MALARIA & AYURVEDA.

Malaria is a mosquito-borne infectious disease of humans and other animals caused by parasitic protozoans (a type of unicellular microorganism) of the genus Plasmodium. Commonly, the disease is transmitted by a bite from an infected female Anophelesmosquito, which introduces the organisms from its saliva into a person's circulatory system. In the blood, the parasites travel to the liver to mature and reproduce. Malaria causes symptoms that typically include fever and headache, which in severe cases can progress to coma or death.

Disease transmission can be reduced by preventing mosquito bites by using mosquito nets and insect repellents, or with mosquito-control measures such as spraying insecticides and draining standing water. Despite a need, no effective vaccine exists, although efforts to develop one are ongoing. Several medications are available to prevent malaria in travellers to malaria-endemic countries. A number of antimalarial medications are available in those who have the disease. Severe malaria is treated with intravenous orintramuscular quinine or, since the mid-2000s, the artemisinin derivative artesunate, which is better than quinine in both children and adults and is given in combination with a second anti-malarial such as mefloquine. Resistance has developed to several antimalarial drugs; for example, chloroquine-resistant P. falciparum has spread to most malarial areas, and emerging resistance to artemisinin has become a problem in some parts of Southeast Asia.

The disease is widespread in tropical and subtropical regions in a broad band around the equator, including much of Sub-Saharan Africa, Asia, and the Americas. The World Health Organization estimates that in 2010, there were 219 million documented cases of malaria. That year, the disease killed between 660,000 and 1.2 million people, many of whom were children in Africa. The actual number of deaths is not known with certainty, data is unavailable in many rural areas, and many cases are undocumented. Malaria is commonly associated with poverty and may also be a major hindrance to economic development.

Classification

Malaria is classified into either "severe" or "uncomplicated" by the World Health Organization (WHO). It is deemed severe when any of the following criteria are present, otherwise it is considered uncomplicated.

• Decreased consciousness
• Significant weakness such that the person is unable to walk
• Inability to feed
• Two or more convulsions
• Low blood pressure (less than 70 mmHg in adults and 50 mmHg in children)
• Breathing problems
• Circulatory shock
• Kidney failure or hemoglobin in the urine
• Bleeding problems, or hemoglobin less than 50 g/L (5 g/dL)
• Pulmonary oedema
• Blood glucose less than 2.2 mmol/L (40 mg/dL)
• Acidosis or lactate levels of greater than 5 mmol/L
• A parasite level in the blood of greater than 100,000 per microlitre (µL) in low-intensity transmission areas, or 250,000 per µL in high-intensity transmission areas

Cerebral malaria is defined as a severe P. falciparum-malaria presenting with neurological symptoms, including coma (with a Glasgow coma scale less than 11, or a Blantyre coma scale greater than 3), or with a coma that lasts longer than 30 minutes after a seizure.

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 will eventually disappear 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 become re-established if conditions revert to a combination that favours 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.

Mosquito control

Man spraying kerosene oil in standing water, Panama Canal Zone1912

Walls where indoor residual spraying of DDT has been applied. The mosquitoes remain on the wall until they fall down dead on the floor.

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 to be 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.

Mosquito nets create a protective barrier against malaria-carrying mosquitoes that bite at night.

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 own ITNs. In 2000, 1.7 million (1.8%) African children living in stable malaria-endemic conditions 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. An increased percentage of African households (31%) are estimated to own at least one ITN in 2008. Most nets are impregnated with pyrethroids, a class of insecticides with low toxicity. A recommended practice for usage is to hang a large "bed net" above the center of a bed to drape over it completely with the edges tucked in. Pyrethroid-treated nets and long-lasting insecticide-treated nets offer the best protection, and are most effective when used from dusk to dawn.

Indoor residual spraying is the spraying of insecticides on the walls inside a home. After feeding, many mosquito 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.

There are 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 in which 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, do not have supporting evidence.

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.Recognizing the disease in the early stages can stop 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.

June has been marked as Anti-malaria month by National Vector Borne Disease Control Programme (NVBDCP) of India with an objective to increase multisectoral collaboration and community involvement in malaria control.

Medications

There are a number of drugs that can help prevent malaria while travelling in areas where it exists. Most of these drugs are also sometimes used in treatment. Chloroquine may be used where the parasite is still sensitive. Because most Plasmodium is resistant to one or more medications, one of three medications—mefloquine (Lariam), doxycycline (available generically), or the combination of atovaquone and proguanil hydrochloride (Malarone)—is frequently needed. Doxycycline and the atovaquone and proguanil combination are the best tolerated; mefloquine is associated with death, suicide, and neurological and psychiatric symptoms.

The protective effect does not begin immediately, and people visiting areas where malaria exists usually start taking the drugs one to two weeks before arriving and continue taking them for four weeks after leaving (with the exception of atovaquone/proguanil, which only needs to be started two days before and continued for seven days afterward).The use of preventative drugs is seldom practical for those who reside in areas where malaria exists, and their use is usually only in short-term visitors and travellers. 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. The use of preventative drugs where malaria-bearing mosquitoes are present may encourage the development of partial resistance.

MALARIA ACCORDING TO AYURVEDA

Ayurvedic cure for malaria

Two plants found in tropical India prove useful

Cissampelos pareiraIT HAS been nearly four decades since the first case of drug-resistant malaria was spotted in the world. Since then scientists have been trying hard to develop medicines to counter its menace.

