AMITY SCHOOL OF PHYSICAL EDUCATION AND

SCIENCE.

2019-22

INTRODUCTION OF HEALTH EDUCATION

COMMUNICABLE:- MALARIA.

SUBMITTED TO: SUBMITTED BY:

DR.ASHWANI SAHANI. MONGAL DAS.

A030106219083

B.PES.

SECTION:B
DEFINATION AND INTRODUCTION

A communicable disease is an illness caused by a specific infectious agent or its toxic

products. It arises through transmission of that agent or its products from an infected
person, animal, or inanimate reservoir to a susceptible host, either directly or
indirectly (through an intermediate plant or animal host, vector, or the inanimate
environment). Control of disease is the reduction of disease incidence, prevalence,
morbidity, or mortality to a locally acceptable level as a result of deliberate efforts;
continued intervention measures are required to maintain the reduction. Control is to
be contrasted with elimination (reduction to zero of the incidence of a specified
disease in a defined geographic area as a result of deliberate efforts; continued
intervention measures are required), eradication (permanent reduction to zero

Communicable diseases may be classified according to the causative agent, the

clinical illness caused, or the means of transmission. Often all three characteristics are
used (e.g., food-borne Salmonella gastroenteritis). Causative agents include bacteria,
viruses, and parasites. Examples of bacterial diseases include pneumococcal
pneumonia and gonorrhea. Viral diseases include influenza, measles, and ebola.
Parasitic diseases include malaria and schistosomiasis. Other communicable
diseases may be caused by other types of microorganisms such as fungi (e.g.,
histoplasmosis). The types of illness include pneumonia, diarrhea, meningitis, or other
clinical syndromes.

Various categorizations of means of transmission have been used. The American

Public Health Association uses these categories: direct transmission, indirect
transmission, and airborne. Direct transmission refers to direct contact such as
touching, biting, kissing, or sexual intercourse, or the direct projection of droplet
spray into the eye, nose, or mouth during sneezing, coughing, spitting, singing, or
talking. This projection usually is limited to a distance of 1 meter or less. Examples of
direct contact transmission include rabies and sexually transmitted HIV (human
immunodeficiency virus). Direct projection is responsible for transmission of diseases
such as measles and influenza.

Indirect transmission may occur through a vehicle or an arthropod vector. The

causative agent may or may not multiply or develop in or on the vehicle. Examples of
possible vehicles include water, food, biological products, or contaminated articles
(such as syringe needles). Water-and foodborne diseases have the potential for
causing outbreaks involving thousands of persons. Before the causative agent was
identified, many cases of HIV resulted from blood transfusion. Since all donor blood
in the United States is now screened for HIV, this is no longer a significant means of
transmission. However, sharing of needles by injection drug users remains an
important factor in the AIDS (acquired immunodeficiency syndrome) epidemic.
Arthropod vectors can spread disease mechanically (as a result of contamination of
their feet or passage of organisms through the gastrointestinal tract) or biologically (in
which the agent must multiply or go through one or more stages of its life cycle before
the arthropod becomes infective). Mechanical spread by arthropod vectors is
uncommon. However, arthropod-borne diseases such as malaria (in which the parasite
develops within the mosquito vector) are still responsible for millions of cases and
hundreds of thousands of deaths each year in tropical countries.

Some infectious agents can be spread through the air over long distances. Airborne
spread requires that infectious particles are small enough to be suspended in the air
and inhaled by the recipient. Tuberculosis and histoplasmosis are bacterial and fungal
diseases spread in this fashion. Airborne transmission could also be used to
disseminate agents of biological warfare or bioterrorism. Anthrax and smallpox have
been considered among the most likely biological weapons.

Diseases of animals that can be spread to humans are called zoonoses. Some zoonotic
diseases include rabies, plague, and tularemia (rabbit fever).

