ABER - Annual Blood Examination Rate. Calculated as (number of slides examined/population) x 100. WHO recommendation for malarious areas is that the number of slides examined per month should equal at least 1% of the population.
Active case detectionThe detection by health workers of malaria infections at community and household level in population groups that are considered to be at high risk. Active case detection can be conducted as fever screening followed by --parasitological examination of all febrile patients or as parasitological examination of the target population without prior fever screening.
Anaemia - decrease in number of red blood cells and/or quantity of hemoglobin. Malaria causes anemia through rupture of red blood cells during merozoite release. The anaemia caused may be extreme. Pallor may be visible in the patient.
Animal trap - A cage, generally made of cloth, that is baited with an animal such as a cow, goat, etc. Collections of mosquitoes are made on the walls of this trap to assess and compare populations biting domestic animals with populations in dwellings.
Annual blood examination rate: The number of examinations of blood slides for malaria by microscopy per 100 population per year.
Anopheles: Anopheles is a genus of mosquito of about 460 species are recognized; while over 100 can transmit human malaria, only 30–40 commonly transmit parasites of the genus Plasmodium, which cause malaria in humans in endemic areas. Wiki/Anopheles
Anthropophagy - the process of feeding on people. Similar to anthropophilic.
Anthropophilic species prefer to feed on people as opposed to animals.
API - Annual Parasite Incidence. API = (confirmed cases during 1 year/population under surveillance) x 1000.
Autochthonous - locally transmitted by mosquitoes. Differentiated from imported, congenital, or blood-borne malaria.
Cerebral malaria - this grave complication of malaria happens at times with P. falciparum infection and involves malaria infection of the very small capillaries that flow through the tissues of the brain. This complication has a fatality rate of 15% or more, even when treated and is extremely serious.
Congenital malaria - malaria acquired from the mother at birth.
Cryptic - an isolated case of malaria not associated with secondary cases, as determined by appropriate epidemiologicinvestigations.
Diurnal - during the daytime. The diurnal resting places of mosquitoes, especially newly-fed females, may be important in malaria control.
EIR = Entomological Inoculation Rate = mas, where ma = number of mosquito bites per night and s = proportion of those bites positive for sporozoites.
Elimination - The process of removing something on a temporary or semipermanent basis.
ELISA - enzyme-linked immunosorbent assay. ELISA is now often used to determine whether mosquito salivary glands are positive for sporozoites.
Endophagic - feeds indoors.
Endophilic - tends to inhabit/rest in indoor areas. Examples of endophilic anopheline species include Anopheles darlingi and An. funestus. Endophilism makes the blocking of malaria transmission through application of residual insecticides to walls easier to accomplish. (MacDonald 1956).
Eradication - The process of removing something permanently.
Erythrocyte - a red blood cell
Erythrocytic schizogony - the process of asexual reproduction of malaria parasites within red blood cells
Exerythrocytic schizogony - the process of asexual reproduction of malaria parasites outside of red blood cells, usually in the liver. This process is asymptomatic.
Exit trap - A trap constructed to capture mosquitoes that are exiting a house or structure. Exit traps are often used in studies that compare the tendency of mosquitoes to rest indoors after feeding versus to fly outside after feeding.
Exophagic - feeds outdoors.
Exophilic - tends to inhabit/rest in outdoor areas. After biting, an exophilic mosquito flies outside and rests woods, grass, or other outside areas.
Exophilism makes use of residual insecticides in buildings less effective.
GIS - Geographic Information System
GPS - Global Positioning System. Common GPS systems receive data that is sensitive enough to map blocks of a city.
Gametocyte - the sexual reproductive stage of the malaria parasite.
Gametocytes circulate in the blood stream, are picked up by the Anopheles mosquito, undergo sexual reproduction in the midgut of the mosquito, and attaches to the mosquito's midgut, where they form an oocyst that eventually produces sporozoites.
Gametocyte rate - percentage of persons in an area who carry gametocytes. Expressed as a percentage. The less the gametocyte rate of an area, the fewer infective humans are available for mosquitoes, and the less likely that transmission is to occur. (MacDonald 1956).
Gametocyte count - number of gametocytes per mm3 of blood. The lower the gametocyte count, the lower the infectivity of the human to the mosquito
Hypnozoite - a stage of malaria parasites found in liver cells. After sporozoites invade liver cells, some develop into latent forms called hypnozoites. They become active months or years later, producing a recurrent malaria attack. Only P. vivax and P. ovale species that infect humans develop latent stage hypnozoites. Primaquine is the only available drug active against hypnozoites.
