Malaria Flashcards by Iseoluwa Ojo

Malaria is a disease caused by (obligate or facultative ?) _____cellular protozoa of the genus __________

it may be acute or chronic.

Obligate

Intra

Plasmodiuman

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Plaasmodium infection is the ____________________________ with or without signs and symptoms

presence of the parasite in the blood

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History

Disease probably originated in _____ and affected prehistoric humans

Was widespread in the (colder or warmer?) regions globally

______ named the disease mal aria (_______) in the 18th century

Africa; warmer

Italians; foul air

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History of malaria

Reference to _________ found in early Hindu and Chinese writings

__________ , the Greek Physician, described the clinical manifestations and some of the complications of malaria in the fifth century B.C
The _____ of the Peruvian quina-quina (______) tree was successfully used for treatment of ________ in the early 17th century

periodic fevers

Hippocrates

bark; Cinchona; intermittent fever

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History of malaria

However, the active ingredient in chinchona tree ( _________ ) was first extracted, isolated, purified and named by French Pharmacists Pierre Joseph Pelletier and Joseph Bienaime Caventou in 1820.

Major breakthrough in the understanding of the etiology was by Laveran, a French army Surgeon in Algeria, in 1880, who first _____________ in a fresh blood from a patient.

alkaloid quinine

described the ex-flagellated gametocytes of P. falciparum

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History or malaria

Transmission remained a mystery until 1880’s, when Patrick Manson discovered that _____ was transmitted by ______ and postulated that malaria might also be _______. This was confirmed by ______ in India, in 1897.

The complex cycle of development was confirmed by Bignami, Bastianelli, and Grassi in Italy in 1898 & 1899, and by Manson et. al., in London & Rome in 1900.

filariasis; mosquitoes

vector borne; Ronald Ross

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Epidemiology
Globally in 2021, there were an estimated ________ malaria cases in _____ malaria endemic countries an increase of _______ cases compared with 2020.

247 million

84; 2 million

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Epidemiology

Four countries accounted for half of all malaria cases globally: ______ accounted for the highest proportion of cases globally (27%), followed by the ____________ (10%), _____ (6%) and ________ (4%).

Nigeria

Democratic Republic of the Congo

India

Mozambique

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Epidemiology

Between 2019 and 2020, estimated malaria cases increased from 218 million to 232 million, and deaths from 544 000 to 599 000 in the WHO African Region

This region accounted for about 95% of cases and 96% of deaths globally; 78.9% of all deaths in this region
were among _________

children aged under 5

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Epidemiology

High-risked groups are children < ___ years, ______ women, __[_ infected persons and _____________

Estimated ____% of all malaria deaths occur in Sub-Saharan Africa, while U5 years account for ___% of all deaths.

5; Pregnant; HIV

non-immune visitors

90; 78

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Epidemiology

140 million Nigerians are at risk of having malaria

____% of population are likely to have an episode of malaria a year

Malaria accounts for >___% of hospital visitations

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Malaria is transmitted by the _________________.

female anopheles mosquito

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Factors which affect mosquito ecology, such as _______ and ________, are key determinants of malaria transmission.

temperature and rainfall

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Mosquitoes breed in (cold or hot?) , ____ areas and below altitudes of ______ meters.

Development of the malaria parasite occurs optimally between ___-___oC and stops below ___oC.

Hot; humid

2000

25-30

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Endemicity refers to the _______ of malaria in an area or community.

Malaria is said to be endemic when there is a __________ over a period of __________

amount or severity

constant incidence of cases

many successive years.

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Endemic malaria may be present in various degrees. Recognised categories of endemicity include :

A. Hypoendemicity -_____ transmission and the disease has ______ effect on the population.

B. Mesoendemicity -______ intensity of transmission; typically found in the _______ communities of the sub-tropics.

C. Hyperendemicity - ______ but ______ transmission; _______ is insufficient to prevent the effects of malaria on all age groups.

little; little

varying; small, rural

intense; seasonal

immunity

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Endemic malaria may be present in various degrees. Recognised categories of endemicity include :

D. Holoendemicity - ______ transmission occurs _____ the year.

As people are continuously exposed to malaria parasites, they gradually develop ______ to the disease. In these areas, severe malaria is mainly a disease of _____ from ______ to ______.

