Personal protection from mosquito bites an<i subsequent malaria encompasses the use of protective cl?thes such as long trousers i1nd long sleeve clothes. This is especially important from the evening till dawn when ;nosquitoes are most active and when they bite. Personal �,rotection also involves use of physical barrier such &s long lasting
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i11secticidal bed nets wl1ich kill and repel mosquitoes. There are many '-'ommercial brands of the nets available in Nigeriar marl<ets and medicine shops. Current strategies for clistI·ibt1tion of long lasting insecticidal nets are social n1arketing, tl1rougl1 rotttine healtl1 services channels. via cornmttnity groups 1nd via mass
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•vacc1nat1on carr,pa1gns.
IBenefits of insecticide treated nets obscrv«!d in experi,ncntal trials inplude reduced vector densities: redt1ced populatio11 of nuisance insects, lowered incidence of malaria infection (Lindl•lade et al., 2015), reduced r,arasitaemia, reduced morbidity, enhanced st1rvival of chil<jren and other persons that are vulnerable to malaria attacks, reduced treatn1ent costs, reduced scl1ool absences anj improved productivity of 'Norkers.
2.8.2 Early diagnosis a·nd prompt treatr-. 1ent of mala1·ia
Early diagnosis and prornpt treatment of malaria is currently the main thrust of malaria contra I in Africa. The four ar,!as of focus to achieve this goal are improvement ir1 quality of health service, t!mpowerment of households for effective management cf malaria, working with traditional medical practitioners and de\ eloping lin�:ages \Vith other sectors. 3arly diagnosis and treatn1ent has been incorporated ,nto the integrated management of childhood illness (IMCI) strategy
(R1mon et al., 2003).
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Rapid diagnosti,c test for malaria (rnRDT) is anantigen-based stick, cassette or card test for tnalaria in whicl1 a coloured line inclicates that plasmodial antigens have been detected. Mala�ia RDT has been developed, validated and introducecl into national programtnes in some countries. RDT is now recomme11ded for confirmation of diagnosis in all suspected cases of malaria prior to treatment with ACTs, hence its wide coverage, (Kyabayi11ze et al., 2012) in Africa. Rapid Diagnostic Test use is expected to red�ce misdiagnosis and cost o · f treating malaria. The test is now used at community/ho111e level in some countries. Trained com1nunity l 1 ealtJ 1 workers can carry out the test satisfactorily (Ruizendaal ,�t al., 2014).
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I 11 Nigeria, tl1ere is a strategy for ho1ne martagen1ent of 1nalaria for children t1nder the age of five years. Ho111e n1a11age1ne11t of malaria can st1bstantially increase tl1e nt1mber of febrile children treated \Vithi11 24 hot1rs of onset of symp .
toms of malaria and decrease tl1e number of febrile children (Nzayira1nbaho et al., 2013). '"fhe main issue is ,vi despread c istribution and t1se of st1bstandard drugs. Chloroquine . s still used for treatn1ent of no11-P. Falcipa,-·z,n1 1nalaria infections. Mefloquine or qt1ir1ine is used for treatment of pr,Jven cases of chloroquine -"esistant malaria while pri1r,aquine is used to eradicate liver pl1asc in P. vivaxand P. ovale i11fections (Carmona Fonseca, 2015).
2.8.2.1 esistance to drugs and insecticides in malaria contrc>I
Drug resistance in malaria treatment is defined as the ability of a parasite strain to sun'i\.e and or multiply despite the administration and absorption of a dn1g given in doses equal to or higher than those usually reco1nmended but within the limits of tolerance of the subject Drug resistanc,e arises when spontaneo 1sly occurri11g
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mutations or amplifications to confer reduced susceptibility are selected and then
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tra11smitted from one parasite to another (Dharia et al., 2009).
Tl,e types of drug resi s tance depend on the exte11t of disappearance of parasites during a 7-day teSt or an exte11ded 28-day test, after a standard a11ti1nalarial drug treatment .
