Abstract
The present program intended at eliminating malaria contagion in Brazil is the nationwide program for malaria stoppage and control, whose goal is to lessen occurrence, death, and transmission of malaria infection within the population living in the metropolitan and local inhabitants. With this study, the high satisfaction rate of malaria management was reported even in high transmission places.
Existing impediments of fighting against malaria in Brazil, especially (Amazon region) is the individuals’ problems with the disease but seem to be asymptomatic. Patients in this group pose a significant threat to malaria eradication because conservative testing approaches available would be unable to establish their infection, not including for PCR, which is demanding and tedious.
This case study seeks a cure to relieve the warning signs of malaria disease that is caused by the plasmodium parasite, conveyed by the mosquito vector. The study is intended to find out the use of Cosmos Sulphureus and Chinchona bark to eliminate the indicators of the number of disease-ridden cases of malaria in Brazil during the 1600s. The Cosmos were acquired for this investigation; it is a herbal that can be located in South America that can possibly be successful as pain reliever remedies, according to Ethnobotany. The bark of the Chinchona tree was also selected for this test. Bark was used since the 1630s, and it is known to have therapeutic properties such as quinine. Quinine is one of the compositions of the bark that can be a helpful agent for decreasing fever. The tree can be traced in the high tropical rain forest of the Amazon Basin. The list of substances and procedures was involved in creating treatment in this experiment:
From experiment one, all the ten patients that were given Cosmos drug stated they had a pain decline of typically seven points five over a pain score often. This shows that the contemporary method was positive in reducing discomfort related to malaria. In experiment two, all the participants administered with Chinchona had a drop of fever from an average of 38.3 degrees Celsius to the normal 370C.
Introduction:
Malaria is one of the leading cause of deaths in the world, particularly in Sub-Sahara and Africa. Although treatments have been discovered that have helped in saving the lives of thousands, malaria becomes quickly resistance to treatments due to mutation of the disease among other factors. This study, therefore, will compare the impact of the traditional treatment of malaria and the modern treatment to determine, which is most effective treatment intervention for malaria between the two.
The field of public health and medicine are heavily reliant on science for new discoveries of pathogens and treatments. The discovery of malaria treatment is done by scientists such as Youyou Tu of China who was awarded The Nobel Prize in the field of medicine in 2015 (Liu & Liu, 2016). In 2017, malaria was responsible for more than 430, 000 deaths globally (WHO, 2019). Although anti-malaria drugs have been discovered and used in saving the lives of thousands affected with malaria since the ancient tera, with time, malaria becomes resistance to such treatments such as chloroquine.
Therefore, this study seeks to answer the research question, “Are ancient treatment to Malaria more effective compared to modern treatment of malaria using Brazil as a case study?” The purpose of this study is to investigate on the most effective treatment method between the ancient methods used in Brazil and the modern treatment methods in reducing pain and fever caused by malaria respectively. The significance of the study is to advice the health sector on the most effective treatment of malaria to help in reducing the global number of deaths caused by malaria. With the findings from the study, the health sector will be better placed to make treatment decision based on the most effective malaria intervention that can quickly reduce pain and fever, the two major symptoms of malaria.
Problem Statement: Malaria is a deadly disease, responsible for the death of thousands of people around the world. Although different treatments have been discovered to fight malaria, the disease becomes highly resistance to treatments over time. However, some traditional methods are still effective in treatment of malaria but they have since been replaced by modern treatments.
Procedures: Two treatments of malaria were sought, Chinchona bark (ancient) and Cosmos Sulphureus (modern) and used in treating fifty participants that were diagnosed with malaria. The study took place in two experiment where experiment one tested the effectiveness of the ancient treatment while experiment two tested for effectiveness of the modern treatment of malaria. In both experiments control groups were included.