METHODS OF CONTROL
Communicable diseases occur only when the causative agent comes into contact with
a susceptible host in a suitable environment. Prevention and control efforts
for communicable diseases may be directed to any of these three elements.
Communicable diseases affect both individuals and communities, so control efforts
may be directed at both. Treatment of persons with communicable diseases with
antibiotics typically kills the agent and renders them non-infectious. Thus, treatment is
also prevention. A simple way to prevent the occurrence of communicable diseases is
to eliminate the infectious agent through, for example, cooking food, washing hands,
and sterilizing surgical instruments between use. Assuring the safety of drinking water
through filtration and chlorination and treating sewage appropriately are other
important means of preventing the spread of communicable diseases.

For most communicable diseases there is an interval between infection and occurrence
of symptoms (the incubation period) in which the infectious agent is multiplying or
developing. Some persons who are infected may never develop manifestations of the
disease even though they may be capable of transmitting it (inapparent infection).
Some persons may carry (and transmit) the agent over prolonged periods (carriers)
whether or not they develop symptoms. Treatment during the incubation period may
cure the infection, thereby preventing both disease and transmission. This preventive
treatment (chemoprophylaxis) is often used in persons who have been exposed to
sexually transmitted diseases such as syphilis and gonorrhea. It also is effective in
persons who have been infected with tuberculosis, although the preventive treatment
must be given for several months.

10 Common Communicable Diseases

healthlove.in
1. Common Cold.

2. Influenza (The Flu)

3. Strep Throat.

4. Fifth Disease.

5. Gastroenteritis.

6. Pink Eye.

7. Chlamydia.

8. Herpes Infections.

9. Chickenpox.

10. Viral Hepatitis.

Each disease is characterised by its own set of symptoms and thus,

the communicable diseases listed below have the following symptoms
slideshare.net
 Influenza has symptoms of fever, constant coughing and
sneezing, sore throat and runny nose,...
 Chickenpox comes with fever, fatigue, vesicles on the body,
itchiness, fatigue.
 Gastroenteritis comes with pain in the...
 Malaria is a mosquito-borne infectious disease that affects humans and other animals.
Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In
severe cases it can cause yellow skin, seizures, coma, or death. Symptoms usually begin
ten to fifteen days after being bitten by an infected mosquito. If not properly treated, people
may have recurrences of the disease months later.[2] In those who have recently survived
an infection, reinfection usually causes milder symptoms.[1] This partial resistance disappears
over months to years if the person has no continuing exposure to malaria.
 It is caused by single-celled microorganisms of the Plasmodium group. The disease is most
commonly spread by an infected female Anopheles mosquito. The mosquito bite introduces
the parasites from the mosquito's saliva into a person's blood. The parasites travel to
the liver where they mature and reproduce. Five species of Plasmodium can infect and be
spread by humans.[1] Most deaths are caused by P.  falciparum because P.  vivax, P.  ovale,
and P.  malariae generally cause a milder form of malaria. The species P.  knowlesi rarely
causes disease in humans.[2] Malaria is typically diagnosed by the microscopic
examination of blood using blood films, or with antigen-based rapid diagnostic tests.
[1]
 Methods that use the polymerase chain reaction to detect the parasite's DNA have been
developed, but are not widely used in areas where malaria is common due to their cost and
complexity.
 The risk of disease can be reduced by preventing mosquito bites through the use
of mosquito nets and insect repellents, or with mosquito control measures such as
spraying insecticides and draining standing water. Several medications are available
to prevent malaria in travellers to areas where the disease is common. Occasional doses of
the combination medication sulfadoxine/pyrimethamine are recommended in infants and
after the first trimester of pregnancy in areas with high rates of malaria. Despite a need, no
effective vaccine exists, although efforts to develop one are ongoing. The recommended
treatment for malaria is a combination of antimalarial medications that includes
an artemisinin. The second medication may be either mefloquine, lumefantrine, or
sulfadoxine/pyrimethamine. Quinine along with doxycycline may be used if an artemisinin is
not available.[5] It is recommended that in areas where the disease is common, malaria is
confirmed if possible before treatment is started due to concerns of increasing drug
resistance. Resistance among the parasites has developed to several antimalarial
medications; for example, chloroquine-resistant P. falciparum has spread to most malarial
areas, and resistance to artemisinin has become a problem in some parts of Southeast Asia.
 The disease is widespread in the tropical and subtropical regions that exist in a broad band
around the equator. This includes much of Sub-Saharan Africa, Asia, and Latin America. In
2018 there were 228 million cases of malaria worldwide resulting in an estimated 405,000
deaths. Approximately 93% of the cases and 94% of deaths occurred in Africa.[3] Rates of
disease have decreased from 2010 to 2014, but increased from 2015 to 2017, during which
there were 231 million cases.[3] Malaria is commonly associated with poverty and has a major
negative effect on economic development. In Africa, it is estimated to result in losses of
US$12 billion a year due to increased healthcare costs, lost ability to work, and negative
effects on tourism
 Signs and symptoms


