10 most frequently asked questions about malaria

Yes, malaria is a disease that can cause death. In fact, malaria causes about four lakh deaths every year globally - a large number of those who die are children below the age of 5 years. According to the WHO, kids below 5 years of age accounted for 67% of all deaths due to malaria in 2018.

Malaria is caused by a parasite called Plasmodium and its different varieties, which are carried by the female Anopheles mosquito. Once it enters the body, Plasmodium affects the red blood cells and their circulation, which affects all the major organs of the body including the liver, kidneys and lungs. Cerebral malaria, which is caused by the Plasmodium falciparum parasite, can affect the brain and lead to its failure.

Anaemia, or low levels of red blood cells in the body, also sets in and affects all the organs of the body and impairs their function very quickly. This can lead to failure of multiple organs of the body. This type of multi-organ failure, especially in the absence of any treatment or intervention, can cause death due to malaria.

Malaria is caused by Plasmodium parasites. When the female Anopheles mosquito bites someone with malaria, it picks up the parasites. When this same mosquito bites another human being (or other animals as well), the parasite enters their body and mixes with the bloodstream to multiply quickly. 

Because every part of the body needs blood to function, the parasite quickly spreads all over and affects the functioning of the body. The parasite particularly weakens the liver, kidneys, lungs and brain. Without proper treatment and intervention, a malaria patient’s condition can deteriorate very quickly.

Contrary to popular belief, malaria is not caused by a virus, and is therefore not a viral infection. It is, in fact, a parasitic infection caused by the Plasmodium parasites. These parasites were first discovered in the blood of malaria patients by Charles Louis Alphonse Laveran in 1880. 

Inspired by Laveran’s hypothesis about the Plasmodium parasites, Ronald Ross in 1897 (in Secunderabad) discovered the existence of said parasites in the stomach tissues of a female Anopheles mosquito, thereby not only proving that malaria is caused by this parasite but also that this particular type of mosquito is the vector (carrier) for the disease. Ross was awarded the Nobel Prize for Medicine in 1902 because of this discovery.

Currently, we know of five protozoan parasites of the Plasmodium genus that cause malaria globally:

• Plasmodium falciparum, which is responsible for the majority of deaths globally and especially affects the sub-Saharan African continent.
• Plasmodium vivax, which affects Asian and Latin American nations and causes the predominant type of malaria in India as well.
• Plasmodium ovale, which has an added devastating effect on the liver because it can stay dormant for years without getting activated.
• Plasmodium malariae, which causes a very small number of malaria infections worldwide. 
• Plasmodium knowlesi, which predominantly affects primates but can also be transmitted to humans.

Malaria is a disease that is categorized as an acute febrile illness - which means it is characterized by a rapid onset of fever accompanied by chills, headache, body aches and joint pain. But this is not the only reason why it’s considered to be one of the deadliest diseases humankind has ever faced. 

Certain types of malaria, especially P. falciparum, can progress to severe illness and cause death if not treated within 24 hours. This becomes a very difficult task to complete if the healthcare system of the affected countries is not up to the task or if the outbreak occurs in poverty-ridden sections of cities, nations or societies. 

If you take a look at the most affected nations, you’ll find that all of these are developing countries in Africa, Asia and Latin America. Because malaria is linked to hygiene, waterlogging and water safety, the poorest of the poor get affected by this disease. Such affected communities might not even have adequate access to healthcare to get treatment and recover from malaria - and this is what makes malaria so deadly.

The incubation period of the Plasmodium parasite is seven to 30 days. This means that if you get bitten by a vector female Anopheles mosquito today, you are likely to show the symptoms of malaria at least a week later. 

The first symptoms of malaria, according to the WHO, are fever, chills and headache. It’s very easy to mistake these primary symptoms to be those of the flu or common cold, but if you live or work in an area where mosquitoes and mosquito bites are common, then you should get tested for malaria immediately because prompt diagnosis and treatment play a key role in recovery.

The secondary symptoms of malaria include muscle pain, joint pain, nausea and vomiting, and diarrhoea. As malaria progresses, it also causes jaundice and anaemia. Further progression can lead to kidney failure, seizures, liver failure, mental confusion, coma and death.