Results: From experiment one all the 10 participants that were given Cosmos treatment reported a pain reduction of averagely 7.5 over a pain score of 10. This means that the modern method was effective in eliminating pain related to malaria. In experiment two, all the patients treated with Chinchona had a reduction of temperature from an average of 38.30C to the normal 370C.
Conclusion: This science project reveals that both traditional and modern methods of treating malaria are effective. Therefore, medical professionals can go back the use of traditional methods and perhaps made the necessary modifications such as have the Chinchona bark in tablet form to suit the modern times. The objectives of the study were met and research question answered.
Science
Malaria is endemic throughout most of the tropical regions, especially in the sub-Saharan part of Africa. In 2018, an estimated 228 million cases of malaria were recorded worldwide (WHO, 2019). Malaria distribution by region shows Africa has the largest morbidity of malaria 93% in 2018 followed by a percentage as low as 3.4% in Asia and even lower percentage 2.1% in the Eastern Mediterranean region (WHO, 2019). The incidence of malaria declined all over the world between the year 2010 and 2017, from 72 to 59 cases per 1000 population at risk; This amount to 18% reduction over the period, the number of cases per 1000 population at risk remain 59 for the past three years (WHO, 2018).
Children less than five years old are the most vulnerable age group affected by malaria. In 2017, infants and children less than five years old account for 61% (266,000) of all malaria deaths worldwide (WHO, 2018). This global reduction in mortality of malaria was found to be 21% and 31% in Africa and South America, having 29% and 37%, respectively (Bianca et al, 2019).
In 2006, Brazil had 1.4 million malaria cases, which was well above half the entire cases within the America region, that sums up to 350,000 cases being reported annually from 2001-2007. The transmittal spread occurs mainly in the Legal Amazon Region, and it estimates for 99.5% of the entire country malaria burden (WHO, 2008).
Malaria parasite called Plasmodium belongs to: Sub-Kingdom-Protozoa, Phylum-Apicomplexa, Class-Sporozoasida, Subclass-Coccidiasina, Order-Eucoccidiorida, Suborder-Haemospororina, Family-Plasmodidae, Genus-Plasmodium. In brazil, malaria is caused by three species of Plasmodium namely: P vivax that estimates for 83.7% of the registered cases, P. falciparum responsible for 16.3% of the cases and P. malariae was registered 4% (Ferreira, 2010). No autochthonous transmission of P. ovale and P. knowlesi occurs.
There are majorly two hosts involved in the life cycle of malaria parasite; human and mosquito. During the course of taking a blood meal i.e when a malaria infected mosquito is feeding on human. It introduces its sporozoites into human. These sporozoites would go on to infect human liver cells and undergo transformation into schizonts. The schizonts furthermore develop and rupture to release merozoites. This is known as the exoerythrocytic schizogony. After which the parasite under goes multiplication in the red blood cell.
The merozoites would infect red blood cells, and the cycle follows through the following stage of development: Mature trophozoites develop into schizonts, which goes further mature by releasing merozoites. Sometimes the parasite may develop into the gametocyte leading to the insect part of its life cycle. Here, the mosquito ingests the gametocytes during a blood meal and become infected. The flow of cycle of infection in the mosquito is from the microgametes (male gametocytes) to the Zygotes known as Ookinetes and to the Oocysts, which later goes on to develop into the sporozoites that are deposited into human to begin the life cycle again. (CDC, 2015).
The symptoms of malaria include fever, shivering, cold, arthralgia (joint pain), headache, anorexia, nausea and vomiting, generalized body weakness, bitterness in the mouth, anemia that cause by hemolysis of the red blood cells, hemoglobinuria and convulsion. Malaria is transmitted by vectors, and the predominant vector responsible for malaria infection in Brazil according to past literature are those belonging to the genus Anopheles, subgenera Anopheles, Cellia, Kerteszia and Nysssorhynchus (Bianca et al, 2019).