 Main symptoms of malaria[9]

 The signs and symptoms of malaria typically begin 8–25 days following infection,[9] but may
occur later in those who have taken antimalarial medications as prevention.[4] Initial
manifestations of the disease—common to all malaria species—are similar to flu-like
symptoms, and can resemble other conditions such as sepsis, gastroenteritis, and viral
diseases. The presentation may include headache, fever, shivering, joint
pain, vomiting, hemolytic anemia, jaundice, hemoglobin in the urine, retinal damage,
and convulsions.
 The classic symptom of malaria is paroxysm—a cyclical occurrence of sudden coldness
followed by shivering and then fever and sweating, occurring every two days (tertian fever)
in P. vivax and P. ovale infections, and every three days (quartan fever)
for P. malariae. P. falciparum infection can cause recurrent fever every 36–48 hours, or a
less pronounced and almost continuous fever.
 Severe malaria is usually caused by P. falciparum (often referred to as falciparum malaria).
Symptoms of falciparum malaria arise 9–30 days after infection.[10] Individuals with cerebral
malaria frequently exhibit neurological symptoms, including abnormal
posturing, nystagmus, conjugate gaze palsy (failure of the eyes to turn together in the same
direction), opisthotonus, seizures, or coma.[10]
 Complications
 Malaria has several serious complications. Among these is the development of respiratory
distress, which occurs in up to 25% of adults and 40% of children with
severe P. falciparum malaria. Possible causes include respiratory compensation
of metabolic acidosis, noncardiogenic pulmonary oedema, concomitant pneumonia, and
severe anaemia. Although rare in young children with severe malaria, acute respiratory
distress syndrome occurs in 5–25% of adults and up to 29% of pregnant
women. Coinfection of HIV with malaria increases mortality. Kidney failure is a feature
of blackwater fever, where hemoglobin from lysed red blood cells leaks into the urine.
 Infection with P. falciparum may result in cerebral malaria, a form of severe malaria that
involves encephalopathy. It is associated with retinal whitening, which may be a useful
 clinical sign in distinguishing malaria from other causes of fever.[15] Enlarged spleen, enlarged
liver or both of these, severe headache, low blood sugar, and hemoglobin in the
urine with kidney failure may occur. Complications may include spontaneous
bleeding, coagulopathy, and shock.

 Cause
 Main article: Plasmodium

 Malaria parasites belong to the genus Plasmodium (phylum Apicomplexa). In humans,

malaria is caused by P.  falciparum, P.  malariae, P.  ovale, P.  vivax and P.  knowlesi. Among
those infected, P. falciparum is the most common species identified (~75%) followed
by P. vivax (~20%).Although P. falciparum traditionally accounts for the majority of
deaths, recent evidence suggests that P. vivax malaria is associated with potentially life-
threatening conditions about as often as with a diagnosis of P. falciparum infection.
P. vivax proportionally is more common outside Africa. There have been documented human
infections with several species of Plasmodium from higher apes; however, except
for P. knowlesi—a zoonotic species that causes malaria in macaques these are mostly of
limited public health importance.
 Life cycle


