To mark World Malaria Day on Saturday, the World Health Organisation (WHO) has released updated guidelines for the treatment of the disease, especially for malaria-endemic regions such as South East Asia. However, experts have said that some of these new guidelines are already in practice and some are debatable.
The first recommendation made by the WHO is use of artemisinin-based combination therapies (ACTs). Artemisinina and its derivatives are a group of drugs that possess the most rapid action of all current drugs against malaria. Treatments containing an artemisinin derivative (artemisinin-combination therapies) are now standard treatment for malaria worldwide.
The second recommendation by states: “To ensure malaria drugs are used only for those who have the disease and that — when a test is negative — other causes of fever are investigated."
Doctors from India said this is already an established protocol for treating malaria. The second recommendation by the international health agency, however, was not well received by them.
“The second guideline is not something that can be blindly followed in a malaria-endemic country ours. Many a times, patients test false negative. In such cases, the clinician’s judgement becomes imperative in administering malarial treatment based on symptoms and empirical findings,” said Dr Monica Goel, consultant physician at Hinduja Hospital.
“These are guidelines or advisory frameworks and must not be assumed to be directives. If a clinician has a high index of suspicion and test reports are negative, it is well within the doctor’s judgment to treat a case for malaria,” said Dr Hemant Thacker, consultant physician at Bhatia Hospital.
The third key recommendation by the WHO said the most vulnerable groups in malaria-endemic areas — pregnant women, children under five and infants — should receive preventive treatment to reduce the risk of malaria. The experts said there is no preventive treatment for malaria.
“There is no medicine that one can take to prevent malaria. There are only precautions that one can exercise is use mosquito nets,” said Dr Pratit Samdani, a consultant physician.
Curable and preventable
* Malaria is a life threatening disease that is transmitted by bites of infected mosquitoes. It is curable and preventable
* Increased prevention and control measures are dramatically reducing the malaria burden
* In an individual with compromised or low immunity, symptoms appear after seven days or more, after the infected mosquito bite
* The first symptoms – fever, headache, chills and vomiting – may be mild and difficult to recognise as malaria. If not treated within 24 hours, malaria can progress to severe illness, leading to death
* Children with severe malaria frequently develop one or more of the following symptoms like severe anemia, respiratory distress in relation to metabolic acidosis or cerebral malaria
* In adults, multi-organ involvement is also frequent. In malaria-endemic areas, persons may develop partial immunity, allowing asymptomatic infections to occur
* Clinical relapses may occur weeks to months after the first infection. In some cases, complete cure is possible after a special treatment.
Who are at risk?
* Young children, who have not developed protective immunity
* Pregnant women, especially in areas of high transmission. Malaria can result in miscarriage and low birth weight, especially during first and second pregnancies
* People with HIV/AIDS