A few years ago a British student visited Botswana for his gap year where he met this girl who later became his girlfriend. He had carried his anti-malaria tablets as advised by his doctor that he used to take once every day. He took these drugs religiously because he had been told that they would protect him from malaria while he was in Botswana.  The girl became sick and tests showed that she was suffering from malaria. It was on a Sunday when the only health center that operated in the area was a dispensary and had ran out of drugs. After testing for malaria she just had to go home to wait for Monday so that she could buy the prescribed drugs from the local pharmacy.

The boyfriend could not stand seeing the girl so sick so decided to give his anti-malaria tablets. The girl took them and remarkable improvement could be noticed the next day. He decided to have her more drugs until she had fully recovered because the drugs were proving to work better than the local drugs. The drugs reduced and the boy had to do without them because he couldn’t find these drugs anywhere in the country. When he got back home he started falling sick and since he did not disclose to anyone that he had not taken his anti-malaria tabs for quite sometime while in Africa, the doctors didn’t give the right treatment. He eventually died because malaria had been in his system for quite a long time.

In Africa alone, malaria is a disease that is estimated to kill a million people per annum.  The most common time of getting malaria is when the climate is at its warmer or wetter months in that area. Widespread resistance has been developing to the original anti-malarial and the newer alternatives developed to replace them.   The development of artemisinin derived drugs, with their higher efficacy, in combination with other longer acting drugs  appears to be the way forward to combat malaria, provided the economic and logistical obstacles of changing many poor counties health policies can be overcome.

Caused by protozoa of the genus plasmodium, malaria has four species that infect humans, P.falciparum, P.malariae, P.vivax and P.ovale, causing an estimated 247 million malaria cases worldwide (in 2006), with over 90% of those caused by just one species, P.falciparum. The WHO currently classifies 109 countries and territories as malaria endemic, with an estimated 3.3 billion people living in areas with moderate transmission risk and 1.2 billion people (about one fifth of the global population) living in areas at high risk for malaria transmission. The human host of the plasmodium parasite is initially infected when a female Anopheles mosquito takes its blood meal, the parasite entering the host when the mosquito injects saliva with anticoagulant and antiplatelet properties.

The human host is infected with sporozoites.  The sporozoites are motile and can quickly enter the systemic circulation, ultimately ending their journey by invading the host’s hepatocytes.  This process takes only minutes from the introduction of the parasite to the human host.  Once the sporozoites are within the hepatocytes, they are almost invisible to the host’s immune system and therefore safe from any immune response. The human host is asymptomatic during the liver stage of the parasite’s development.  After approximately six days, each sporozoite will yield many thousands of merozoites.  These then escape the hepatocytes, killing it in the process, and enter the circulation.

Once in the blood, merozoites invade erythrocytes and begin developing down one of two possible paths.  In one path, merozoites develop through the ring, trophozoite and schizont stages until the schizont eventually ruptures, killing the erythrocyte and releasing more merozoites into the circulation which are free to perpetuate the cycle.  The other path includes the first intraerythrocytic stage, the ring stage, but the merozoites then develop into gametocytes rather than trophozoites.  The gametocyte is the brief stage when the parasite is in a diploid state.