Hundred Lines on Malaria

• When a mosquito bites you, you scratch with excoriation,

It passes Plasmodium into blood circulation,

It causes Malaria which is a known infection,

That presents with fever, seldom comes with convulsion.

• It enters your red cells and causes fragmentation,

It causes body pain and alters body function,

When you vomit from it, you lack adequate nutrition,

You may pass a loose stool in altered bowel function.

• In neonates and children, it could be an abomination,

They come with high fever and sometimes with convulsion,

When a child has fever, do not wait for convulsion,

Quickly see a doctor to prevent complications.

• And in pregnant women, it is as aforementioned,

Hence, there is need in them for Fansidar prevention,

Insecticide treated net is a weapon in prevention,

Then keeping compounds clean to stop its multiplication.

• Do you know it could spread through blood transfusion?

It can also be spread through transplacental transmission,

It could harm unborn baby with a Folate reduction,

It can kill unborn baby or cause congenital infection.

• A baby may have low weight or get lost as abortion,

With a deprived nutrition, comes foetal growth restriction,

Give mothers haematinics for blood supplementation,

Folic acid helps foetus in neural tube formation.

• After taking a history, do an examination,

Check for fever and pallor, access for dehydration,

If patient had convulsions, it is a complication,

So keep in mind to manage a cerebral infection.

• Patient may be in distress for pain or respiration,

Thus, it gives you a clue in an altered lung function,

A child may get so weak and comes with prostration,

Or in coma or shock, commence resuscitation.

• Malaria could get worse and affect kidney function,

In child; nephrotic syndrome or liver complication,

Check for oedema and jaundice during examination,

The spleen may get enlarged, which you pick on palpation.

• Check pulse and blood pressure, there could be hypotension,

And check for crepitation during chest auscultation,

You must make sure you rule out a secondary infection,

Like bacterial meningitis which causes inflammation.

• To treat a pregnant woman, you need this information,

Malaria could be symptomless, no complain at visitation,

Such that it is just picked on routine investigation,

And most of these patients do not require admission.

• In mild cases we do give some oral medications,

Treat her with oral Quinine in first third of gestation,

Then from fourth till ninth month, Artemisinin combination,

And counsel her to ensure having adequate nutrition.

• A woman can present with a severe infection,

If she is vomiting, institute fluid resuscitation,

Infuse IV Quinine in all months of gestation,

When she can take oral, change to its oral formulation.

• Pregnancy in sicklers is a riskier situation,

They have low red cell mass with ongoing destruction,

Give Proguanil daily to prevent this infection,

Based on her packed cell volume, she may need blood transfusion.

• Mothers in good setting can have a vaccination,

It’s better if we aim at disease elimination,

And when we think higher, disease eradication,

For now just counsel her with proper health education.

• It’s management in children is based on this classification,

It could be complicated or with no complication,

A mild form of infection has no serial convulsions,

Neither with shock nor coma, not even prostration.

• If it is complicated, use Artesunate injection,

When they tolerate oral, change to Artemisinin combination,

If there is no Artesunate, use Artemeter injection,

When they  tolerate oral, change to Artemisinin combination.

• You may use titred Quinine as intravenous infusion,

When oral feeding resumes, give its oral formulation ,

Educate patient’s mother on a good feeding option,

So that she knows the need for an adequate nutrition.

• With other complications, not just serial convulsions,

In coma you can best offer child intubation,

Administer oxygen to aids lung’s ventilation,

In raised ICP Mannitol is given as ten per cent solution.

• In hypoglycaemia, give bolus of glucose infusion,

This is later followed by ten per cent dextrose infusion,

A brain in starvation can get into destruction,

Tepid sponge in high fever, offer anti pyretic medications.

• In acute kidney injury, offer haemodilution,

A peritoneal dialysis is also a good option,

In abnormal bleeding, give vitamin K injection,

You can transfuse whole blood or platelets concentration.

• Metabolic acidosis may lead into confusion,

Exclude hypoglycaemia then offer electrolyte correction,

Administer oxygen which aids lung’s ventilation,

If patient is convulsing, you must abort convulsions.

• When they present in shock, exclude septic condition,

Use broad spectrum antibiotics to treat secondary infection,

I don’t wish but some may need intensive intervention,

Monitor their vital signs and haemoglobin concentration.

• Mothers of sick babies can run into depression,

So husbands should be with them in presence and attention,

You as a good father, buy your child’s medication,

And help convince your wife to accept doctor’s decision.

• This is a piece for us in endemic location,

And those that come to us when they are on vacation,

So tell all mothers and wives or better all relations,

I wish the government will have this piece of information.

Written by Dr Khadijat Mustapha

Reviewed by Dr. Mohammad Yahya

Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto.