The Effectiveness of Different Solutions to Prevent or Treat Malaria
Issue Report: The Effectiveness of Different Solutions to Prevent or Treat Malaria
Malaria is a mosquito-borne infectious disease commonly known in tropical and subtropical regions such as Sub Saharan, Africa, Asia and America. It is a potentially fatal blood disease caused by protozoan parasites of the genus Plasmodium. There are four types of plasmodium parasite that can infect humans and these are: Plasmodium falciparum and Plasmodium vivax, Plasmodium ovale and Plasmodium malariaecan.
Malaria parasites are transmitted successively infecting two types of hosts: Female Anopheles mosquitos and humans. This is how the Malaria Life Cycle works:
Bitten by a mosquito, during feeding, malaria parasites (sporozoites) leave the mosquito salivary gland and enter the human bloodstream. Then the malaria parasites enter the liver, infect the liver cells (hepatocytes) where they multiply into merozoites parasites. The liver cells eventually rupture and release more parasites in the blood. The parasites invade the red blood cells where they continue to multiply and develop to trophozoites and schizonts and rupture the cells. The blood stages cause the clinical symptoms of malaria. Some parasites enter the red blood cells and develop into male and female reproductive cells (termed gametocytes). The gametocytes are transferred to another mosquito when it feeds on the human. Then the phase of sexual reproduction continues in the mosquito. In the mosquito’s gut the male cell fertilizes the female cell to form a zygote. Then the zygote enlarges and migrates to the outer wall of the gut. There the parasites multiply several times and then released. Te parasites then migrate to the mosquito’s salivary gland. The parasites accumulate in the salivary glands, ready for transfer to another human. When the mosquito bites another human, the parasites leave the mosquito salivary gland and enter the human bloodstream.
- arthralgia (joint pain)
- anemia (caused by hemolysis)
- retinal damage convulsions.
Now, in the 21st century no 100% treatment against malaria is available. But the most common ways to treat malaria is through Antimalarial drugs which are used in order to prevent or cure malaria. Such drugs may be used for some or all of the following:
- Treatment of malaria in individuals with suspected or confirmed infection
- Prevention of infection in individuals visiting a malaria-endemic region who have no immunity (malaria prophylaxis)
- Routine intermittent treatment of certain groups in endemic regions (intermittent preventive therapy)
Quinine is the standard anti-malarial and the first effective treatment in drug in the management of severe forms of malaria. It is an alkaloid extracted from guanine bark. The drug works to slow down the parasites' heme polymerase, the enzyme that polymerizes toxic heme to hemozoin. Toxic free heme builds up in the parasites, leading to their death. Quinine hunts for the pathogen and kills the organism causing the disease. Also it may cause an elevation in the pH of the pathogen, affecting the acidity of its cellular biology. But as most of the drugs Quinine also has side effects such as Convulsions at high doses (during injections), vomiting and Hypoglycaemia.
Chloroquine has long been used in the treatment or prevention of malaria and until recently was the most widely used anti-malarial. Chloroquine is a complicated compound with still an unclear way of how it works. What do we know is that inside the red blood cells, the malaria parasite must corrupt the hemoglobin for the gaining of essential amino acids, which the parasite requires to construct its own protein and for energy metabolism which is essential for it to grow. Chloroquine raises the pH inside parasite’s acidic vacuole. Chloroquine then binds to heme forming a complex which is highly toxic thus leading to disrupt membrane function and cause death.
This table shows the different derivatives that exist, due to different efficacy levels, of quinine and chloroquinine such as mefloquinine and amodiaquine.
Also it shows how efficient they are and if they are expensive or not.
Drug resistance has been defined to be the ability of the parasite to survive and withstand the drug to which they were once sensitive and were once slowed in growth or killed outright. Either the drug is poor, poor absorption, misdiagnosis and incorrect doses being given or drug resistance parasites lead to malaria treatment failure. Nearly all anti-malarial drugs have a drugs resistance parasite out of the four plasmodium species. This is because in different regions the drugs acts differently on each plasmodium species, therefore there are derivatives for each drug. For example quinine is especially useful in areas where there is known to be a high level of resistance to chloroquine,mefloquine, and sulfa drug combinations with pyrimethamine. Quinine is less effective and more toxic as a blood schizonticidal agent than chloroquine; however, it is still very effective and widely used in the treatment of acute cases of severe P. falciparum. Chloroquine being the cheapest, the best tested and the safest of all existing drugs, has been used all over the world leading to malaria parasite Plasmodium falciparum to develop a widespread resistance to it. Now, new potential uses of this drug have been investigated.