•The principle of drug use in areas of druf�- resistant malaria is si1nuitaneous use o·f
•two or inore antimalarials witl1 different me:chanisms of action and wl1ich do not sha;e tl1e satne resistance 111ecl1anism. Tl1is will redt1ce the chat1ce • o f resistance. WHO
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guidelines advice p o l icy review whe n adequate cli n ical a n d parasit o l o gical resp onse is up t o o r more tnan 25.0 o/o failure rate. '
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Parasite resista.nce to arte111isin i11 the core comp o und of ACTs - l1a s bee n detected in f o t1r cot1ntries in Sot1th-East Asia: in Carr.bodia, Myan1nar, Thailand a n d Viet Nam
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(Bustos et al., 2013). For now, ACTs remain effective in al111 o st all settings, so long as the partner dt ug in tl1e c o mbi n ation is locally effective. "The G/.ob a l p lan for
a rte111isini11 re.,ist an ce cont a it1nze11t, released i n 2011, c o ntains strategic guida n ce fr o 1n WHO on h o \v t o 1nanage this glc)bal threat. WHO currently recommends chloroquine for the treatment o f P. viv a x malaria where the drug remai11s effective.
When infectio 1 is acquired in chlor o quine sensitive areas, it is recommended that chloroquine alone is shou
•l d be given. But when malaria infection is acquired in
chloroquine-resistant areas, ACTs could be given. The first line drugs recommended by \VHO for treatment of malaria are art�mether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, and artesunate p lus sulfadoxine
pyrimethamine. The second-line drugs tor malaria treatment arc artesunate plus
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tetracyline, do>eycyclineor cl' d in amyc1n. Also, qu1n1ne may be given 1n comb1nat1on . . . . . . . with tetracycli11e, doxycycline or clindamy:in.
ACTs are effective i11 treatm t f hi en o c oroqume-res1stant . . P. vivax malaria (Douglas et . al., 20l 0). Th,irteen additional countries l1ave observed treat1nent or prophylactic failure witl1 chloroqui11e but further studies are required to confirm resistance in those countries. M o� , quito resistance to at least c,ne insecticide used for malaria control has
been ide11tifie9 in 64 cottntries around the \.vorld.
•2.9 Histor:r a11d development of guidelines fo1· diag11osis ancl treatment of
Tl1e first editic>n of Guidelines for treatn1e11t of 1nalaria was published in 2006 by the ,vorld health organization (WHO). In Mar�h, 20 IO WHO released new guidelines for the treat1nent of malaria. The guidelines provide evidence-based and up-to-date recommendati0ns for countries on malari, . diagnosis and treatment. These guidelines help cot1ntries for1nulate tl1eir policies and strategies. The main chang-�s from the first
•edition of the guideli11es are the emphasis on testing before treating and the addition of a ne\.v ACT to the list of recommended �reatments .
In scope, the guidelines cover diagnosis and treatment of ttncomplicated and severe malaria cause,j by all types of malaria in special groups (such as young children, pregnant \vorr en and HIV/ AIDS patients), in travellers (from non-n1alaria ende111ic regions) and 1n epidemics and complex emergency situations. The second edition introduced a rew (fifth) ACT named dih) droartemisinin plus piperaquine to the four already recommended for the treatment c,f uncomplicated rnalaria. F'urtherrnore, the guide) ,nes rec om rnend a paras1tolog1cal confirmation of diag11osis ir1 a 11 pntic11t,
suspected ot· having ,nalaria before trcatrnt�nt .
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Move towards universal d · . 1agnost1c testir.g for malaria (Bai den et al., · . 2014) is a . ig against ma aria. This w1ll allow for the targeted use of critical step for\vard in the ti ht · l . . .
ACTs for those who actually ha ve ma aria. e l · Th · · a11n 1s to reduce the emergence an d
spread of drug 'resistance and to help identify patients who have fever, but do not have
malaria, so that alternative diagnoses can be made and appropriate treatment
provided. Thu:; bette1· treattnent of malar1a has positive impact on 1nanagement of
other childl100,i illness and overall child su
1rvival.
In document
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