______ women are also highly susceptible because the natural immune defence mechanisms are impaired during pregnancy.

intense; throughout; immunity

children; the first few months of life to age 5 years

Pregnant

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Endemic malaria may be present in various degrees. Recognised categories of endemicity include :
A. ____endemicity
B. ____endemicity
C. _____endemicity
D. ____endemicity

Hypo
Meso
Hyper
Holo

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Etiology of malaria

Plasmodium ———-
Plasmodium _______
Plasmodium _______
Plasmodium ______
Plasmodium _______

falciparum

malariae

ovale

Vivax

knowlesi

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Etiology of malaria

Plasmodium falciparum (> ____% of infections )

Plasmodium malariae (<___ %) Plasmodium ovale (<___ %)

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Etiology

Plasmodium species that are found in man and they undergo ____ cycles of asexual division (_______ or _______ ) in ____ and _____ sexual reproductive cycle ( _______ ) in ______

Two; schizogony, or merogony

man

Single

sporogony; mosquito

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most dangerous species of plasmodium

Falciparum

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Plasmodium _______ is not found in Nigeria

Plasmodium ______ is zoonotic

vivax

knowlesi

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Relationship Between the Life-cycle and the Manifestations of Malaria

Relapse:________ of parasitaemia (from ___________ phase in the _____ = _______ stage) in a sporozoite-induced infection following adequate ___________ therapy;

E.g P._______ & P. ______ infections

Re-appearance

exoerythrocytic; liver

hypnozoite

blood schizonticidal

ovale; Vivax

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Relationship Between the Life-cycle and the Manifestations of Malaria Recrudescence: _____ease in parasites that has persisted at ___ levels in the blood. E.g —————————- P. ______ & P. _______ infections

Incr low inadequately treated P. falciparum & P. malariae infections

Relationship Between the Life-cycle and the Manifestations of Malaria Synchronicity: Tendency for Parasites to _________ causing _________ to occur at ____________:

grow in synchrony fever paroxysms; regular intervals of time

Relationship Between the Life-cycle and the Manifestations of Malaria Synchronicity: ______ in tertian malaria ( benign tertian malaria due to P. ____ & P. ______ , and Malignant tertian malaria due to P. ______) ______ in quartan malaria due to P. ____

48 hrs; vivax; ovale falciparum 72 hrs; malariae

The periodicity of fever becomes (more or less?) regular as the malaria infection progresses

Relationship Between the Life-cycle and the Manifestations of Malaria Sequestration This is the _______ of the parasites from ____________ and be retained or sequestered in ___________. This is characteristic of P. _________ infection

removal of stages peripheral bloodstream various host tissues falciparum

Relationship Between the Life-cycle and the Manifestations of Malaria Sequestration In P. falciparum, __________(_____) are present in ___________ and later developmental stages such as the ______ are sequestered within the _____ of various organs

early trophozoites (rings) peripheral circulation schizonts capillaries

Sequestration is caused by the ________________________________________ by means of a specific interaction between a _______ molecule present at the surface and specific host cell receptors

adherence of infected erythrocytes to capillary endothelial cells parasite-derived

Sequestration The packing of cerebral capillaries with these adherent, highly metabolically active cells is responsible for ______________ (including _______ and _____ ), which may in turn lead to ______ and —————

local metabolic defects hypoglycaemia and hypoxia comma and cerebral malaria

e.g of red cell receptors in sequesteration are: _______,______,______,______ etc

ICAM-1,CD36, VCAM-1, Chondroitin sulphate

sequestered _____ in capillaries consume _____% more glucose than ______ in peripheral circulation

Schizonts 75 Trophozoites

Sequestration has an important consequences for the diagnosis of _______ malaria as parasites may __________________ at a time when the clinical picture is most suggestive

falciparum not be found on a blood film

Sequestration During pregnancy, infected erythrocytes are preferentially retained in the ______. This is more common among the _______ than women who __________

placenta primigravida have had more than one pregnancy

Pathophysiology of Malaria Pathophysiologic changes involve many different organ systems and stem from several different parasite derived stimuli ______-stage parasites are the main source of stimuli __________ stages, ________, and _______ do not induce pathophysiologic changes