 The life cycle of malaria parasites. A mosquito causes an infection by a bite. First, sporozoites enter
the bloodstream, and migrate to the liver. They infect liver cells, where they multiply into merozoites,
rupture the liver cells, and return to the bloodstream. The merozoites infect red blood cells, where they
develop into ring forms, trophozoites and schizonts that in turn produce further merozoites. Sexual
forms are also produced, which, if taken up by a mosquito, infects the insect and continue the life
cycle.
 In the life cycle of Plasmodium, a female Anopheles mosquito (the definitive host) transmits a
motile infective form (called the sporozoite) to a vertebrate host such as a human (the
secondary host), thus acting as a transmission vector. A sporozoite travels through the blood
vessels to liver cells (hepatocytes), where it reproduces asexually (tissue schizogony),
producing thousands of merozoites. These infect new red blood cells and initiate a series of
asexual multiplication cycles (blood schizogony) that produce 8 to 24 new infective
merozoites, at which point the cells burst and the infective cycle begins anew.
 Other merozoites develop into immature gametocytes, which are the precursors of male and
female gametes. When a fertilized mosquito bites an infected person, gametocytes are taken
up with the blood and mature in the mosquito gut. The male and female gametocytes fuse
and form an ookinete—a fertilized, motile zygote. Ookinetes develop into new sporozoites
that migrate to the insect's salivary glands, ready to infect a new vertebrate host. The
sporozoites are injected into the skin, in the saliva, when the mosquito takes a subsequent
blood meal.
 Only female mosquitoes feed on blood; male mosquitoes feed on plant nectar and do not
transmit the disease. Females of the mosquito genus Anopheles prefer to feed at night. They
usually start searching for a meal at dusk, and continue through the night until they
succeed. Malaria parasites can also be transmitted by blood transfusions, although this is
rare.
 Recurrent malaria
 Symptoms of malaria can recur after varying symptom-free periods. Depending upon the
cause, recurrence can be classified as either recrudescence, relapse, or reinfection.
Recrudescence is when symptoms return after a symptom-free period. It is caused by
parasites surviving in the blood as a result of inadequate or ineffective treatment. Relapse is
when symptoms reappear after the parasites have been eliminated from blood but persist as
dormant hypnozoites in liver cells. Relapse commonly occurs between 8–24 weeks and is
often seen in P. vivax and P. ovale infections.[4] However, relapse-like P. vivax recurrences
are probably being over-attributed to hypnozoite activation. Some of them might have an
extra-vascular merozoite origin, making these recurrences recrudescences, not relapses.
[31]
 One newly recognized, non-hypnozoite, possible contributing source to recurrent
peripheral P. vivax parasitemia is erythrocytic forms in bone marrow. P. vivax malaria cases
in temperate areas often involve overwintering by hypnozoites, with relapses beginning the
year after the mosquito bite. Reinfection means the parasite that caused the past infection
was eliminated from the body but a new parasite was introduced. Reinfection cannot readily
be distinguished from recrudescence, although recurrence of infection within two weeks of
treatment for the initial infection is typically attributed to treatment failure. People may
develop some immunity when exposed to frequent infections.
 Climate change

 Global climate change is likely to affect malaria transmission, but the degree of effect and the
areas affected is uncertain. Greater rainfall in certain areas of India and following an El
Niño event is associated with increased mosquito numbers.
 Diagnosis

The blood film is the gold standard for malaria diagnosis.


 Ring-forms and gametocytes of Plasmodium falciparum in human blood

 Owing to the non-specific nature of the presentation of symptoms, diagnosis of malaria in

non-endemic areas requires a high degree of suspicion, which might be elicited by any of the
following: recent travel history, enlarged spleen, fever, low number of platelets in the blood,
and higher-than-normal levels of bilirubin in the blood combined with a normal level of white
blood cells. Reports in 2016 and 2017 from countries where malaria is common suggest high
levels of over diagnosis due to insufficient or inaccurate laboratory testing.
 Malaria is usually confirmed by the microscopic examination of blood films or by antigen-
based rapid diagnostic tests (RDT). In some areas, RDTs must be able to distinguish
whether the malaria symptoms are caused by Plasmodium falciparum or by other species of
parasites since treatment strategies could differ for non-P. falciparum infections. Microscopy
is the most commonly used method to detect the malarial parasite—about 165 million blood
films were examined for malaria in 2010. Despite its widespread usage, diagnosis by
microscopy suffers from two main drawbacks: many settings (especially rural) are not
equipped to perform the test, and the accuracy of the results depends on both the skill of the
person examining the blood film and the levels of the parasite in the blood. The sensitivity of
blood films ranges from 75–90% in optimum conditions, to as low as 50%. Commercially
available RDTs are often more accurate than blood films at predicting the presence of
malaria parasites, but they are widely variable in diagnostic sensitivity and specificity
depending on manufacturer, and are unable to tell how many parasites are present.
 In regions where laboratory tests are readily available, malaria should be suspected, and
tested for, in any unwell person who has been in an area where malaria is endemic. In areas
that cannot afford laboratory diagnostic tests, it has become common to use only a history of
 fever as the indication to treat for malaria—thus the common teaching "fever equals malaria
unless proven otherwise". A drawback of this practice is overdiagnosis of malaria and
mismanagement of non-malarial fever, which wastes limited resources, erodes confidence in
the health care system, and contributes to drug resistance.[55] Although polymerase chain
reaction-based tests have been developed, they are not widely used in areas where malaria
is common as of 2012, due to their complexity.