The Amazon region and South-Eastern regions are said to be diverse for both Nyssorhynchus and Anopheles vector. Other vectors peculiar to the Amazon region include: Anapheles darling, Anopheles albitarsis, Anopheles braziliensis, Anopheles argyritaris Anopheles nunesztovari, Anopheles Oswaldo, and Anopheles triangulates (Bianca et al, 2019).
The World Health Organization (WHO) recommended a three-pronged approach to the strategic framework for the prevention of malaria and control in Brazil (WHO, 2007). These include the use of continuous preventive treatment (IPT) for pregnant women, Insecticide- treated bed nets (ITN), the use of indoor residual spraying or mosquito repellant creams and adequate case management of malaria illness through recommended drugs.
Several malaria control schemes were introduced at different years in Brazil in a bid to eradicate the loss of lives due to malaria infections. At the beginning of the 20th century, water collections were buried, including other measures which birth relative successes and outcomes in some parts of Brazil. Between the end of 1930 and the beginning of 1940, there was a campaign against Anopheles gambiae in Brazil, which was fuelled by total commitment to eradicate malaria in some parts of Brazil (Jose et al, 2006).
The World Health Organization (WHO)) eradication initiative based on vector control was adopted in Brazil in the year 1965. The initiative is a means of limiting malaria infection by taking measures such as deforestation, urbanization, and upgrade of a population of rural dwellers, which later led to a moderate reduction in malaria infection. However, the same cannot be said for Amazon region due to the high presence who already are infected (Jose et al, 2006).
In 1992, the World Health Organization introduced another malaria control initiative based on early diagnosis and rapid treatment, which was adopted by Brazilian authority under the name Integrated malaria control program (IMCP) (Jose et al, 2006).
The current program aimed at eradicating malaria infection in Brazil is the national program for malaria prevention and control, whose objective is to reduce incidence, mortality, and transmission of malaria infection within the urban populace and local dwellers (Ministeno da saude, 2003). With this program, the high success rate of malaria control was recorded even in high transmission areas (Suarez-Mutis et al, 2004).
Current challenges of controlling malaria in Brazil (Amazon region) is the problem of individuals with the infection but seem to be asymptomatic. Individuals in this category pose a great danger to malaria control because conventional testing methods available would not be able to tell of their infection except for PCR, which is difficult and tedious.
The following are the suggested method of alleviating malaria infections in Brazil:
- By determining the immune mechanism through which asymptomatic individuals can develop antimalarial immunity such that they do not manifest the symptoms of the disease even though they were infected.
- By deducing other modalities or other methods of diagnosing asymptomatic individuals with much more accuracy and turnaround time.
- By determining the incidence and or prevalence of asymptomatic malaria infections among geographical regions (Jose et al, 2006)
Culture
Brazil’s culture is a mix of mostly the Portuguese culture alongside cultural influences from African, Indian, and other European states. Brazil in the colonial period harbor a lot of African slaves and it constituted a black majority during the 1600s (Marshall, 1998). During the colonial period, the Portuguese imposed their culture and religion (Catholicism) on the people. However, Africans still fashioned a way of blending theyre religious beliefs into Catholicism, which include the Candomble and Umbanda worshippers that worship Orixias and made a blend of their belief with Catholicism where Virgin Mary is referred to as Nemanja and Xango as Saint John (Marshall, 1998).
There was no historical information on the presence of malaria among dwellers/inhabitants of the Amazon region of Brazil as they do not have formal education (Hern et al, 1994). Evidence presented by two priests; Father Manoel da No ‘Brega and father Jose de Anchieta who were missionaries sent to Brazil between 1549 and 1553 described Brazil as land with healthy individuals. The lived up to good old age before they pass away and that death in Amazon region at this time could not be attributed to any form of the disease, but old age (Freitas, 1986).