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This table displays some of the drugs that face drug resistance. Some of those have been reported so derivatives can be used instead. In addition in the table the fact that every drug has side effects shows that the treatment has to be controlled and any other information about something that could cause a side effect such as receiving any other drug, for example a painkiller, should be notified to the doctor.
As stated by the journal of Nicholas J.White:“Resistance has emerged to all classes of antimalarial drugs except the artemisinins and is responsible for a recent increase in malaria-related mortality, particularly in Africa.” Artemisinin is a drug that has the most effective management out of all current drugs against Plasmodium falciparum malaria. The use of this drug as a monotherapy (only one type of drug used) is clearly discouraged by the World Health Organization as there have been signs and evidence that malarial parasites are on the increase of resistance of the drug. It is only given in combination with other anti-malarials and therefore is the preferred treatment for malaria and is both effective and well tolerated in patients. From a number of 5000 traditional Chinese medicines Artemisinin was not only the only one that was effective, but it was found to clear malaria parasites from patients' bodies faster than any other drug in history.
Quinine and Chloroquine are examples of monotherapy, which means treating a disorder with a single drug. These drugs and their derivatives are not very efficient since malaria parasites are increasing in resistance to the drugs as time passes and they will be effective in even less regions around the world. Therefore new ways to treat malaria such as combination therapy have been revealed. This is the ability to use two different drugs at the same time, with different mechanisms of action and act at different targets on the parasite. The use of this combination therapy contributes to the essential goal of anti-malarial care which is to decrease morbidity( occurrence of a disease) and the mortality( the proportion of deaths to population).
There are two types of combination therapies, Non-artemesinin-based combinations and Artemesinin based combinations.
A Non-artemesinin-based combination drug is amodiaquine plus sulfadoxine-pyrimethamin which according to Wikipedia’s table “This combination has been shown to produce a faster rate of clinical recovery than SP and chloroquine, but is clearly inferior to artemisinin-based combinations (ACTs) for the treatment of malaria.” This drug is a great way to treat malaria and better than other non-artemisinin based combination drugs, but due to the fact that resistance has rapidly increased on sulfadoxine-pyrimethamin drug it is no longer recommended by the WHO (World Health Organization).
Instead, an artemisin combination therapy is preferred and for example Artemether and lumefantrine which shows evidence by being tested extensively in 16 clinical trials presenting high efficiency especially in children under five years old. This drug is the most promising and even better than other artemisin combination therapies such as artesunate plus mefloquin. In addition no serious side effects were acknowledged but it is not recommend to pregnant women due to limited data and tests.
According to the table artemether-lumefantrine is highly effective in most parts of the world since it has less than 10% treatment failure, with an exception of Cambodia. The red line on 10% indicates a boundary and that the drug given should not exceed it, otherwise an appropriate measure must be taken by changing the partner drug of the artemisin combination therapy so that to not allow resistance increase to the drug.
This graph highlights that from the point of intervention of Artemisin combination therapies(ACT) the malaria diagnosis has decreased giving evidence that these therapies work and are efficient in treating malaria.
The table shows an increase in the use of ACT as years pass by and ACT is becoming more tolerable and more efficient since it is now the main form of treatment of malaria. But this table also shows a problem which is that less developed countries didn’t have an increase in the use of ACT and this is due to the drug’s high cost; High cost drugs can have devastating results in the economic life of a person or a family!