Blood exoerythrocytic gametocytes; sporozoites

Pathophysiology of Malaria ______ enter the blood and within minutes attach to and invade the ___ cells by binding to ______ and _____ The Multiply rapidly and as many as ———- _______ are released when each infected _____ ruptures

Sporozoites liver; thrombospondin and properdin 30,000 merozoites hepatocyte

P. _____ and P._____ form hypnozoites

vivax; ovale

Pathophysiology of malaria _______ bind by parasite _____-like molecule to ______ on the ____ molecules on the surface of RBCs

Merozoites lectin sialic residue; glycophorin

Pathophysiology of malaria Within the RBC , parasite grow in ________ bound ________ to become ________, hydrolyses _____, polymerises ____ to form _________ Divide to form —————- or _________ Infected RBC _____ to release _____

membrane digestive vacuole mature trophozoites ; haemoglobin haem; hemozoin pigment. schizont –merozoites or gametocyte lyses; merozoites

P.falciparum infects rbcs of ___ age

any

Pathophysiology of malaria P. vivax and P. ovale preferentially invade ______ and therefore only very rarely cause parasitemias greater than ____%.

reticulocytes; 2

Pathophysiology of malaria P. malariae preferentially infects (younger or older?) erythrocytes and may cause (acute or chronic?), (symptomatic or asymptomatic?) parasitemia lasting for many years

Older Chronic ; asymptomatic

Pathophysiology of malaria Pf infected cells clump together (______)s\ and sticks to _______ of (small or large?) blood vessels ( ________ ) and thereby __________

rosetting; endothelial lining Small sequestration blocks blood flow

Pathophysiology of malaria Several proteins including __________________ (PfEMP1) form ______ on the surface of rbcs. PfEMP1 binds to ligands on endothelial cells including _____,_______,______,________

P. falciparum erythrocyte membrane protein 1 knobs CD36,thrombospondin,VCAM1,ICAM1 and E-selection

Pathophysiology of malaria ______ due to poor perfusion –_________–main cause of death in ________.

Ischaemia cerebral malaria children

Pathophysiology of malaria Pf induces high levels of ______ production including _____,______, and _____ by releasing of parasite proteins like _______________ (MSP)

cytokine TNF, IFN-γ and IL-1 merozoite surface protein

Pathophysiology of malaria Cytokines ________ the production of RBCs, _____ease fever, induce _______ production –tissue damage and induce expression of ___________ for ________ , thereby increasing __________

suppress incr; nitric oxide endothelial receptors for PfEMP1 squestration

Pathogenesis of malaria Most of the pathologic findings of malaria result from ___________

the destruction of red blood cells.

Red cells are destroyed both by the ____________ and by the action of ______________________

release of the merozoites the spleen to first sequester the infected red cells and then to lyse them.

The enlarged spleen characteristic of malaria is due to ___________, coupled with __________ of __________ and __________

congestion of sinusoids with erythrocytes hyperplasia of lymphocytes and macrophages

Malaria caused by P. __________ is more severe than that caused by other plasmodia.

falciparum

Plasmodium falciparum It infects far more red cells than the other malarial species T/F

Plasmodium falciparum occlusion of the capillaries with aggregates of parasitized red cells leads to life-threatening _______ and _______, particularly in the ________

hemorrhage and necrosis brain

Plasmodium falciparum extensive hemolysis and kidney damage occur, with resulting _________. The ——- colored urine gave rise to the term “ __________ .”

hemoglobinuria dark blackwater fever

Plasmodium falciparum The hemoglobinuria can lead to _________

acute renal failure.

Host resistance to malaria Inherited genetic alteration in RBCs –________________________________ Absence of protein to which parasite bind – Absence of ________________– P. _______ Immune response due to ______________________________

Heterozygous sickle cell trait (HbAS, HbAC) Duffy blood group antigen ; Vivax repeated or prolonged exposure to Plasmodium spp

Clinical features of uncomplicated malaria – Acute febrile _____ characterized by ___,_____, and ________ stages. – The symptoms include _____,________,________,__________ , nausea, GIT complaints etc.

paroxysms; cold, hot, and sweating fever, body and joint aches, headache, loss of appetite

