Experts have shown concern over the rising cases of cerebral malaria in Sindh, especially flood-affected areas, and demanded of the authorities to take urgent steps for draining out stagnant floodwater, improve sanitation and launch fumigations to eliminate breeding grounds of mosquitoes.
Cerebral malaria is a severe disease and fatal in many cases. According to the World Health Organisation (WHO), it affects nearly 300-500 million people every year, causing over one million deaths, hence having a very high mortality ratio compared to other forms of malaria.
Associate Professor of Pathology at Chandka Medical College (CMC) Larkana, Dr Akbar Ali Soomro says cerebral malaria is a type of malaria, which is an infectious disease caused by a parasite (plasmodium), transmitted from human to human by the bite of infected female Anopheles mosquitoes. He said that four species of the parasite plasmodium were responsible for malaria in humans: Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and Plasmodium falciparum, adding Plasmodium falciparum and Plasmodium vivax are mainly behind malaria cases in Sindh province.
Cases of malaria including cerebral malaria are on the rise in Sindh province, especially its ‘rice
belt’ including Larkana, because of accumulated water in rice fields, says Professor Soomro. He said that after the recent floods when a huge area came under floodwater, more cases of waterborne diseases, including malaria were being reported. He said, “Poor sanitation and drainage systems in our towns and villages also provide new breeding grounds for mosquitoes and resulting in more and more cases of malaria”.
Malaria is transmitted through the female Anopheles mosquito, which becomes infected by ingesting blood containing the sexual forms of the parasite plasmodium. After developing in the mosquito, the plasmodium is inoculated into humans when the mosquito next feeds (bites). The first stage of plasmodium development in humans takes place in the liver. When the more mature plasmodium escapes from the liver and enter the bloodstream, they infect red blood cells and multiply, causing the red blood cells to burst open after about two to three days and to release a new crop of parasites (plasmodium).
The cycle of invasion, multiplication, and red blood cell rupture may be repeated many times.
Prof Soomro said that the cerebral malaria was the most serious and life-threatening form of malaria. There were three initials of cerebral malaria:
Cold Stage: It ranges from chills to extreme shaking for 1-2 hours; Hot Stage: It was characterised by a high fever up to 107F (41.7C) for 3-4 hours; Wet Stage: It was characterised by profuse sweating for 2-4 hours. Since cerebral malaria gets fatal within a few days of infection, immediate treatment is necessary.
The natural immunity to this disease is not very clear but it can be artificially controlled by preventive strategies like anti-malarial chemotherapy and adjunctive measures.
Malarial attacks present over four to six hours with shaking chills, high fever, and sweating, and are often associated with fatigue, headache, dizziness, nausea, vomiting, abdominal cramps, dry cough, muscle or joint pain, and back ache. The attacks may occur every other day or every third day.
Cerebral malaria and death can occur, sometimes within 24 hours, if the infection is caused by plasmodium falciparum.
Prof Soomro said the methods of diagnosis include complete medical history of symptoms, physical examination, and blood tests, including thick and thin blood films, to identify the plasmodium species responsible for infection. He said that medical treatment should be sought immediately.