Malaria can cause serious problems and one of this is the economic cost. As it is known malaria provides increasing mortality (the proportion of deaths to population). Malaria has a tendency to occur in the season where workers are most needed to collect their crops and therefore these workers are not able to receive their own income. “Studies have shown that affected families clear only 40 % of land for crops compared to healthy families (WHO, 1998)” Other problems connected to this situation and increasing the problem of economic costs can be malnutrition or lack of medical care, and as I mentioned above, effective combination therapies and antimalarial drugs can be expensive and either people do not receive them or they pay a lot to be given to them. Such payments include payments for treatment, time and transport costs in connection to the treatment. In a much bigger scale such as a community and not only an individual’s cost this would lead to a serious social problem resulting in lowering the standard of living. In addition, greater difficulties would occur such as to hurt the continuing economic development of projects because of the lack of workers participating, leading to falling behind in the progress of the community. Instead the community is responsible in order to pay for the treatment of workers; costs of medicines and doctors, therefore increasing its expenses. A clear-headed problem is the education of the children as it is affected by the disease and children are not able to receive the basic schooling.” It has been estimated that the learning of 35 to 60 % of the children in an endemic country may be impacted by the disease”. Moreover the knowledge and the information about the treatments and how to prevent the disease are not accessible in the endemic countries therefore it leads to an unchangeable situation and people continue to get malaria. In a much bigger scale such as globally, malaria could slow down the growth thus leading to more economic costs being produced as more people get infected by malaria. This results in poverty and therefore a lower level of affluence which would be catastrophic!
Risks and benefits:
Anti-malarial drugs have to be used with care in order to be efficient. For example before taking the drug the following should be considered by the doctor: age, weight, dosage of drug, pregnancy in women, receiving other drugs as well during the treatment, any diseases from the past e.g. asthma. Without this in consideration the drug would cause side effects. In monotherapy, guanine would cause: Convulsions at high doses (during injections), Tinnitus (a hearing impairment), rashes, vertigo, nausea, vomiting, abdominal pain, regression when reducing doses, Hypoglycaemia, Thrombocytopaenia, Photosensitivity; allergy (pruritus, hives, generalized skin rash, anaphylactic shock. In an artemisinin combination therapy, although they are the best treatment available for malaria, there are still some drug combinations that cause side effects, for example: Dihydroartemisinin +piperaquine + trimethoprim causes to the Digestive: nausea, vomiting, abdominal pain, diarrhoea; Neurologic: dizziness, cephalea, irritation, asthenia, insomnia; Allergy: pruritus, skin rash; Transitory increase in ASAT/ALAT ratios; Leukopaenia, thrombocytopaenia.
Although these drugs can cause side effects, they can be very effective once treated in the correct way. By considering the factors influenced that are mentioned above, the patient can have a normal treatment, healing properly from the disease of malaria due to the functions of the drugs. We know that malaria takes place in developing countries where people have been already struggling with their economy and many diseases. If antimalatial drugs were accessible to these countries this could save millions of lives, especially children. Serious health problems usually follow one or more episodes of malaria. Families whose have children that died of malaria will never recover from the lost. However, with antimalarial drugs, children will be safe from malaria infection. Antimalarial drugs will control the spread of the disease, providing a healthy environment for everybody. Eventually, society will recover from the lost and shock caused by malaria.
A method to prevent malaria to take place is to use Insecticide-treated bed nets (ITNs). These are nets that prevent the entrance of mosquitoes in the personal area of an individual leading to a bite and therefore an infection causing malaria. These nets are usually placed around a bed while people are sleeping in order to form a protective barrier. But still even the nets cannot prevent all the mosquitoes feeding on the people as they pass through little holes. Therefore an insecticide is applied to the nets in order to improve the protection of the nets. The insecticide used not only kill mosquitoes but other insects as well leaving you have an undisturbed sleep. If not killing the mosquitoes then it repels them reducing their number that enters the area and feed on the people. If ITNs are used in a large scale then this will achieve a decrease in numbers of mosquitoes benefiting not only those using ITNs but also those they don’t. There are several insecticides but only pyrethroid insecticides are approved for use on ITNs. This is because they “pose a very low health risks to humans and other mammals, but are highly toxic to insects and knock them down, even at very low doses. Pyrethroids do not rapidly break down unless washed or exposed to sunlight.” (Center for disease control and prevention). Previously nets had to be retreated every 6-12 months with insecticide and this cost. But now they have developed long-lasting insecticide-treated nets (LLINs) that maintain effective levels of insecticide for at least 3 years. The WHO approved 12 of these LLINs and is recommending to be given free since they support that “A recent gap analysis estimated that between 2008 and 2012, 327 million LLINs would be needed to achieve full coverage of women and children in malaria-endemic countries of Africa, while 545 million LLINs would be needed to achieve universal coverage in that same region.”