Clinical features of uncomplicated malaria Signs- _____eased temperature _____cardia ________________ ____________ skin e.t.c

Incr Tachy hepatosplenomegally warm flushed

Clinical features of Severe or complicated malaria _______ consciousness but _____ ______ malaria (____________). _______tion, extreme ______ shock ______ failure Respiratory _____ Multiple ________ Circulatory collapse/shock (______ malaria) Pulmonary ______

Impaired; rousable Cerebral; unarousable coma Prostra; weakness Renal; distress; convulsions Algid ; oedema

Clinical features of complicated malaria Abnormal _______ Jaundice ____scopic ________ Severe anaemia (hb <__g/dl or PCV <___%). _____glycaemia (<40mg/dl or 2.2 mmol/L) Metabolic (acidosis or alkalosis?) _____pyrexia (T ≥____°C) or ____°F Hyperparasitaemia (——% or ________/μl)

bleeding Macro; haemoglobinuria 5; 15 Hypo; acidosis ; Hyper; 40.5; 106 5; 500000

MALARIA DIAGNOSIS CLINICAL DIAGNOSIS- This is _______, based on clinical signs and symptoms of _____,________,________etc.

presumptive; fever, anorexia, malaise

MALARIA DIAGNOSIS LABORATORY DIAGNOSIS This is _____ and (more or less?) reliable. WHO current policy is that there must be _____________ before antimalarial administration

definitive More parasitological diagnosis

LABORATORY DIAGNOSIS of malaria laboratory techniques to confirm and diagnose malaria : the traditional ______ techniques, _____________ tests (RDTs) and molecular techniques such as the ___________

microscopy rapid malaria diagnostic polymerase chain reaction (PCR).

WHO 2010 Policy on Malaria the policy allows: •_____________________ of non-malarial febrile illness •greater certainty on the incidence of malaria enabling the _____ to predict accurately the ________ and target programme resources to areas with greatest malaria burden •the NMEP to assess the impact of changes in malaria control interventions such as ITN and IRS.

enhanced management NMEP; antimalarial drug requirements

Laboratory diagnosis of malaria __________ is the gold standard

Microscopy

Laboratory diagnosis of malaria ____________ film made from peripheral blood and stained with _______. ________ or ________ stains may also be used It is (simple or complex?) , (low or high?) cost with (low or high?) specificity and ability to assess parasite density.

thin and thick; Giemsa Wright’s or Field’s Simple; low High

Thick Blood Film is used for : – Parasite _______ – Parasite ________ Thin film –parasite _______

identification; density Speciation

Quantitative Buffy Coat Test – Blood is mixed with ______ –_______ in a capillary tube – Read directly with a ___________

acridine orange Centrifuge fluorescent microscope.

Rapid Diagnostic Tests (RDTs) RDTs are based on the detection of _________________.

circulating parasites antigens

Rapid Diagnostic Tests (RDTs) RDTs are based on the detection of circulating parasites antigens. Which include: –____________ (HRP2) (recommended for the diagnosis of malaria in all age groups.) –____________(PLDH) – _________ . Immunological based technique

Histidine Rich Protein 11 Plasmodium Lactate Dehydrogenase Aldolase

E.g. of RDTs ___________ test- Malaria antigen or enzyme test- (PfHRP-II). __________________- (PfHRP-II).  ‘_________ Test’-Detection of Parasite Lactate Dehydrogenase (pLDH).

ParaSight FTM Immuno-chromatographic card (ICT) OptiMAL

E.g. of RDTs  ParaSight FTM test- Malaria antigen or enzyme test- (_________).  Immuno-chromatographic card (ICT)- (________).  ‘OptiMAL Test’-Detection of _________

PfHRP-II PfHRP-II pLDH

Rapid diagnostic tests - 1 Para Sight F Test – A dip stick antigen capture assay – Using a ________ against ___________ (PfHRP-2) – It is a (slow or rapid?) , sensitive and specific for P. ________.

monoclonal antibody P. falciparum histidine rich protein-2 Rapid falciparum

The Immunochromato-graphic test (ICT): OptiMAL • Dip stick coated with ________ against _____________ •Allows for _______ between the pLDH isoforms.