Now a research has shown the potential of two plants—Tinospora cordifolia (guduchi) and Cissampelos pareira (akanadi)—commonly used in ayurveda, as an antidote to malaria.

The plants are found in tropical parts of India. Guduchi is used to cure ulcers, dysentery, urinary diseases and diabetes. Akanadi finds use as a diuretic, anti-inflammatory and digestive medicine.

Photo: Aashish BhatnagarTo test the efficacy of the plants the team from Department of Bioscience, Himachal Pradesh University divided mice into four groups. They all were inoculated with Plasmodium berghei. One group was given the recommended dose of chloroquine, commonly used to cure malaria. The second group was given plain water. The third and the fourth group were administered with extract from Tinospora and Cissampelos respectively.

The mice were checked for the presence of the parasite in the blood stream. The group which was treated with plant extracts had less than half the parasitaemia than the untreated ones. Thus these plant extracts can effectively be used to treat malaria. The study was published in the November 24 issue of Current Science.

Commenting on the study A C Dhariwal, Director of the National Vector Borne Disease Control Programme says, “It is always beneficial if we have alternatives for fighting the disease, and it is even better if the cure is from a source available easily in our country.” The government has decided to tackle malarial drug resistance by treating patients with artemisinin-based combination therapy, he adds. Such treatments are now a standard treatment worldwide but are expensive. The starting compound artemisinin is isolated from the plant Artemisia annua, a herb described in Chinese traditional medicine. 

MEDICINES AND PRESCRIPTIONS

In case of remittent fever, the one which continues without decreasing, the following ayurvedic drugs are recommended.

MEDICINE	DOSE
Vishmushtyadi Vati,Talam Bhasma, Karanjadi Vati	240mg of each of Vishmushtyadi Vati, Talam Bhasma and Karanjadi Vati to be taken with juice of tulsi leaves thrice daily.
Sarjika,Sudarshana Churna, Sphatika	500mg of Sarjika, 2gm of Sudarshana Churna and 240mg of Sphatika to be taken with warm water twice daily.
Karanja Churna,Jwarankusha, Tala Bhasma	500mg of Karanja Churna, 120mg of Jwarankusha and 240mg of Tala Bhasma to be taken with juice of tulsi leaves thrice daily.

These medicines are for the first attacks of malaria.

MEDICINE	DOSE
Shuddha Sphatika(alum),Mahajwaarankusha Rasa	240mg of Shuddha Sphatika(alum) and 120mg of Mahajwaarankusha Rasa to be taken with juice of tulsi leaves twice daily.
Sheetamani Rasa	240mg to be taken twice daily with honey

The following medicines are given when the attacks are intermittent.

MEDICINE	DOSE
Tuvrimallayoga	60mg to be taken twice daily.
Flesh of Karanja,Shuddha Sphatika, Godanti Bhasma	120mg of each of Flesh of Karanja, Shuddha Sphatika and Godanti Bhasma should be made into six pills and taken at an interval of two hours.

Apart from the ayurvedic medicines there are also many potent herbs which are also useful for the treatment of malaria.

Ayurvedic Name	Common English	Benefits
Afsanthin	Wormwood	Wormwood is taken to reduce the symptoms of malarial fevers on a daily basis. It should not be taken during pregnancy.
Amla or Amlaki	Indian Gooseberry	Amla is the richest source of vitamin C and so it helps to replenish the loss of this vitamin through the symptoms of malaria.
Neem	Margosa Tree	The neem tree contains gedunin, which very effective for the traditional cure of malaria, i.e. quinine.
Shikakai	Acacia	An infusion of the leaves of the shikakai tree is useful in reducing the fevers caused due to malaria.

Home Remedies for Malaria

1. Boiled rice along with boiled pulses and vegetables should be given to a malaria patient, for the diet is nutritious and also easily digestible.

2. Eating plenty of grapes is a helpful malaria remedy.

3. Drinking orange juice and a water diet help to deal with malaria.

4. Boil a piece of ginger and 2-3 teaspoons of raisins in 1 glass water until the mixture reduces to half. Let it cool and make the patient drink it. This is an effective home remedy for malaria.

5. Dissolve 2-3 teaspoons of powdered clove and cinnamon powder in 1 glass water. Boil the mixture until it reduces to half. Allow it to cool; then add some honey to the mixture and let the patient drink it thrice daily. This treats malaria efficiently.

6. Mix 2-3 tablespoons of lemon juice in half cup water. Give the patient to drink the solution. This helps to fight against malaria.

7. Extract juice of 10-15 basil leaves, add 1 tablespoon black pepper to the juice and give to the patient. This remedy reduces the severity of malaria.

8. Powder a piece of roasted alum. Make the patient take 1 teaspoon of the powder daily. This is a beneficial cure for malaria.

9. Application of cold packs on forehead is effective in bringing down malaria fever.

10. Let the patient consume fenugreek seeds in diet, for it strengthens immune system and allows easy tackling of the disease malaria.

11. 6 grams of the seeds of fever nut plant may be given to the patient along with half cup water. This treatment should precede the expected onset of malaria fever. The second dose should be given 1 hour after the onset. This is a good malaria cure.

12. Make the patient drink small quantities of cow milk thrice a day. This alleviates the symptoms of malaria.