The history of malaria in Brazil is dated back to the 17th century due to European colonization and the compulsory migration of Africans to Brazil as slaves. At the end of the century, malaria has spread all over Brazil and, most importantly, through to the Amazon region (Martins-Costa 1888; Camargo, 2003). The spread of malaria during this period was without an epidemic until the Amazon area became attractive to migrants owing to rubber latex extraction and Madeira Mamore Road construction leading to migration of the larger number of individuals who haven’t been exposed to Plasmodium infections in time past probably due to their background and environment. They became exposed to the parasite in the Amazon region, and this led to an epidemic claiming thousands of lives (Camargo, 2003). A repeat of history was observed in mid-20th century due to the fact that natural rubber was essential in developing Brazil’s economy; migrants were encouraged to migrate in search of a source of livelihood and work in the Amazon region (Stephan, 2003).
Materials
This case study seeks treatment to alleviate the symptoms of malaria disease that is caused by the plasmodium parasite, transmitted by the mosquito vector. The study is designed to discover the use of Cosmos Sulphureus and Chinchona bark to relieve the symptoms of the number of infected cases of malaria in Brazil during the 1600s. The Cosmos were obtained for this experiment; it is a plant that can be found in South America that can potentially be effective as pain reliever drugs, according to Ethnobotany (Botsaris, 2007). The bark of the Chinchona tree was also obtained for this experiment. Bark was utilized since the 1630s, and it is known to have medicinal properties such as quinine. Quinine is one of the components of the bark that can be a beneficial agent for reducing fever (Gatchelin, at., 2017). The tree can be found in the high jungle of the Amazon Basin. The list of materials and steps was applied to create medicine in this experiment:
- Cosmos sulphereus- 200 pieces of the leaves of medium sizes were collected and was first dried in the sun for five days, then ground to a fine powder.
- Chinchona bark- 100 pieces of sticks were also collected, each stick was measured by hand from thumb to pinky and was first dried in the sun for five days, then ground to a fine powder.
- Medium stone- were obtained in this experiment and was used to grind the 100 pieces of bark, as well as the 200 pieces Cosmos sulphureus leaves. In preparing the treatment medicine • Small wooden noggin mug- were obtained with half of water, 10 small wooden teaspoons of bark powder were added and were stirred for 2 minutes. Another wooden mug was used with half of the water to mix with 10 small wooden spoons of Cosmos powder and were Stirred for 2 minutes.
- Small wooden spoon- were obtained for this experiment to measure the amount was given to the participants.
- Black pen and pad were obtained for recording results.
The thermoscope was used for this experiment to check for the fever to determine the changes in the participant’s temperature. A form of oral medication methods was applied to this experiment. The experiment was divided into two. Experiment 1: The twenty participants ranged 5 to 12 years of age were conducted to take Cosmos Sulphureus orally, and ten participants were under a placebo treatment. Experiment 2: Twenty participants ranged 18 to 35 years of age were conducted to take Chinchona bark orally, and another 10 were under a placebo treatment.
A total of fifty participants were diagnosed with malaria disease are involved in both studies, and all total participants showed symptoms such as fever, and pain. Each participant was asked their level of illness; Ten being the highest and zero the lowest level. Children are the most vulnerable age group affected by malaria (WHO, 2018). Therefore, thirty participants in the experiment ranged from 5 to 12 years of age. Four participants were 5 years of age, and seven were 8 years of age, five are 7 years of age, four are 10 years of age, five are 9 years of age, five are 12 years of age. The other twenty participants in the experiment #1 ranged from 7 to 35 years of age. Three are 18 years of age; five are 20 years of age seven are 22 years of age, two are 29 years of age, one are 32 years of age, two are 35 years of age.
Methods
This study was done at Amazon Region, where malaria disease spread widely. The study designed to discover a new potential treatment of the use of Cosmos to relieve the pain of the participants and the effectiveness of the ancient method of use of bark to treat fever. The fifty participants that were diagnosed with malaria disease with symptoms of fever and pain were involved in the study.