monoclonal antibodies; parasite lactate dehydrogenase (pLDH). speciation

pLDH is produced only by ________ Hence ICT-optimal test has the ability to differentiate _____ from ________

live parasites live from dead organisms

Advantages of RDT Unlike the various microscopy techniques, RDTs do not require _________ and are all based on the same principle and detect malaria antigen in blood flowing along a membrane containing specific —————— Minimal ________ is needed Not dependent on ______ _______ and can be used in PHCs Several studies have reported the performance of RDTs to be excellent.

laboratory equipment ; anti- malaria antibodies . training power; Portable

RDT limitations RDT limitations currently reported and experienced include _________, inability to be used as ‘__________’ diagnostic test, lack of community and Health worker ———- in them failure to detect mixed malaria infections.

variation in sensitivity stand alone confidence

RDT limitation Most of the available RDTs are P. _________ specific (either _____________ or ___________ ) while some RDTs detect P. falciparum and other Plasmodium proteins such as aldolase or pan-malaria pLDH.

falciparum protein histidine rich protein II -HRP-II or lactase dehydrogenase-LDH

OTHER INVESTIGATIONS for malaria Full Blood Count (FBC) - PCV, ____ (total & differential), _____ count & Coagulation tests Blood ______ level Blood Chemistry Urinalysis- haemoglobinuria, protein etc Screening for ______ deficiency

WBC Platelet Glucose G6PD

MALARIA TREATMENT General – ________ measures Specific measures – ____________

supportive antimalarial drugs

MALARIA TREATMENT General – supportive measures – ______ agents –_______ – oral or IV – Blood _______ – Anti- ______ and feeding – Treatment of associated conditions

Antipyretic Rehydration transfusion emetics

MALARIA CHEMOTHERAPY The choice of an antimalarial depends on a variety of factors classified into PARASITE FACTORS –  Parasite ____________  Level of ____________

strain or species drug resistance

MALARIA CHEMOTHERAPY The choice of an antimalarial depends on a variety of factors classified into PATIENTS FACTORS Patient’s general health and medical history – age and genetic origin of the patient (G6PD deficiency), immune status-

Yes

Malaria must be treated urgently and intensively in order to prevent complications or death. T/F

AVAILABLE ANTIMALARIAL DRUG’S CLASS List 6

Biguanides Antifolates Phenantrine methanol 4-Aminoquinolines 8- Aminoquinolines Cinchona Alkaloids

AVAILABLE ANTIMALARIAL DRUG’S CLASS 4-Aminoquinolines •_________,________ 8- Aminoquinolines •_________ Antifolates •______ ,_________ Biguanides •_______,________ Cinchona Alkaloids •________,_______ Phenantrine methanol •_________,________,________

Chloroquine, amodiaquine primaquine Sulphones, sulphonamides proguanil, pyrimethamine Quinine, quinidine Halofanthrine, desbutylhalofantrine, lumephantrine

AVAILABLE ANTIMALARIAL DRUG’S CLASS PANSQ

Pyronaridine Antibiotics Naphthoquinones Sesquiterpene lactones Quinoline Methanols

AVAILABLE ANTIMALARIAL DRUG’S CLASS Sesquiterpene lactones •________ – Quinoline Methanols •__________ – Naphthoquinones •__________ – Pyronaridine •______________,

Artemisinin derivatives mefloquine Atovaquinone a benzonaphthyridine

Treatment solely on the basis of clinical suspicion should only be considered when a ____________________

parasitological diagnosis is not accessible.

________________ are the recommended treatments for uncomplicated P. falciparum malaria.

Artemisinin-based combination therapies (ACTs)

The following ACTs are recommended for use in Nigeria ____________ and __________

Artemether-lumefantrine, Artesunate-amodiaquine,

Artemisinin and its derivatives should be used as monotherapy in the treatment of uncomplicated malaria T/F

F Should not

________ is the recommended medicine for the treatment of uncomplicated malaria in the first trimester and in children less than 5kg, however, ACTs can be used under supervision by the health care provider

Oral Quinine

_________ is the recommended treatment of uncomplicated malaria in the second and third trimesters of pregnancy.

ACTs

Severe malaria is a medical emergency. After rapid clinical assessment and confirmation of diagnosis where feasible, commence immediate treatment with parenteral medication. _________ ———— is preferred for the treatment of severe P.falciparum malaria

Intravenous artesunate

Severe malaria _________ Or ________ is an acceptable alternative if artesunate is not available.

