KURSUS T.O.

T
END-GAME APPROACH
PROGRAM ELIMINASI MALARIA

PENGURUSAN KES
& RAWATAN
MALARIA
 CONTROL
VS.
ELIMINATION
CONTROL ELIMINATION
CONTROL STRATEGY ELIMINATION
APPLICATION OF MENU STRATEGY
INTERVENTIONS TO APPLICATION OF
GRADUALLY REDUCE THE TARGETED AND LOCALLY
BURDEN OF THE DISEASE IN
ADAPTED MEASURES TO
A POPULATION
TRACK DOWN THE LAST
FOCI AND CASES OF
MALARIA – MAKING SURE
 PENDEKATAN STRATEGIK

1. KESAN

2. RAWAT
Ambil pendekatan
lain bagi :
mencegah
jangkitan kepada
nyamuk anopheles /
cegah jangkitan
kepada individu
daripada anopheles
terjangkit
4. Cegah
3. Urus KES
FOCI IMPORT
 PENGURUSAN KES
 Menurunkan reservoir parasit dengan pantas
 Cegah transmisi
 Menyembuhkan penyakit
 Cegah komplikasi dan kematian

Rawat semua jangkitan dalam

komuniti, simptomatik atau
asimptomatik,
Untuk menyekat transmisi
 DIAGNOSIS DALAM
PROGRAM ELIMINASI
MALARIA

Dalam fasa eliminasi, semua kes malaria mesti dikesan

dan disahkan melalui ujian parasitologi dengan
mengenalpasti jenis spesis parasit, peringkat parasit
dan densiti parasit.
MICROSCOPY - HIGHLY SENSITIVE AND SPECIFIC IN IDENTIFYING
PARASITE
SPECIES, STAGES AND QUANTIFICATION OF MALARIA
PARASITES.
A SYSTEM FOR QUALITY ASSURANCE IS
ESSENTIAL.
RAPID DIAGNOSTIC TESTS (RDTS) MAY BE USEFUL FOR
(I) THE SCREENING OF TRAVELLERS
(II) WHEREVER THERE IS LACK SKILLED MICROSCOPY
POLYMERASE CHAIN REACTION (PCR) MAY BE USED FOR POPULATION
SCREENING AND
FOR IDENTIFYING MORPHOLOGICALLY SIMILAR SPECIES E.G..
P. MALARIAE AND P. KNOWLESI). IT IS PRESENTLY NOT
INDICATED FOR
TREATMENT OF
MALARIA CASES
IN THE CONTEXT
OF ELIMINATION
AIM IS AT
COMPLETE
PARASITOLOGICAL
CURE (RADICAL
CURE),
INCLUDING
KILLING OF THE
PARASITES IN
THEIR SEXUAL
STAGES
CIRI RAWATAN DALAM FASA ELIMINASI

Penggunaan combination therapy (act) – As First-

line Treatment
RAWATAN RADIKAL JANGKITAN PF
RaWATAN RADIKAL JANGKITAN PV
RAWATAN KES SEVERE MALARIA
MENghapuskan reservoir PARASIT
KEMOPROFILAKSIS
FIGURE 1. P. VIVAX LIFE CYCLE AND SITES OF ACTION FOR DIFFERENT
ANTIMALARIALS.
Contents :

1. Epidemiology of Malaria
2. Malaria Parasite
3. Clinical Features of Malaria
4. Diagnosis of Malaria
5. Malaria Treatment
6. Management of Severe and
Complicated Malaria
7. Management of Malaria in
Paediatrics
8. Malaria Chemoprophylaxis
9. Treatment Response
Monitoring (DRS)
 Current National Malaria Treatment Policy In Malaysia
Diagnosis Species
P. falciparum P. vivax / ovale
Uncomplicated • ACT(AL) (3 days treatment with total 6 • Oral Chloroquine 10mg base/kg stat
malaria doses) Then, 5mg base /kg at 6H later, Day 2 and
Day 3
• Add Primaquine 0.75mg/kg (Max • ACT (AL) (3 days treatment with total 6
45mg) at day 1 of treatment doses)
AND
• Primaquine 30mg OD for 14 days
Severe malaria • IV Artesunate 2.4mg/kg • IV Artesunate 2.4mg/kg
(at 0H, 12H, 24H) and daily subsequently (at 0H, 12H, 24H) and daily subsequently
(Min 3 doses / till patient can tolerate orally (Min 3 doses / till patient can tolerate orally
and switch to oral treatment) and switch to oral treatment)
• Oral Doxycycline 100mg BD • Oral Doxycycline 100mg BD
• Add Primaquine 0.75mg/kg (Max 45mg)
at day 1 of treatment
Malaria in 1st Trimester • Oral Chloroquine 10mg base/kg stat
pregnancy • Oral Quinine (10mg/kg) 8 hourly Then, 5mg base /kg at 6H later, Day 2 and
• Oral Doxycycline 100mg BDx 7days Day 3
• Same as for P.falciparum
2nd and 3rd Trimester AND
• ACT (AL) (3 days treatment with total 6 • Primaquine 30mg OD for 14 days
doses) Followed by 300mg weekly until delivery
Full course of Primaquine will only be given
Current National Malaria Treatment Policy In Malaysia
Diagnosis Species
P. malariae / knowlesi
Uncomplicated • ACT (AL) (3 days treatment with total 6
malaria doses)