Hypoglycaemia - hypoglycemia -blood glucose less than the lower value of normal (70-110 mg/dl ). Glucose levels of 40 and below constitute severe hypoglycemia, a life-threatening emergency.
Hypoglycemia is common in malaria, as malaria parasitized red blood cells utilize glucose 75 times faster than uninfected cells. In addition, treatment with quinine and quinidine stimulate insulin secretion, reducing blood glucose.Imported malaria - A case of malaria that is brought into an area by someone who has become infected somewhere else. The person could be either a tourist or immigrant.
Induced malaria - Malaria acquired through artificial means (e.g. blood transfusion, dirty syringes, or malariotherapy).Introduced malaria - malaria acquired by mosquito transmission from an imported case in an area where malaria is not a regular occurrence.Infant parasite rate - The percentage of infants below one year old who show parasites in their blood films. If the infant parasite rate is zero for three consecutive years in a locality, this is regarded as absence of local transmission, provided that the survey is done every year and enough slides have been examined.
Longevity - the longevity, or length of lifespan of the mosquito is of considerable importance in malaria control. There are two reasons for this. The first is that the reproductive cycle of malaria in the mosquito takes 10-11 days, and the second is that if the mosquito lives a long time, it will be able to take several blood meals, and will have a higher chance of biting a human who has malaria parasites.
Macrogametocyte - the female form of the gametocyte.
Malaise - subjective feeling of being sick, ill, or not healthy. The feeling is generalized, varying from mild to severe in intensity. It may be the lone clinical manifestation of malaria, or may accompany other signs and symptoms, such as fever, headache, or nausea. This may be expressed as "feel achey all over," "flu-like symptoms," etc.
Microgametocyte - the male form of the gametocyte.
Oocyst - oocysts are Plasmodium cysts located in the outer stomach wall of mosquitoes, where sporozoite development takes place. When mature, the oocysts rupture and release sporozoites. Sporozoites subsequently migrate to the mosquito's salivary gland, and are injected into the host when the mosquito feeds.
Orthostatic hypotension - decrease in blood pressure occurring when an individual arises from a seated or lying position. A small decrease in blood pressure is normal, but large decreases are abnormal, especially if accompanied by clinical manifestations such as faintness, light-headedness, dizziness, or increased pulse. Orthostatic hypotension is a common finding in patients with malaria infections. The patient may complain of notable tiredness after conducting light office work, etc.
Outbreak of Malaria: Outbreak is a term used in epidemiology to describe an occurrence of disease greater than would otherwise be expected at a particular time and place. It may affect a small and localized group or impact upon thousands of people across an entire continent. Two linked cases of a rare infectious disease may be sufficient to constitute an outbreak. Outbreaks may also refer to epidemics, which affect a region in a country or a group of countries, or pandemics, which describe global disease outbreaks.
Pandemic: A pandemic is an epidemic of infectious disease that has spread through human populations across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic. Further, flu pandemics generally exclude recurrences of seasonal flu. Throughout history there have been a number of pandemics, such as smallpox and tuberculosis. More recent pandemics include the HIV pandemic as well as the 1918 and 2009 H1N1 pandemics.
Parasitaemia - the status of having parasites. This term is often used to express the quantity of parasites in the blood. If no fever or other symptoms are present, the condition is referred to as 'asymptomatic parasitaemia.'
Paroxysm - paroxysm - a sudden attack or increase in intensity of a symptom, usually occurring in intervals. Malaria is classically described as producing fever paroxysms; sudden severe temperature elevations accompanied by profuse sweating. Paroxysms occurring at 48-hr intervals are typical of Plasmodium vivax infection, particularly in semi-immune persons.
Plasmodium: Plasmodium is a genus of Apicomplexan parasites. Infection by these organisms is known as malaria. Of the over 200 known species of Plasmodium, at least 11 species infect humans. The parasite always has two hosts in its life cycle: a vector—usually a mosquito—and a vertebrate host.Wiki/Plasmodium
Pathogen: A pathogen in the oldest and broadest sense is anything that can produce disease. Typically the term is used to mean an infectious agent (colloquially known as a germ) - a microorganism, in the widest sense such as a virus, bacterium, prion, or fungus, that causes disease in its host. The host may be an animal, human, a plant, or even another microorganism.
