine. 
- Maloprim (containing pyrimethamine and dapsone)
This drug isn’t used any more, because it has some negative effects.

The malaria mosquito has became much more resistant to the drugs during the years, medicines that protected you five years ago maybe do not work anymore. The resistance to cloroquine is increasing and throughout sub-Saharan Africa, Southeast Asia, the Indian subcontinent, and large portions of South America the malaria Plasmodium falciparum already resist that drug. So, that is why we still try to invent new medicines. 

Treatment

How is the disease diagnosed?
The symptoms of malaria are similar to those of many other feverish diseases and infections, which can upset the stomach. That is why you should always tell your doctor if you have been abroad, especially if you have been to the tropics in the last 12 months and if you are feeling ill.
The actual diagnosis is made by detecting the parasite in the blood. This is done using a special product mixed with one to two drops of the patient's blood and spreading it on a microscope slide. This is then stained and examined carefully under a microscope. The examination may have to be repeated if the fever has only just begun and/or preventive medication is to some extent keeping the numbers of the malaria parasite low.

But what if you do get malaria?
When you have malaria, normally you would go to a hospital for treatment, especially when it is malignant malaria, which can have a fatal outcome in only a few days. When getting qualified treatment is impossible, e.g. when you are in a remote area, then you can choose for outpatient treatment, or even self-threatment, but qualified is better of course. When you have used the correct product, in correct amount and regularly before catching it, then there is a big chance that this parasite was resistant to the product, then you better use another product for threatment. Otherwise, if you have not used anything before, (which is not clever!) you better start with the best one for that area immediatly, the best one is the one with the lowest resistance. 

Possible solutions

As you know, malaria can be fatal. Therefore it is important to prevent the disease. Of course that often does not success. The mosquito sustains the disease. There are far too much mosquitoes to be all killed, so that is no possible solution. 
What people can do, is to avoid the mosquitoes as much as possible. In rural areas this is more difficult, because they are poor, so they can not buy protecting things like we have (e.g. mosquito-sticks). The education is not that good, and health is also bad. Not only because of malaria, there are also other diseases and the daily using things are also bad; bad water to drink and no clean clothes or toilets etc. Our possible solutions for that is:
· better education. Send people to school and teach them about the important things for health etc. in life.
· more money. Collect money in richer countries for charity, so there can be built schools, toilets, houses and of course money for medicines. Just give them a better life, like us!
· send people to teach them education etc. And learn them how to keep the toilets etc. clean, so there will be less diseases. And there are less mosquitoes in buildings than outside. They can also teach them how to protect themselves to the mosquitoes, for example with the mosquito nets. 
· invent new medicines. This is of course a difficult solution, because you can not invent a new, good medicine on one day to another, but it is possible to invent a new one. Maybe there is then more money needed, but that can be collected in richer countries, like told above. 
These are some possible solutions we thought of. There is a (big) chance that the solutions will fail because of the richer countries that do not want to help. The people who will teach them education and how to solve health problems etc. may be women. They can teach it to the women there, who will teach it to their children. If the solutions want to succeed, people of other countries must help. If they do not, there is less chance that our solutions will help. 

Conclusion

This was the topic about malaria, one of the biggest health problems in the world. In a few sentences it is:
A terrible disease that causes a very big problem for the health of people in tropical and subtropical regions. The parasite attacks the red blood cells in your blood. There are four different types; Plasmodium falciparum is fatal, the others not. Mosquitoes sustain it by biting people with malaria. When they bite the next person, that one also gets malaria. Malaria has to be stopped and helped, especially in the rural areas.
There must be even more and better protection to make less people die. More people must know exactly how the disease works, what the symptoms are and what they can do about it (how they can protect themselves).
The provided solutions are that you have to take medicines and that you have to go to see your pharmacist before you go abroad. Our solutions also include medicines, but also education (and of course more money), clean environments and help of the outside countries. If the other (richer) countries are able to help and will help, the fighting against malaria can succeed more than before. 
Excially the information in this topic must be read by more people than only you, because more people must know the importance of the disease malaria!!

After word

We chose a subject, found the information and divided it in two parts. We read all the text and made our own story from it. Then we made all the other things and printed it out and now it is ready for reading!
What we liked about the project? We could choose a subject and we really worked together. 
We have learned a lot about this subject during this project and perhaps we’ll think back if we’re going to the tropics J !

Sources

We used:
o internet; www.google.com à http://www.who.int/inf-fs/en/fact094.html
o lots of brochures about malaria
o Geography in action