 Prevention


 An Anopheles stephensi mosquito shortly after obtaining blood from a human (the droplet of blood is
expelled as a surplus). This mosquito is a vector of malaria, and mosquito control is an effective way of
reducing its incidence.

 Methods used to prevent malaria include medications, mosquito elimination and the
prevention of bites. There is no vaccine for malaria. The presence of malaria in an area
requires a combination of high human population density, high anopheles mosquito
population density and high rates of transmission from humans to mosquitoes and from
mosquitoes to humans. If any of these is lowered sufficiently, the parasite eventually
disappears from that area, as happened in North America, Europe, and parts of the Middle
East. However, unless the parasite is eliminated from the whole world, it could re-establish if
conditions revert to a combination that favors the parasite's reproduction. Furthermore, the
cost per person of eliminating anopheles mosquitoes rises with decreasing population
density, making it economically unfeasible in some areas.
 Prevention of malaria may be more cost-effective than treatment of the disease in the long
run, but the initial costs required are out of reach of many of the world's poorest people.
There is a wide difference in the costs of control (i.e. maintenance of low endemicity) and
elimination programs between countries. For example, in China—whose government in 2010
announced a strategy to pursue malaria elimination in the Chinese provinces—the required
investment is a small proportion of public expenditure on health. In contrast, a similar
program in Tanzania would cost an estimated one-fifth of the public health budget.
 In areas where malaria is common, children under five years old often have anemia, which is
sometimes due to malaria. Giving children with anemia in these areas preventive antimalarial
medication improves red blood cell levels slightly but does not affect the risk of death or need
for hospitalization.
 Mosquito control
 Further information: Mosquito control
 
 Man spraying kerosene oil in standing water, Panama Canal Zone, 1912

 Vector control refers to methods used to decrease malaria by reducing the levels of

transmission by mosquitoes. For individual protection, the most effective insect repellents are
based on DEET or picaridin.] Insecticide-treated mosquito nets (ITNs) and indoor residual
spraying (IRS) have been shown highly effective in preventing malaria among children in
areas where malaria is common. Prompt treatment of confirmed cases with artemisinin-
based combination therapies (ACTs) may also reduce transmission.


 Walls where indoor residual spraying of DDT has been applied. The mosquitoes remain on the wall
until they fall down dead on the floor.
 
 A mosquito net in use.

