Review Of Clinical Features Of Malaria

Malaria has had a major impact on the life and economies of affected populations since antiquity. Ancient Assyrian, Chinese and Indian religious and medical texts made references to intermittent and seasonal fevers. Hippocrates in 500Bc first described the clinical features of malaria and some of its complication. Association of fever with stagnant water and swamps, led to the drainage of such waters by the Greeks and Romans in the 4th, 5th and 6th century BC. In the early 17th century, the “Peruvian Bark” or Jesuits Powder” was discovered to be of value in the treatment of certain fevers. The tree was later to be named cinchona from which quinine was extracted in 1820. Such fever was known as the agues in England, in Italy as mal'aria and in France as Palludisme due to their association with the fetid air of marshlands. Malaria was an effective obstacle to the colonization of the African heartland by the European Powers in the 16-19th centuries; till quinine chemoprophylaxis was introduced in 1850. Significant progress was made in the understanding of malaria with the description by Laveran of malaria parasites in blood film in 1880. Ronald Ross in 1891 demonstrated the development of malaria parasites in mosquitoes. Patrick Mansion in a series by field experiments confirmed the transmission of malaria by the bite of Anopheles mosquitoes in 1900. The worldwide distribution of malaria peaked by the end of the 19th and beginning of the 20th country. Apart from the tropics and subtropics, it was common in the temperate lands including the USA, Europe, Northern Eurasia and Asia. In the early part of the 20th century larvicidal and natural methods were engaged to control vector breeding. The ravages of malaria during the World Wars, and the scarcity of quinine stimulated research into discovery of synthetic antimalarials. This resulted in the introduction of pamaquine in 1924 (Germany), mepecrine 1930 (Germany), chloroquine1934 (Germany), proguanil 1944 (England) amodioquine 1946, primaquine 1950 and pyrimethamine in 1952 (USA). DDT, (dichlorodiphenyl –trichloroethane ) with residual insecticidal action was discovered in Switzerland in late 1940 raising great hopes for the prospect of global malaria eradication. In 1957 the world health organization launched the Global Malaria Eradication Campaign. The programming went on for the next 15 year with excellent results in North America, Europe, Former USSR, part of Asia and Australia. The result in tropical countries was less dramatic. Malaria continues to be a major cause of human morbidity and mortality. It is the world's largest killer of all parasitic diseases and a major public health problem. Although malaria has been eradicated in most temperate zones, it still affects 40% of the world population living in endemic zones of the tropics and subtropics namely; Central and South America, Hispaniola, Sub-Saharan Africa, the Indian subcontinent, South East Asia, Middle East and Oceania [Fig. 1]. Current malaria facts and figures are daunting: worldwide, 2.4 million people are at risk of malaria, with 300 to 500 million people affected annually. Malaria results in 1 to 3 million deaths annually with 90% of the deaths occurring in sub-Saharan Africa. Most of the deaths are of under 5-year old children. In Africa, malaria is the leading cause of under 5 mortality as it kills an African child every 30seconds. It makes up 10% of the disease burden, contributing 30% to 50% of inpatient admissions and 50% of outpatient consultation. Malaria accounts for 40% of public health expenditure and reduces the annual GDP by 1-4%. Key Words: malaria, severe disease, resistance Orient Journal of Medicine Vol.16(2) 2004: 38-58