World Malaria Day (April 25)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.
The theme of ‘World malaria day’ is to raise awareness about the urgent actions needed in the fight against malaria, emphasizing the importance of continued commitment for the global malaria eradication(1). Malaria remains a leading cause of preventable illness and death in the world(5,6). Malnutrition, anemia, jaundice, hepatitis and renal failure are the most common systemic manifestations of long-term and severe malaria. New and improved diagnostics are essential for the effective control of malaria. Routinely performed complete hemogram (CBC) along with new and improved fifth generation IVD laboratory tests are essential for the effective detection and control of malaria(2). Easy-to-use point of care tests (POCTs) based on immunochromatography, PCR, RT-PCR and DOT-BLOT can diagnose the malaria parasites that cause an infection and identify its drug resistance profile(3). A malaria-free world would mean millions of lives saved and a return on investment of billions of rupees(4).
Q1. What is the theme of World Malaria Day?
ANS: The theme for World Malaria Day 2025 is to increase awareness about the urgent actions required in the fight against malaria. This theme emphasizing the importance of continued investment in malaria elimination, introduction of innovative test methods, collaboration with different countries and commitment for the global malaria eradication(1,9).
Note
(A) Malaria eradication requires a global effort, working together with various affected countries, international organizations, research institutions, and civil society organizations(4).
(B) Strong political commitment is needed to sanction appropriate funds, create and implement effective policies, and organize support for malaria control and elimination(5).
(C) WHO Country Office (WCO) for India has supported the National Vector Borne Disease Control Programme (NVBDCP) for the development of a strategic plan for malaria elimination. The important features of the plan are: Effective use of malaria surveillance, introduction of mechanisms for early detection and prevention of outbreaks of malaria, promotion of actions such as prevention of malaria by the use of long lasting impregnated nets, regular use of indoor insecticide sprays and increase in the manpower and capacities for strategic implementation in the next five years(1,9).
Q2. Why malaria eradication is difficult?
ANS: Malaria eradication is difficult due to the multiple stages of the parasite in both humans and mosquitoes, making it difficult to target a single stage for vaccination. Malaria parasite exhibits antigenic variability, that makes protective tasks of immune system difficult. Exposure to malaria parasites does not always confer long-lasting immunity, and acquired immunity is often incomplete. There are lots of difficulties in reaching several remotely placed endemic regions in the world(1,9).
Note
(A) Malarial parasites are found in all countries and the tropical zone is the main endemic zone(10).
(B) Anopheles mosquito requires water for their aquatic larvae and pupae development. Suitable water sources range from puddles, water tanks, ditches, ponds, to swamps. The adult mosquitoes can live in dry regions. They can travel far and can be swept many times to hundreds of kilometers by blowing winds. Adults can become dormant in hot dry weather and also can travel in the form of carrier patients and through the baggages of passengers to different places(10).
(C) Male Anopheles cannot feed on blood, however, can live for about a week by feeding on nectar and other sources of sugar. Female Anopheles feed on a blood meal for the development of eggs(10).
Q3. Which species of the plasmodium parasite can infect humans?
ANS: Five species of the plasmodium parasite can infect humans: Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, Plasmodium falciparum and Plasmodium knowlesi(2).
Note
(A) The life cycle of malaria parasite requires two types of hosts: Host 1: Female anopheles mosquito, where the parasite reaches sexual maturity. Parasite in the form of sporozoite is introduced in the humans (and other vertebrates), when mosquito bites. Host 2: Humans (and the vertebrates), where, the sporozoites enter liver through blood circulation and develop into merozoite, which infect red blood cells. Merozoites develop into trophozoite and gametocytes. Gametocytes infect the mosquito(2).
(B) Development of sporozoites damage liver cells, leading to hepatic condition. Merozoite development causes destruction of RBCs leading to anemia(2).
(C) Patient suffers from high fever and chills, when RBCs are ruptured during the development stages of trophozoites(2).
Q4. Describe the fever cycle related to malaria.
ANS: The fever cycle is repeated (with exceptional cases) after every 48 hours in the case of Plasmodium falciparum, 48-72 hrs in the case of Plasmodium vivax, Plasmodium ovale, and 72 hours in the case of Plasmodium malariae(2).
Q5. What are the symptoms of malaria infection?
ANS: The common symptoms of malaria may include high fever, headache, chills, sweats, and vomiting.
Note
(A) Severe malaria may progress to anemia and jaundice along with blood coagulation defects, shock, central nervous system disorders, liver and kidney failure, coma, and death (if not treated in time).
(B) The time between the infectious mosquito bite and the development of malaria symptoms typically ranges from 10 days to 30 days. It depends on the type of malarial parasite involved. Dormant forms of malarial parasite can cause illness after many months to years.
(C) Although, malaria parasite transmission occurs primarily through the bite of infected female Anopheles mosquitoes, it may also occur through shared needles, blood transfusions, organ transplants, and also from mother to child during pregnancy or childbirth(9).
(D) Patients with repeated malaria attacks may develop a partially protective immunity. These patients can still get infected by malaria parasites. However, disease may not be severe and frequently lack any specific malaria symptoms.
Q6. What is the best time to collect blood and the preparation of blood smears to detect malarial parasites in the stained blood smears?
ANS: During fever, trophozoites are released from destroyed RBCs and are present in blood. Hence, blood is collected during fever and smears are prepared for staining and microscopic examination. Trophozoites could be flagged by appropriate Hematological analyzer(2).
Q7. What is the significance of detection of nucleated RBCs (NRBCs) in blood of malaria affected patient?