 Mosquito nets help keep mosquitoes away from people and reduce infection rates and
transmission of malaria. Nets are not a perfect barrier and are often treated with an
insecticide designed to kill the mosquito before it has time to find a way past the net.
Insecticide-treated nets are estimated to be twice as effective as untreated nets, and offer
greater than 70% protection compared with no net. Between 2000 and 2008, the use of ITNs
saved the lives of an estimated 250,000 infants in Sub-Saharan Africa. About 13% of
households in Sub-Saharan countries owned ITNs in 2007 and 31% of African households
were estimated to own at least one ITN in 2008. In 2000, 1.7 million (1.8%) African children
living in areas of the world where malaria is common were protected by an ITN. That number
increased to 20.3 million (18.5%) African children using ITNs in 2007, leaving 89.6 million
children unprotected and to 68% African children using mosquito nets in 2015. Most nets are
impregnated with pyrethroids, a class of insecticides with low toxicity. They are most
effective when used from dusk to dawn. It is recommended to hang a large "bed net" above
the center of a bed and either tuck the edges under the mattress or make sure it is large
enough such that it touches the ground.
 Indoor residual spraying is the spraying of insecticides on the walls inside a home. After
feeding, many mosquitoes rest on a nearby surface while digesting the bloodmeal, so if the
walls of houses have been coated with insecticides, the resting mosquitoes can be killed
before they can bite another person and transfer the malaria parasite. As of 2006, the World
Health Organization recommends 12 insecticides in IRS operations, including DDT and the
pyrethroids cyfluthrin and deltamethrin. This public health use of small amounts of DDT is
permitted under the Stockholm Convention, which prohibits its agricultural use. One problem
with all forms of IRS is insecticide resistance. Mosquitoes affected by IRS tend to rest and
live indoors, and due to the irritation caused by spraying, their descendants tend to rest and
live outdoors, meaning that they are less affected by the IRS.
 People have tried a number of other methods to reduce mosquito bites and slow the spread
of malaria. Efforts to decrease mosquito larva by decreasing the availability of open water
where they develop, or by adding substances to decrease their development, is effective in
some locations. Electronic mosquito repellent devices, which make very high-frequency
sounds that are supposed to keep female mosquitoes away, have no supporting evidence of
effectiveness.
 Other methods
 Community participation and health education strategies promoting awareness of malaria
and the importance of control measures have been successfully used to reduce the
incidence of malaria in some areas of the developing world.[79] Recognizing the disease in the
early stages can prevent the disease from becoming fatal. Education can also inform people
to cover over areas of stagnant, still water, such as water tanks that are ideal breeding
grounds for the parasite and mosquito, thus cutting down the risk of the transmission
between people. This is generally used in urban areas where there are large centers of
population in a confined space and transmission would be most likely in these
areas. Intermittent preventive therapy is another intervention that has been used successfully
to control malaria in pregnant women and infants, and in preschool children where
transmission is seasonal.
 Medications

 There are a number of medications that can help prevent or interrupt malaria in travelers to
places where infection is common. Many of these medications are also used in treatment. In
places where Plasmodium is resistant to one or more medications, three medications—
mefloquine, doxycycline, or the combination of atovaquone/proguanil (Malarone)—are
frequently used for prevention. Doxycycline and the atovaquone/proguanil are better
tolerated while mefloquine is taken once a week. Areas of the world
with chloroquine sensitive malaria are uncommon.
 The protective effect does not begin immediately, and people visiting areas where malaria
exists usually start taking the drugs one to two weeks before they arrive, and continue taking
them for four weeks after leaving (except for atovaquone/proguanil, which only needs to be
started two days before and continued for seven days afterward). The use of preventative
drugs is often not practical for those who live in areas where malaria exists, and their use is
usually only in pregnant women and short-term visitors. This is due to the cost of the
drugs, side effects from long-term use, and the difficulty in obtaining anti-malarial drugs
outside of wealthy nations. During pregnancy, medication to prevent malaria has been found
to improve the weight of the baby at birth and decrease the risk of anemia in the mother. The
use of preventative drugs where malaria-bearing mosquitoes are present may encourage the
development of partial resistance.
 Drug resistance poses a growing problem in 21st-century malaria treatment. Resistance is
now common against all classes of antimalarial drugs apart from artemisinins. Treatment of
resistant strains became increasingly dependent on this class of drugs. The cost of
artemisinins limits their use in the developing world. Malaria strains found on the Cambodia–
Thailand border are resistant to combination therapies that include artemisinins, and may,
therefore, be untreatable. Exposure of the parasite population to artemisinin monotherapies
in subtherapeutic doses for over 30 years and the availability of substandard artemisinins
likely drove the selection of the resistant phenotype. Resistance to artemisinin has been
detected in Cambodia, Myanmar, Thailand, and Vietnam, and there has been emerging
resistance in Laos. Resistance to the combination of artemisinin and piperaquine was
detected in 2013 in Cambodia, and has since spread
through Laos, Thailand and Vietnam (with up to 80 percent of malaria parasites resistant in
some regions).
Reference