There are several substrates including pathways whereby pathogens can invade a host. The principal pathways have different episodic time frames, but soil contamination has the longest or most persistent potential for harboring a pathogen. Diseases caused by organisms in humans are known as pathogenic diseases. Some of the diseases that a pathogen can cause are smallpox, influenza, mumps, measles, chickenpox, ebola and rubella.
Not all pathogens are necessarily undesirable to humans. In entomology, pathogens are one of the "Three P's" (predators, pathogens and parasitoids) that serve as natural or introduced biological controls to suppress arthropod pest populations. wiki/Pathogen
Proportional case rate: The number of cases diagnosed as clinical malaria for every 100 patients attending hospitals and dispensaries .
Protozoan: A member of the Kingdom Protista. Protozoa are single-celled organisms . The single cell performs all necessary functions of metabolism and reproduction. Some protozoa are free-living, while others, including malaria parasites, depend on other organisms for their nutrients and life cycle. Malaria parasites are members of the Phylum Apicomplexa.
Radical Cure - treatment intended to achieve cure of P. vivax or P. malariae malaria. These two species have exoerythrocytic stages. Requires primaquine treatment, which destroys latent exoerythrocytic stage parasites (hypnozoites). Typical case patient: a returned traveller from Central America who has had a relapse of malaria.
Recrudescense - a repeated attack of malaria (short term relapse or delayed), due to the survival of malaria parasites in red blood cells. Characteristic of P. malariae infections.
Recurrence - a repeated attack weeks, months, or occasionally years, after initial malaria infection, also called a long-term relapse. Due to re-infection of red blood cells from malaria parasites (hypnozoites) that persisted in liver cells (hepatocytes).
Relapsing malaria - Renewed manifestation (of clinical symptoms and/or parasitemia) of malaria infection that is separated from previous manifestations of the same infection by an interval greater than any interval resulting from the normal periodicity of the paroxysms.
Refractory malaria - malaria that is not responsive to residual treatment. The cause of the lack of response to residual treatment is usually defined to be factors other than physiological insecticide resistance. Examples of causes of refractory malaria are vector exophily and zoophily with failure to enter houses. An example of refractory malaria occurred in the Jordan Valley during the early 1950s. Anopheles sergenti and Anopheles superpictus were evading residual treatment of dwellings by resting in caves and natural fissures in earth (Farid 1954).
Reproduction rate - Reproduction rates > 1.0 indicate an expansion of infections in a population while those < 1.0 indicate a decline in infections in the population. The goal of malaria control is to decrease the reproduction rate. This can be accomplished by altering mosquito numbers, longevity of female anophelines, biting habits, and recovery rate of gametocytemic person.
Reduction of mosquito numbers through larval control is less effective by itself than causing mosquito mortality through adult control. The reason is that not only does adult control cause a reduction in mosquito numbers, but it also causes reduction in longevity of female anophelines . The fewer gonotrophic cycles that a female mosquito has, the less likely that it is to transmit sporozoites (MacDonald 1956, p. 620).
Residual treatment - treatment of houses, animal sheds, and other buildings where people or animals spend nighttime hours with insecticide that has residual efficacy. The goal of residual treatment is to block transmission by stopping human-vector contact.
Splenomegaly - an enlarged spleen. A common finding in malaria patients that sometimes can be detected by physical examination. May occur in otherwise asymptomatic patients and is of use in conducting malaria surveys of a community, although it should not be the only factor considered when counting cases.
Sporozoite - the infective stage of the malaria parasite that is passed to the human host from the salivary glands of the mosquito. Sporozoites infect liver cells, disappearing from bloodstream within 30 minutes. The mechanism for this amazingly rapid disappearance from the bloodstream to the liver is still unknown. Sporozoites are delicate and spindle-shaped stages that are released into the haemocoel of the mosquito when the oocyst ruptures. Some eventually find their way to the salivary glands of the mosquito.
Sporozoite rate - The percentage of female anopheline mosquitoes of a particular species that bear sporozoites in their salivary glands. Expressed as a percentage.
Stockouts: A stockout, or out-of-stock (OOS) event is an event that causes inventory to be exhausted. While out-of-stocks can occur along the entire supply chain, the most visible kind are retail out-of-stocks in the fast moving consumer goods industry (e.g., sweets, diapers, fruits). Stockouts are the opposite of overstocks, where too much inventory is retained. Stockout is generalized problem in Togo, as retailers do not buy again until stockout causing delays that are often months.