Parenteral quinine or artemether

Parenteral antimalarial medicines in the treatment of severe malaria should be administered for a minimum of ______ once started (irrespective of _________________) and thereafter, complete treatment with a complete course of ________

24 hours the patient's ability to tolerate oral medication earlier an ACT

In settings where complete treatment of severe malaria is not possible, patients should be given ______ treatment and _____ immediately to an appropriate facility for further treatment.

pre-referral referred

The recommended pre-referral treatment options include any of these; ___________ or ______ , and ________.

artesunate IM or rectal quinine IM

The recommended chemoprophylaxis for non immune visitors will be as available in the visitor's country of origin or as recommended in Nigeria. T/F

______________ is the recommended medicine for Intermittent Preventive Treatment in Pregnancy

Sulphadoxine-Pyrimethamine

PROPHYLACTIC DRUGS ________ (LariamR). ________ (VibramycinR) __________________ (Proguanil) Others: ________ (Atovaquone + proguanil) ,_______ and _______

Mefloquine Doxycycline Chloroquine plus Paludrine Malarone; Pyrimethamine and Chloroquine

PROPHYLACTIC DRUGS Mefloquine (_______). It gives >____% protection and if combined with _____ against mosquito bites, about ___%. Doxycycline (__________) Chloroquine plus Paludrine (_____) is useful in some parts of ____ but not recommended in _____

LariamR; 90; personal protection; 99 VibramycinR Proguanil; Asia; Africa

Doxycycline is not an effective alternative to mefloquine in Africa T/F

F It is

Malaria prophylaxis is generally not necessary in persons living in a malaria endemic area T/F With reason

T because it may slow down the ability of the individual to develop partial immunity which protects from developing the severe form of the disease.

Intermittent Preventive Therapy (IPT) with ____________ is recommended for pregnant women Non-Immune Visitors / Residents - __________ or _________

Sulfadoxine-Pyrimethamine Mefloquine or Atovaquone-Proguanil

Control of malaria in pregnancy •Intermittent preventive treatment(IPTp) -Requires a functional and effective health care system -____________(ITN) -Use currently low in the country Distribution and utilization being promoted by various bodies e.g. RBM Prompt diagnosis & treatment of cases with effective drug

Insecticide treated bed nets

Chemoprophylaxis versus IPT Chemoprophylaxis aims at sustaining blood levels ___________________________ for a prolonged period. IPT on the other hand is the use of ___________ given in treatment doses at predefined intervals e.g after the 1st trimester (Adopted in 37 countries)

above minimum inhibitory concentration (MIC) antimalarial drugs

IPT is Better for residents of endemic countries T/F

Mechanism of resistance resistance appears to occur through _________ that confer reduced sensitivity to a given drug or class of drugs

spontaneous mutations

For some drugs, only a single point mutation is required to confer resistance, while for other drugs, multiple mutations appear to be required. T/F

Mechanism of resistance drug pressure will __________ while _____________

remove susceptible parasites while resistant parasites survive.

Mechanism of resistance Single malaria isolates have been found to be made up of _____geneous populations of parasites that can have widely varying drug response characteristics, from ______ to _____ Over time, ——— becomes established in the population and can be very stable, persisting long after specific drug pressure is removed.

hetero highly resistant to completely sensitive resistance

Chloroquine resistance Chloroquine resistance in P. falciparum appears to have a _______,_______ basis

multifactorial, multigenic

Chloroquine resistance The Chloroquine resistant P. falciparum are able to _________ to the extent that ___________ is prevented

expel the drug from the food vacuole inhibition of heme polymerisation

mutations in the pfcrt gene found on the parasite’s chromosome ____ and pfmdr1 gene, on chromosome ____ of P. falciparum have been linked with Chloroquine resistance

7 5

Resistance to ACTs The first evidence of resistance to artemisinins on the ___________ border emerged from routine efficacy testing in 2006.