There is only one way to test for malaria and identify exactly which type of Plasmodium caused the disease - finding out the latter is important to get proper treatment - and that is by getting a drop of the patient’s blood and checking it under a microscope for the parasites.

If you are sick, have the symptoms of malaria, and either live or have recently travelled to an area with a malaria outbreak, you should contact a doctor immediately and get a blood test done to confirm your diagnosis and get adequate and timely treatment. In areas where malaria outbreaks are frequent, malaria Rapid Diagnostic Tests (RDTs) are made available by government agencies, the WHO and healthcare providers.

All RDTs are equipped to detect the specific antigens or proteins produced by malaria parasites, although variations can occur in these products. Some RDTs can detect only one species of Plasmodium, while others are equipped to detect multiple species. The best part about RDTs is that the blood of the patient is drawn through a simple finger prick, which means that these can be used at home or while travelling as well.

With proper and timely treatment, malaria can be cured pretty quickly. The expected duration of complete remission of all symptoms is two weeks. Relapses do occur in some cases, but they’re extremely rare.

However, without proper treatment, malaria can progress very quickly and cause coma or even death. In milder cases, malaria episodes can return periodically. This is the reason why people who have travelled to areas with malaria outbreaks are asked to give their travel for up to a year during doctor’s appointments.

Repeated exposure to the Plasmodium parasites can make patients partially immune to malaria and cause only milder forms of the disease to come up periodically. This has been noticed especially in some sub-Saharan African communities.

Following a healthy and easily digestible diet while suffering from malaria is very important. The below-mentioned foods should be prepared properly, while maintaining hygiene, and be consumed by the patient of malaria.

• Fluids: Drink safe, potable water. If you do not have access to filters that perform reverse osmosis or other purifying methods, boiling the water before drinking is a good thing to do. You can also drink fresh fruit and vegetable juices, coconut water and other detoxifying and immune-boosting drinks. (Read more: How to increase immunity: foods and remedies)
• Carbohydrates: Easily digestible carbohydrates like rice should be eaten for energy and to relax the stomach.
• Protein: Thin lentil soups, dal, chicken broth, fish soup, milk, curd, buttermilk and boiled lean chicken are dependable sources of protein while recovering from malaria. Protein is necessary for energy as well as to fight off weakness.
• Vitamins and minerals: Malaria can deplete the vitamin and mineral levels in your body, which is why it’s very important to replenish them as soon as possible. Opting for fresh fruits and vegetables is a good way to do this, but if your doctor recommends it, you can also opt for vitamin B-complex, vitamin A and vitamin C supplements.

Simply put, the answer is yes, you can get malaria twice. The primary reason behind this is the different species of Plasmodium that can cause malaria. You might have, for example, contracted P. vivax once, gone through the entire treatment protocol and recovered completely. This might give you some immunity from P. vivax. But if you are bitten by a mosquito carrying P. falciparum a year later, you could contract malaria again.

People who grow up in areas with a high occurrence of malaria can sometimes develop a partial immunity from the disease. But there is no guarantee for this, and there are very few communities which have developed this type of herd immunity. 

Read more: What is herd immunity and can it help stop COVID-19?

A much graver complication which is posing a problem to healthcare systems around the world is that Plasmodium species are gaining resistance to malaria drugs - which suggests mutation of these parasites and reinfections as well as outbreaks of malaria in communities which might have built even a partial immunity. 

The WHO mentions this resistance to antimalarial drugs is a major and recurring problem which affects malaria control efforts and reverses any progress made in this direction. The WHO has repeatedly launched efforts to counter the spread of drug-resistant malaria parasites in different parts of the world.

No, malaria is not contagious or infectious and you cannot catch it by being physically close to somebody who has the disease. Sharing the same space or even kissing an infected person will not transmit malaria to you, because this disease - unlike viral and bacterial infections - is caused by parasites which are activated only once they enter your bloodstream.

Malaria is spread when a female Anopheles mosquito carrying one of the Plasmodium parasites bites a human being and the parasites enter the bloodstream. Since the parasites thrive in the bloodstream, the only way malaria can be transmitted from one person to the next is via blood transfusion or organ transplants. It is also possible for pregnant women to pass the parasite on to their babies during the later stages of pregnancy or during childbirth.

Read more: Checkups during pregnancy: tests and ultrasounds in all three trimesters