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Course: Pediatric Nursing

Topic: Nursing Care of Child with Communicable Diseases II

The Nurses International Community

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Module Goals

Learners will be able to:

Explain causes and risk factors for malaria
Describe clinical manifestations and complications of malaria
Identify common diagnostic tests for malaria
Identify preventive measures for malaria
Discuss the nursing management of a child with malaria

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Malaria

Every two minutes, a child under 5 dies of malaria
The world’s third most deadly disease for young children between one month and 5 years, following pneumonia and diarrhea

Unicef, 2021

Unicef, n.d

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Malaria

An acute febrile illness caused by Plasmodium parasites, which are spread to people through the bites of infected female Anopheles mosquitoes
Preventable and curable

WHO, 2022

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Malaria- Cause

Plasmodium species :

P. vivax
P. ovale
P. malariae and
P. falciparum

P. falciparum and P. vivax – poses the greatest threat
The most common infections are with P. vivax and P. falciparum
P. vivax is the dominant malaria parasite in most countries outside of sub-Saharan Africa

WHO, 2022

Better Health, 2015

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Malaria- Risk Population

Infants
Children under 5 years of age
Pregnant women
HIV/AIDS
People with low immunity moving to areas with intense malaria transmission such as:

Migrant workers
Mobile populations and travellers

WHO, 2022

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Malaria- Clinical Manifestations

The first symptoms usually appear 10-15 days after the infective mosquito bite:

Fever
Headache
Chills
Shivering
Excessive sweating
Diarrhoea
Generally feeling unwell,malaise
Anemia and associated symptoms

WHO, 2022

Better Health, 2015

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Malaria- Uncomplicated Vs Severe

Uncomplicated:

Mild symptoms
Fully alert and able to stand and walk
Passing urine
Not vomiting repeatedly, and able to take oral medication
No signs of organ failure

Better Care, 2022

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Malaria- Uncomplicated Vs Severe (Continued)

Severe:

Signs of cerebral malaria
Breathing difficulty
Hypoglycaemia, jaundice or severe anemia (Hb less than 5 g/dl)
Repeated vomiting, apparent dehydration or little urine passed
shock

Better Care, 2022

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

Research countries where malaria is common.

Discuss the incidence and treatment.

What risk factors can be identified for Malaria in these countries?

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Malaria- Transmission

Malarial parasites are carried by the female anopheles mosquito (active at dusk and early evening)
Onset of symptoms ranges from eight to 30 days, once again depending on the parasite species
Less common modes of transmission:

Blood transfusion
Sharing needles or syringes, and
Congenital infection

Better Health, 2015

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Malaria- Complications

Jaundice
Coagulation defects (blood doesn't clot)
Rupture of the spleen
Hemolytic anaemia (the red cells don't live a normal life span)
Shock
Kidney failure
Liver failure
Pulmonary edema
Cerebral malaria, producing coma
Death

Better Health, 2015

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Malaria- Diagnosis

The malaria parasites seen within red cells in a stained thick blood smear
Rapid antigen test: to detect malaria proteins
Blood gas including
Glucose
Full Blood Count (Thrombocytopenia is highly suggestive of malaria)

Better Care, 2022

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Malaria- Treatment (Uncomplicated)

In children of 5 kg or more:

One dose of Coartem should be taken immediately, then again after 8 hours, followed by a twice daily dose for the next 2 days
Each dose is 1 tablet if 5–14 kg, 2 tablets if 15–24 kg, 3 tablets if 25–34 kg and 4 tablets if 35 kg or more
Best taken with food.

In children less than 5 kg:

Oral quinine is 10 mg/kg 8 hourly for 7 days PLUS clindamycin 10 mg/kg 12 hourly for 7 days
Older children may also be treated with oral quinine

Better Care, 2022

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Malaria- Treatment (Severe)

The preferred treatment:

Artesunate 2.4 mg/kg intravenously

(immediately and after 12 and 24 hours followed by a daily dose until the child can take oral Coartem)

Must be started immediately and urgently referred to hospital
Should be monitored weekly for up to four weeks after treatment for evidence of hemolytic anemia

Rectal artesunate is also an effective emergency treatment

Better Care, 2022

CDC, 2020

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Malaria- Prevention

Avoid outdoor activity around dusk and dawn
Wear loose, long, light-coloured clothing
Use mosquito repellents on exposed skin and clothing
Don't wear perfumes, colognes or aftershave
Use 'knockdown' sprays, mosquito coils and plug-in vaporising devices indoors
Sleep under mosquito nets treated with repellents or insecticides

Better Health, 2015

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

Discuss the connection between anemia and Malaria.

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Malaria- Prophylaxis

Malanil (atovaquone plus proguanil) daily for children of 10 kg or more
Mefloquine (Larium) once weekly for children of 5 kg or more
Doxycycline daily for older children (over 8 years)
Chloroquine alone, chloroquine with proguanil, and Coartem should not be used for prophylaxis

Better Care, 2022

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Antimalarial Drugs: Side Effects

Diarrhea
Nausea/ Vomiting
Anorexia
Vivid dreams
Headache
Changes in sleep
Hallucinations
Prolongation of QT intervals (Associated with lethal ventricular dysrhythmias)

Herchline, 2020

Albright, Binns, & Katz, 2002

Contact info: info@nursesinternational.org

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Malaria- Nurses Role

Assessment:

Monitor vital signs
Monitor for the sign of anemia
Monitor side effects of antimalarial drugs

Improve body temperature (Warm water compression, antipyretic)
Encourage plenty of fluids to address perspiration
Health education:

About disease, transmission and prevention

Psychological support

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

Develop a community teaching session to help prevent malaria.

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Red Flags

Children under 5 years, especially children under 5 kg, should not to enter a malaria area

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

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References:

Albright, T.A, Binns, H.J., & Katz, B.Z. (2002). Side effects of and compliance with malaria prophylaxis in children. J Travel Med. 2002 Nov-Dec;9(6):289-92. doi: 10.2310/7060.2002.30091. PMID: 12962582.https://pubmed.ncbi.nlm.nih.gov/12962582/#:~:text=Side%20effects%20for%20mefloquine%20included,nausea%2C%20and%20changes%20in%20sleep
Better Health. (2015). Malaria. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/malaria

Better Care. (2022). Parasites: Malaria. Child Healthcare: a guide to common paediatric disorders. https://bettercare.co.za/learn/child-healthcare/text/11.html#malaria

CDC. (2020). Treatment of Malaria: Guidelines for Clinicians (United States). https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html

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References:

Herchline, T. E. (2020). What are the possible adverse effects of antimalarial drugs for the treatment of malaria?. Medscape.https://www.medscape.com/answers/221134-40857/what-are-the-possible-adverse-effects-of-antimalarial-drugs-for-the-treatment-of-malaria

Unicef. (n.d). Childhood Diseases. https://www.unicef.org/health/childhood-diseases

WHO. (2022 April 6). Malaria. https://www.who.int/news-room/fact-sheets/detail/malaria

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