Another way to prevent malaria occurring is the use of an insect repellent. This is put on the person in order to repel the mosquitoes away from the person in order not to bite him and get infected. These repellents have to be dealt with care: to be careful not to ingest, breathe or get any of the repellent into your eyes. Only apply it when you are outdoors and only on unbroken skin - do not apply to sores or areas where the skin is broken. Remove the repellent from your skin when finished outdoor by either washing the area to which you applied it, or having a shower. If any of the products has been ingested please consult your health practitioner immediately. Using insect repellent could have some damaging effects. “Studies have shown that DEET causes brain cell death and behavioral changes in rats after frequent and prolonged use. This exposure causes neurons to die in regions of the brain that control muscle movement, learning, memory, and concentration. Rats treated with an average human dose of DEET (40 mg/kg body weight) performed far worse when challenged with physical tasks requiring muscle control, strength and coordination. In addition to that exposure to DEET and other insecticides would lead to symptoms such as memory loss, headache, weakness, fatigue, muscle and joint pain, tremors and shortness of breath. These symptoms might not be revealed until months or even years after the exposure to the insecticides.
Validity and Reliability of Sources: sources used in this report were very reliable and valid. Two of these are explained below:
World Malaria Report 2011
Numerous people contributed to the production of this report. The information and data in the report was gathered from 106 malaria-endemic countries. It is reliable as it is very recent, published in 2011. This is shown in the Acknowledgement of the Report and it proves its validity as the information comes from various sources all around the world and the contribution of specialized people such as Dr. Melanie Renshaw (senior malaria advisor at UNICEF). Her interview speaks about the progress and the success of malaria control and this enhances the validity of WHO information. (). In addition a report was made with title “EVALUATION OF WHO’s CONTRIBUTION TO “3BY5” stating that “Reviewing the process and the findings, the Steering Committee is satisfied that the challenges encountered during the course of the evaluation have not affected its overall integrity, balance or independence. We consider the report to be clear, largely factual and accurate, and grounded in evidence.” ()
Medicines for Malaria Venture
In my opinion both sources are valid since they both contribute actively in defeating malaria. Both sources have similar information and data about how to treat malaria, in what ways and through which drugs and this shows the reliability of the sources. Also this due to the fact that product development partnerships (PDPs) were created from a desire to generate new approaches to improve the global trouble of abandoned diseases by taking the expertise and knowledge of both the private and public sectors, and exploiting each of their strengths to find the most efficient and effective solutions. Rob Newman’s interview explains the importance of partnerships (). Both videos are published in 2011 therefore they are recent and proves the work done and data and information collected are valid!
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World Health Organization (WHO), World Malaria Report 2011 Available at: (Date accessed: 27/1/2012)
Medicines for Malaria Venture, Timothy N. C. Wells*, Pedro L. Alonso and Winston E. Gutteridge, New medicines to improve control and contribute to the eradication of malaria, Available at: (Date accessed: 2/2/2012)
Antimalarial drugs: Available at: (Date accessed: 27/1/2012)
The Journal of clinical investigation: Antimalarial drug resistance by Nicholas J. White, published April 15, 2004; Available at: (Date accessed: 4/2/2012)
Malaria control and its effects on the environment: Economic and Social costs: 2.4 Economic costs, 2.4.1 individual costs, 2.4.2 community costs, 2.4.3 national costs, Available at: (Date accessed: 5/2/2012)
Centers for Disease Control and Prevention: Insecticide-Treated Bed Nets,
Available at: (Date accessed: 10/2/2012)
Quantum Health, Insect Repellents, Available at: (Date accessed: 12/2/2012)
Evros Philiastides Biology Issue Report
Here's what a teacher thought of this essay
**** This report contains a great deal of technical detail and appropriate A level biological terminology. A little more background information about the distribution of the disease, differences in mortality and how these are linked to particular Plasmodium species would be useful. The issue of resistance is complex but it would, perhaps, have been useful to attempt a global overview of where resistance to particular drugs / drug combinations by particular Plasmodium species is greatest.