Anti-plasmodial Property Of Moringa Oleifera Seed Extract On Swiss Mice

Owing to the non-specific nature of the presentation of symptoms, diagnosis of malaria in non-endemic areas requires a high degree of suspicion, which might be elicited by any of the following: recent travel history, enlarged spleen, fever, low number of platelets in the blood, and higher-than-normal levels of bilirubin in the blood combined with a normal level of white blood cells (Nadjm and Behrens, 2012).   Malaria is usually confirmed by the microscopic examination of blood films or by antigen-based rapid diagnostic tests (RDT). Microscopy is the most commonly used method to detect the malarial parasite about 165 million blood films were examined for malaria in 2010 (Nadjm and Behrens, 2012).  Despite its widespread usage, diagnosis by microscopy suffers from two main drawbacks: many settings (especially rural) are not equipped to perform the test, and the accuracy of the results depends on both the skill of the person examining the blood film and the levels of the parasite in the blood. The sensitivity of blood films ranges from 75–90% in optimum conditions, to as low as 50%. Commercially available RDTs are often more accurate than blood films at predicting the presence of malaria parasites, but they are widely variable in diagnostic sensitivity and specificity depending on manufacturer, and are unable to tell how many parasites are present (Nadjm and Behrens, 2012).
In regions where laboratory tests are readily available, malaria should be suspected, and tested for, in any unwell person who has been in an area where malaria is endemic. In areas that cannot afford laboratory diagnostic tests, it has become common to use only a history of fever as the indication to treat for malaria thus the common teaching "fever equals malaria unless proven otherwise" (Mens et al., 2012).  A drawback of this practice is over diagnosis of malaria and mismanagement of non-malarial fever, which wastes limited resources, erodes confidence in the health care system, and contributes to drug resistance.[46] Although polymerase chain reaction-based tests have been developed, they are not widely used in areas where malaria is common as of 2012, due to their complexity (Nadjm and Behrens, 2012).
2.1.7 Management of Malaria
2.1.7.1 Conventional Therapeutic Agents
Malaria can lead to fatal outcomes in only few days, thus treatment should be started as soon as possible. The main targets of current antimalarial chemotherapy are the asexual blood stages of the parasite, responsible for the malaria symptoms. Nowadays, the available antimalarial drugs can be grouped into five classes according to their chemical structure and biological activity: (i) Quinoline based antimalarials: 4-aminoquinolines (chloroquine, amodiaquine and piperaquine) and 8-aminoquinolines (premaquine and Tafenoquine) (ii) Arylaminoalcohols Quinine, Mefloquine, Halofantrine and Lumefantrine (iii) Antifolate compounds (pyrimethamine , proguanil, dapsone, and sulfadoxine), (iv) Artemisinin and derivatives: first generation (dihdyroartemisinin, artesunate, arteether, and artemether) and second generation artemisinin (artemisone) and (v) Hydroxynapthoquinone Atovaquone (Nicoletta et al., 2015).
WHO recommends artemisinin-based combination therapies (ACT) for the treatment of uncomplicated malaria caused by falciparum parasite or by chloroquine resistant vivax, ovale, malariae and knowlsi. Quinine plus clindamycin is used for uncomplicated malaria treatment in the first trimester of pregnancy (WHO, 2015). In Ethiopia, Coartem TM is the        recommended first-line drug for uncomplicated falciparum malaria and chloroquine for other species but oral quinine is used as a second-line drug (FMoH, 2012).
More recently, injectable artesunate becomes the treatment of choice for severe malaria worldwide in infants, children, lactating women and pregnant women in all trimester. After 24h, the treatment should be completed with oral ACT (WHO, 2015). Quinidine plus doxycycline, tetracycline, or clindamycin is the preferred drug in the U.S. (CDC, 2013). Coming to Ethiopia, injectable artesunate is the preferred drug and intramuscular artemether is an alternative drug. If these two drugs are not available, injectable quinine can be used to manage severe malaria (FMoH, 2012).