Severe malaria • IV Artesunate 2.4mg/kg

(at 0H, 12H, 24H) and daily subsequently
(Min 3 doses / till patient can tolerate orally
and switch to oral treatment)
• Oral Doxycycline 100mg BD
• Add Primaquine 0.75mg/kg (Max 45mg)
at day 1 of treatment

Malaria in 1st Trimester

pregnancy • Oral Quinine (10mg/kg) 8 hourly
• Oral Doxycycline 100mg BDx 7days

2nd and 3rd Trimester

• ACT (AL) (3 days treatment with total 6
doses)
Maintain QUALITY
ASSURANCE
Small Stocks AND
of LOGISTICS OF
- Quality ANTI-
MALARIAL
Assured Anti- MEDICINES
malarial FOR CASE
MANAGEMEN
Medicines T
- Effective for
rapid treatment
 ROLE OF PRIVATE HEALTH CARE SECTOR AND
OTHER SECTORS PROVIDING SERVICES
Elimination programmes aim – 100%
detection and notification of malaria
Full cooperation of the privatecases
health sector.
All patients, whether nationals, temporary or permanent immigrants,
people in transit, or residents of neighbouring countries who live in
border areas can easily access services --- FOC diagnosis &
treatment including consultation fees.
Monitoring of the national supply of antimalarial medicines;
STOP over-the-counter sale of antimalarial medicines;
maintenance of skills of health personnel and updating of their
knowledge.
Mass Screening and
Treatment (MSAT) USE OF
Mass Drug ANTIMALARIAL
Administration(MD
MEDICINES
A)
FOR
Seasonal Treatment
REDUCING
to reduce P. vivax PARASITE
hypnozoite carriers RESERVOIR
 MSAT : Mass Screening And
Treatment
Mass screening for parasitaemia and treating all infected
persons in a targeted area or population, regardless
whether they are symptomatic or not = aim is to rapidly
reduce the size of infectious reservoir in targeted area
screening tools : RDT vs. Microscopy vs. PCR
repeated at intervals once or twice
time-consuming and may miss low-density parasitaemia.
Exclusions: contraindications to the medicines used, pregnant
women, young infants and other population groups
Not for relapsing malarias
(no test for detecting hypnozoites)
 MDA : Mass Drug
Administration
Campaign for treating every individual in a defined
population or geographical area with antimalarial
treatment on a given day, in a coordinated manner.
A well conducted MDA can result in a major reduction in the
parasite mass
 The treatment is usually the same as is used in case management for
the species, which is targeted.
 usually considered in the end-stage, for management of last
remaining small foci, with accessible population and very low risk of
importation
 Full cooperation of the community is essential to reach 100%
coverage
 MDA - CONCERNS
Rebound
The area can return to its original prevalence levels, if vectorial
capacity is not reduced and maintained at below the critical level.
time to return to the original levels of transmission depends on the
prevailing vectorial capacity.
The rebound may be associated with higher morbidity and mortality if
people lost herd-immunity against malaria.
A coordinated attack of vector control and use of drugs to reduce the
parasite reservoir may solve the problem of rebound .
 Enhance resistance against the medicines if larger
population of parasites targeted with MDA
 Mass drug administration difficult to explain to the population
 Side effects, especially of primaquine
 SEASONAL TREATMENT OF P. VIVAX
HYPNOZOITE CARRIERS
Used to interrupt transmission in areas with seasonal
transmission of P. vivax (about 3-5 months) , where foci are
small and high coverage can be achieved,
All individuals to be treated with primaquine for 14 days (Except
pregnant women and children under one year)
Usually conducted in spring, about two months before the onset
of transmission.
The pre-condition: primaquine is not associated with any
significant risk of toxicity in the target population, population is
fully informed of signs of primaquine toxicity, fully cooperative.
 ABCD
4 PRINCIPLES OF MALARIA
PROTECTION
Be Aware of the risk, the incubation period, the
possibility of delayed onset, and the main symptoms.
Avoid being Bitten by mosquitoes, especially
between dusk and dawn.
Take Chemoprophylaxis when appropriate, to
prevent infection from developing into clinical
disease.
Immediately seek Diagnosis and treatment if a
fever develops 1 week or more after entering an area
where there is a malaria risk and up to 3 months (or,
rarely, later) after departure from a risk area.