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1) Malaria is very common (endemic) in tropical Africa, including Nigeria. Of the estimated 300-500 million cases of malaria that occurs annually, 90% occurs in tropical Africa.

2) Malaria is responsible for approximately 1-3 million deaths per year, most of these deaths occur among children living in Africa, where a child dies every minute from falciparum malaria. Together, the Democratic Republic of the Congo and Nigeria account for over 40% of the estimated total of malaria deaths globally.

3) There are five parasite species that cause malaria in humans:
* Plasmodium falciparum
* Plasmodium vivax
* Plasmodium malariae
* Plasmodium ovale
* Plasmodium knowlesi (peculiar to South-East Asia)

4) The predominant species that cause malaria in Africa is Plasmodium falciparum . Unfortunately, Plasmodium falciparum is the MOST DANGEROUS (most deadly) of the five species of human malaria.

5) Malaria is transmitted (transfered to the human body) mostly through the bites of Anopheles mosquitoes. Malaria can also be transmitted through blood transfusion. The Anopheles mosquitoes bite at night and breed in water.

6) Symptoms: some authors have described malaria as a MASQUERADE because of the very many symptoms that have been associated with it and its ability to mimic many other diseases.

Some of the notable symptoms of malaria include fever, headache (almost always present), chills (feeling of cold), vomiting, Cough, Fatigue (feeling weak), Malaise (feeling unwell), rigors (shaking),
Arthralgia (pain in the joint), Myalgia (pain in the muscles),etc

7) Diagnosis of malaria should be based on symptoms AND diagnostic testing to confirm parasitaemia (by microscopy or rapid diagnositic test). Diagnosis based on symptoms alone has been shown to have very low specificity (ie results in giving anti-malarial drugs to many patients without malaria) and should be discouraged.

POINT 8. Because malaria and parasitaemia (finding of malaria parasite in blood) is endemic (very common) in tropical Africa including Nigeria, positive diagnositic test result does not necessarily mean malaria is the cause of the persons symptoms. The physician should exclude other possible causes of the person's symptoms before arriving at the diagnosis of malaria and prescribing anti-malaria drugs.

9) In all situations falciparum malaria should be treated with COMBINATION anti-malaria drugs. The use of a single anti-malaria drug is wrong.

10) The combination anti-malaria drugs that have been recommended by experts include:

* Artemisinin Combination Therapy (ACT) : is the first choice for most persons. ACT options include:
- Artemether plus Lumefantrin (coartem)
- Dihydroartemisinin plus piperaquine
- Artesunate plus amodiaquine
- Artesunate plus mefloquine

* Other recommended anti-malaria combinations include:
- Artesunate plus doxycyline (or tetracycline)
- Artesunate plus clindamycin
- Quinine plus tetracycline (or doxycycline or clindamycin)

Some References
http://www.malaria.org/wheredoesitoccur.html
http://www.who.int/mediacentre/factsheets/fs094/en/
http://emedicine.medscape.com/article/221134-overview

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