Temperature - the optimal temperature for development of P. falciparum is 30oC , while the optimal temperature for development of P. vivax is 25oC . The time required for development of the sexual phases of the malaria parasite in the mosquito is 10-11 days at these temperatures.
Tinnitus - ringing sound in the ears, a common side effect of quinine treatment.Vector competence - the ability to transmit malaria. Said of Anopheles mosquitoes.
Vulnerability: Either proximity to a malarious area or the frequencyof influx of infected individuals or groups and/or infective anophelines.
Zoophagy - the process of feeding on animals (example: cattle).
Zoophilous - prefers to feed on animals.
Acronyms and AbbreviationsACD Active case detectionACT Artemisinin-based combination therapyAMC Anti-Malaria CampaignAPI Annual parasite indexDDT dichlorodiphenyltrichloroethaneG6PD Glucose-6-phosphate dehydrogenaseIRS indoor residual sprayingITN insecticide-treated netLLIN long-lasting insecticidalnetPCD Passive case detectionPCR polymerase chain reactionRDT Rapid diagnostic testWHO World Health OrganizationacrOnyms and abbrEviatiOns
Annual parasite index
The number of reported malaria cases per 1 000population at risk per year.Case-based surveillanceEvery case is reported and investigated immediately(and also included in the weekly reporting system).Case definition (control programmes)confirmed malariaSuspected malaria case in which malaria parasites havebeen demonstrated in a patient’s blood by microscopyor a rapid diagnostic test.presumed malariaSuspected malaria case with no diagnostic test toconfirm malaria but nevertheless treated presumptivelyas malaria.suspected malariaPatient illness suspected by a health worker to be dueto malaria. Fever is usually one of the criteria.Case definition (elimination programmes)autochthonousA case locally acquired by mosquito-borne transmission,i.e. an indigenous or introduced case (also called“locally transmitted”).importedA case the origin of which can be traced to a knownmalarious area outside the country in which it wasdiagnosed.indigenousAny case contracted locally (i.e. within nationalboundaries), without strong evidence of a direct linkto an imported case. Indigenous cases include delayedfirst attacks of Plasmodium vivax malaria due to locallyacquired parasites with a long incubation period.inducedA case the origin of which can be traced toa blood transfusion or other form of parenteral inoculationbut not to normal transmission by a mosquito.introducedA case contracted locally, with strong epidemiologicalevidence linking it directly to a known imported case(first generation from an imported case, i.e. the mosquitowas infected from a case classified as imported).locally transmittedA case locally acquired by mosquito-borne transmission,i.e. an indigenous or introduced case (also called“autochthonous”).malariaAny case in which, regardless of the presence orabsence of clinical symptoms, malaria parasites havebeen confirmed by quality-controlled laboratorydiagnosis.x Eliminating Malaria | Progress towards elimination in Sri Lanka | GlossaryCase investigationCollection of information to allow classification of amalaria case by origin of infection, i.e. imported, introduced,indigenous or induced. Case investigation includesadministration of a standardized questionnaireto a person in whom a malaria infection is diagnosed.Case managementDiagnosis, treatment, clinical care and follow-up ofmalaria cases.Case notificationCompulsory reporting of detected cases of malaria byall medical units and medical practitioners, to eitherthe health department or the malaria eliminationservice (as laid down by law or regulation).Certification of malaria-free statusCertification granted by WHO after it has been provedbeyond reasonable doubt that the chain of local humanmalaria transmission by Anopheles mosquitoes has beenfully interrupted in an entire country for at least3 consecutive years.EliminationReduction to zero of the incidence of infection byhuman malaria parasites in a defined geographical areaas a result of deliberate efforts. Continued measures toprevent re-establishment of transmission are required.EndemicApplied to malaria when there is an ongoing,measurable incidence of cases and mosquito-bornetransmission in an area over a succession of years.Entomological inoculation rateThe number of infectious mosquito bites received perperson per unit time.EpidemicOccurrence of cases in excess of the number expectedin a given place and time.EradicationPermanent reduction to zero of the worldwideincidence of infection caused by human malariaparasites as a result of deliberate efforts. Interventionmeasures are no longer needed once eradication hasbeen achieved.EvaluationAttempts to determine as systematically and objectivelyas possible the relevance, effectiveness and impact ofactivities in relation to their objectives.FocusA defined, circumscribed locality situated in a currentlyor former malarious area containing the continuousor intermittent epidemiological factors necessary formalaria transmission. Foci can be classified as endemic,residual active, residual non-active, cleared up, newpotential, new active or pseudo.GametocyteThe sexual reproductive stage of the malaria parasitepresent in the host’s