Cambodia-Thailand

Resistance to ACTs The use of _____________ threatens the therapeutic life of ACTs by fostering the spread of resistance to artemisinin.

oral artemisinin-based monotherapies

Resistance to ACTs WHO recommends the withdrawal of _____________________ from the market and the use of ______ instead, as endorsed by the World Health Assembly in 2007. It also calls upon manufacturers to cease production and marketing of oral artemisinin- based monotherapies.

oral artemisinin- based monotherapies ACTs

Malarial control STRATEGIES: (i) disease management through early ________ and complete _______ (ii)_________________ (IVM) to reduce the risk of ______________________ (iii) supportive interventions which include communicating behaviour change, capacity building and monitoring and evaluation of programmes.

case detection; treatment integrated vector management vector-borne transmission

VECTOR CONTROL TECHNIQUES Measures directed against the vector: Destroying __________- The use of indoor residual insecticides especially in cases where the vector enters houses and feeds predominantly on man.

adult mosquitoes

VECTOR CONTROL TECHNIQUES Measures directed against the vector: Destroying adult mosquitoes- The insecticides in common use are; _________ e.g. DDT (____________, indoor residual spray’ (IRS) with synthetic _______

Chlorinated hydrocarbons dichlorodiphenyl pyrethroids

Antilarval Measures Mechanical: Prevent the breeding of mosquitoes by _________ e.g. the ___________ , flooding or flushing of breeding places and also ___________ in ponds, pot-holes, drainages, ditches etc.

altering the habitat drainage of swamps filling

ANTI-LARVAL measures Chemical: the _________, such as _________ derivatives, ______ and _____ , and Paris Green,on pools and collection of water found to be breeding sites.

spraying of larvicides petroleum oil dieldrin and aldrin

Anti-larval measure Biological: includes introduction of ________ e.g._______ and _____ ; & use of Biocides from bacterium ___________

larvivorous fish gambusia & guppy Bacillus thuringiensis .

VECTOR CONTROL OPTIONS- 2 Measures designed to reduce man’s contact with anophiline mosquitoes include: _______ of houses Mosquito _____ – particularly ____________

Siting bed nets pyrethroid-treated bed nets (ITN)

VECTOR CONTROL OPTIONS Clothing- wearing protective clothing such as long trousers, long skirts, sarongs, and garments with long sleeves. Mosquito (insect) repellents- e.g. _______ and __________

diethyl toluamide and dimethyl phthalate.

Malaria elimination This refers to the ________________________________________ as a result of delibrate efforts.

reduction of the incidence of infection to zero in a defined geographical area

Malaria eradication is the (temporary or permanent?) reduction to ____ of the worldwide incidence of infection caused by a particular malaria parasite species. Intervention measures will no longer be needed once this has been achieved.

Permanent zero

PREVENTIVE OPTIONS FOR MALARIA- Malaria vaccine(_______ ; brand name: ____) for children Avoiding mosquito bites- so reducing the risk of infection. Chemoprophylaxis- using drugs to prevent ________ before or after transmission has occurred.

RTS,S; mosquirix symptomatic infection

PREVENTIVE OPTIONS FOR MALARIA- IPTp=________________ in _______ (__ or more doses) 37 countries adopted IPTi= in __________ and _________ (6 of 16 Countries recommended by WHO adopted it not yet implemented

Intermittent preventive therapy in pregnancy; 3 infants and children U5 years

Malaria Chemoprevention IPTp – Administration of _____________ during 2nd & 3rd trimester of pregnancy

sulfadoxine-pyrimethamine (SP)

Malaria chemo prevention Seasonal malarial chemoprevention (SMC) with ________ plus ______ (AQ+SP) for children aged 3- 59months (works by maintaining therapeutic antimalarial drug conc in the blood during periods of greatest malaria risk.

amodiaquine plus SP

Malaria chemo prevention IPTi with ____ delivered at routine childhood immunization clinics (protect in the ______ year)

SP first 1

Other Control Strategies ____________ mosquitoes ____prophylaxis and _______-treated livestock _______ administration to humans _____-baited mosquito trapping systems

genetically modified Zoo; insecticide Ivermectin Odor

We should pay a lot of attention to P.falciparum T/F

P.falciparum Affects ___ ages of rbcs Affects ____ age groups Affects ____ organs

all All Most

Most prevalent plasmodium specie in Nigeria ??

Falciparum