ANS: Bone marrow stem cells are affected by malarial parasites. Due to the stress created by excessive destruction of RBCs, NRBCs are released and detected in general blood circulation of the patient(2).
Q8. Why following treatment, malaria reappears in many patients?
ANS: Malaria mixed infections are often unrecognized by the laboratory tests and a delay or failure to treat mixed malaria infections with poor follow-up treatment may lead to frequent reinfections, aggravated morbidity and increased mortality(7).
CASE STUDY 1
A 47-year-old-female presented with occasional high fever, headache, and chills for about five days and did not respond to treatment given by the physician. Her blood was collected during fever for complete hemogram. The following were her complete histogram reports:
COMPLETE HEMOGRAM:
| PARAMETER | VALUE | NORMAL RANGE |
| Hemoglobin | 9.5 g/dl | 12–16 g/dl |
| Total erythrocyte count | 3.8 X 1012/l | 4.3 ± 0.5 X 1012 /l |
| Total leukocyte count | 7,800 | 7.0 ± 3.0 X 109/l |
| Differential leukocyte count | ||
| Neutrophils | 68% | 40–75% |
| Lymphocytes | 30% | 20–45 % |
| Eosinophils | 1% | 1–4% |
| PCV | 30.5% | 36–48% |
| MCV | 88.5 fL | 82–92 fL |
| MCH | 28.5 pg | 27–32 pg |
| MCHC | 33 % | 32–36 % |
| RDW- CV | 15.8 | 12–14 |
| Platelet count | 160 X 109 /l | 150–400 X 109/l |
| Histogram Flags | ||
| Presence of malarial parasites and Nucleated Red Blood Cells (NRBCs) | ||
| Stained peripheral blood smear Microscopic observations | ||
| Hypochromia | ++ | Normal cells |
| Microcytes | + | Normal cells |
| Ring forms of malarial trophozoites detected | ||
| Nucleated red blood cells detected | ||
Diagnosis
Malaria
Malaria parasites and presence of NRBC indicate that the patient was suffering from malaria. Appropriate treatment was advised to cure malaria and to treat related anemia.
Q9. How do early detection of malaria impact patient outcomes and overall healthcare costs?
ANS: Since 2000, increased awareness, use of routine and advanced IVD laboratory tests, use of hematology analyzers, funding, effective interventions, and political commitment have dramatically reduced the global burden of malaria, preventing 2.2 billion cases and saving 12.7 million lives(4).
Note
According to the latest world malaria report(1,9), there were an estimated 263 million cases of malaria in 2023, leading to 597,000 deaths worldwide. Approximately 94 percent of all cases and 95 percent of all deaths occurred in Africa. Several persons at risk still lack access to the services which enable prevention, detection and treatment of malaria.
Q10. What sociodemographic variables are responsible for the increased incidences of Malaria?
ANS:
(A) Sociodemographic variables such as income, education level, ethnicity, and geographic location can significantly impact the risk of increase in the incidences of malaria.
(B) Malaria disproportionately affects vulnerable populations in resource-limited areas, where access to healthcare, diagnostic tools, and effective treatments is often limited.
(c) Malaria has a significant impact on the health of infants, young children, and pregnant women worldwide. More than 800,000 African children under the age of five die of malaria each year(1,9).
References
(1) World Health Organization. Malaria. https://www.who.int/news-room/fact-sheets/detail/malaria.
(2) Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.
(3) Christian Nsanzabana, Frederic Ariey, Hans-Peter Beck, Xavier C Ding, and et al. Molecular assays for antimalarial drug resistance surveillance: A target product profile. PLoS One. 2018 Sep 20;13(9):e0204347. doi: 10.1371/journal.pone.0204347.
(4) Jiaofeng Huang, Yuekai Hu, Yinlian Wu, Li Pan, Mingfang Wang, Wei Wang & Su Lin. Global burden of malaria before and after the COVID-19 pandemic based on the global burden of disease study 2021.Scientific Reports volume 15, Article number: 9113 (2025)
(5) Monroe, A., Williams, N. A., Ogoma, S., Karema, C. & Okumu, F. Reflections on the 2021 world malaria report and the future of malaria control. Malar. J. 21, 154. https://doi.org/10.1186/s12936-022-04178-7 (2022).
(6) Feachem, R. G. A. et al. Malaria eradication within a generation: ambitious, achievable, and necessary. Lancet 394, 1056–1112. https://doi.org/10.1016/s0140-6736(19)31139-0 (2019).
(7) Aongart Mahittikorn, Frederick Ramirez Masangkay, Kwuntida Uthaisar Kotepui, Giovanni De Jesus Milanez. The high risk of malarial recurrence in patients with Plasmodium-mixed infection after treatment with antimalarial drugs: a systematic review and meta-analysis. Parasit Vectors. 2021 May 25;14:280. doi: 10.1186/s13071-021-04792-5.
(8) Wylie WNT (1983). “Poverty, Distress, and Disease: Labour and the Construction of the Rideau Canal, 1826–32”. Labour/Le Travail. 11: 7–29. doi:10.2307/25140199. JSTOR 25140199. S2CID 143040362.
(9) “CDC – Malaria – About Malaria – Where Malaria occurs”. cdc.gov. April 9, 2020. Retrieved December 20, 2022.
(10) “Anopheles Mosquitoes”. Global Vector Hub. Retrieved 15 December 2023.Kasturi Haldar, Narla Mohandas. Malaria, erythrocytic infection, and anemia. Hematology Am Soc Hematol Educ Program. 2009:87–93. doi: 10.1182/asheducation-2009.1.87