red blood cells.HypnozoiteThe dormant stage of the malaria parasite present inthe host’s liver cells (limited to infections with P. vivaxand P. ovale).Incubation periodThe time between infection (by inoculation orotherwise) and the first appearance of clinical signs.Intervention (public health)Activity undertaken to prevent or reduce the occurrenceof a health condition in a population. Examplesof interventions for malaria control include the distributionof insecticide-treated mosquito nets, indoorresidual spraying with insecticides, and the provisionof effective antimalarial therapy for prevention orcurative treatment of clinical malaria.Local mosquito-borne malaria transmissionOccurrence of human malaria cases acquired in agiven area through the bite of infected Anophelesmosquitoes.Eliminating Malaria | Progress towards elimination in Sri Lanka | Glossary xiMalaria-freeAn area in which there is no continuing local mosquito-borne malaria transmission and the risk for acquiringmalaria is limited to introduced cases only.Malaria incidenceThe number of newly diagnosed malaria cases duringa specified time in a specified population.Malaria prevalenceThe number of malaria cases at any given time in aspecified population, measured as positive laboratorytest results.Monitoring (of programmes)Periodic review of the implementation of an activity,seeking to ensure that inputs, deliveries, work schedules,targeted outputs and other required actions areproceeding according to plan.Parasite prevalenceProportion of the population in whom Plasmodiuminfection is detected at a particular time by means ofa diagnostic test (usually microscopy or a rapiddiagnostic test).Passive case detectionDetection of malaria cases among patients who, ontheir own initiative, go to a health post for treatment,usually for febrile disease.Population at riskPopulation living in a geographical area in which locallyacquired malaria cases occurred in the currentyear and/or previous years.Rapid diagnostic testAn antigen-based stick, cassette or card test for malariain which a coloured line indicates that plasmodial antigenshave been detected.Rapid diagnostic test positivity rateProportion of positive results among all the rapid diagnostictests performed.ReceptivityRelative abundance of anopheline vectors andexistence of other ecological and climatic factorsfavouring malaria transmission.Re-establishment of transmissionRenewed presence of a constant measurable incidenceof cases and mosquito-borne transmission in anarea over a succession of years. An indication of thepossible re-establishment of transmission would bethe occurrence of three or more introduced and/orindigenous malaria infections in the same geographicalfocus, for two consecutive years for P. falciparum andfor three consecutive years for P. vivax.Relapse (clinical)Renewed manifestation of an infection after temporarylatency, arising from activation of hypnozoites(and therefore limited to infections with P. vivax andP. ovale).Sensitivity (of a test)Proportion of people with malaria infection (truepositives) who have a positive test result.Slide positivity rateProportion of microscopy slides found to be positiveamong the slides examined.Specificity (of a test)Proportion of people without malaria infection(true negatives) who have a negative test result.Spleen rateThe prevalence of splenomegaly.Surveillance (control programmes)Ongoing, systematic collection, analysis and interpretationof disease-specific data for use in planning,implementing and evaluating public health practice.Surveillance (elimination programmes)That part of the programme designed for the identification,investigation and elimination of continuingtransmission, the prevention and cure of infections,and the final substantiation of claimed elimination.xii Eliminating Malaria | Progress towards elimination in Sri Lanka | GlossaryTransmission intensityRate at which people in a given area are inoculatedwith malaria parasites by mosquitoes. This is oftenexpressed as the “annual entomological inoculationrate”, which is the number of inoculations withmalaria parasites received by one person in one year.Transmission seasonPeriod of the year during which mosquito-bornetransmission of malaria infection usually takes place.Vector controlMeasures of any kind against malaria-transmittingmosquitoes intended to limit their ability to transmitthe disease.Vector efficiencyAbility of a mosquito species, in comparison withanother species in a similar climatic environment, totransmit malaria in nature.Vectorial capacityNumber of new infections that the population of agiven vector would induce per case per day at a givenplace and time, assuming conditions of non-immunity.Factors affecting vectorial capacity include: the densityof female anophelines relative to humans; their longevity,frequency of feeding and propensity to bite humans;and the length of the extrinsic cycle of the parasite.VigilanceA function of the public health service during aprogramme for prevention of reintroduction oftransmission, consisting of watchfulness for anyoccurrence of malaria in an area in which it had notexisted, or from which it had been eliminated, andapplication of the necessary measures against it.
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