Experiment 1: The first twenty participants were instructed to take Cosmos orally; each participant was given 2 spoons of cosmos medicine every 4 hours. The other ten participants were under the placebo treatment. Each participant was examined by a physician every 2 hours after they have taken the cosmos and were asked their level of pain as well as the participants that were under placebo, ten being the highest and zero to lowest. The procedure was repeated for 3 days. Handwritten data of the level of pain on each participant were documented by the physician.
Experiment 2: Another twenty participants are instructed to take bark orally; each participant was given 4 spoons of bark medicine every 4 hours. The other ten participants were under the placebo treatment. Each participant was examined by the physician every 2 hours after they have taken the bark medicine to check the participant temperature, as well as the participants under a placebo. The procedure was repeated for 3 days. Handwritten data of temperature on each participant were documented by the physician.
Results
Experiment 1: The results of 20 participants that consumed two spoons of liquid that contained cosmos medicine every 4 hours for three days showed the highest reduction of pain. Their pain reduced to an average of 7.5 levels from 10 levels. This shows that the participant’s pain level reduced by 8 levels. From the 20 participants under the cosmos medicine, 2 teaspoons taken orally every four hours for three days with a two-hour interval checkup, 10 participants showed a reduction of 6 pain score level from 10 pain score level; thus, their reduced pain score level was 4. From the 20 participants, 4 experienced a pain reduction from 10 to 3 pain level score, thus a reduction of 7 pain level scores. On the other hand, 6 participants showed a pain level reduction of 2 from 10 levels of pain, which means that their pain reduction level was 8. From the results of 10 participants under the placebo treatment there were no changes in pain level observed or recorded.
Impact of Cosmos Suphureus on Pain Reduction.
Fig1: Number of participants and the total pain score reduced
Experiment 2: The results of 30 participants that consumed 4 teaspoons of liquid containing Chinchona bark medicine (every 4 hours for 3 days resulted in normal body temperature at 370 Celsius. From the 30, 5 participants recorded body temperature of 370C from 38OC. Another 6 participants recorded a normal body temperature from 38.20C, while 4 stabilized to the normal body temperature from 38.9 OC (highest of the fevers` experienced among the 30 adult participants). On the other hand, the control received 4 teaspoons of saline water every 4 hours for three days. the results of 15 participants under the placebo treatment resulted in no decline of their body temperature where some experienced higher body temperatures than initially recorded. From the 15 participants, 1 who initially recorded 38.0OC recorded 39.5OCby the end of the experiment.
Fig 2: Fever Reduction following treatment with traditional Bark medicine
Conclusion
In summary, Malaria remains one of the primary causes of death globally, with Sub-Sahara and Africa being the most vulnerable places. In Brazil the focus of this study, the cases of malaria are traced back in the eighteenth century because of European settlement and the obligatory exodus of Africans to Brazil as slaves. Towards the end of the era, malaria had ranged in all parts of the country and, most prominently, through to the Amazon area. The prevalent of malaria during this epoch was short of an endemic until the Amazon zone became eye-catching to immigrants due to rubber latex extraction and Madeira Mamore Road construction resulting in movement in larger number of persons who had not been effected with Plasmodium diseases previously probably because of where they came from and surrounding environment. They became susceptible to the parasite in the Amazon parts, and contributed to the illness causing thousands of lives. A similar trend was witnessed in 1950s because the natural rubber was crucial in steering the country’s fortune; immigrants were persuaded to seek alternative source of living and offer their labor in the Amazon areas.
Scientists continue to make discovery of treatment methods of Malaria. On the other hand, the disease keeps mutation making it resistant to anti-malaria drugs over time. More so, due to constant use of a certain type of malaria drug, a patient gradually becomes resistant to that drug. Therefore, it is important to have an array of alternative drugs to treat malaria in the case of some becoming ineffective. In experiment one, twenty patients provided were provided with cosmos medicine while the second experiment, thirty participants were administered with Chinchona bark medicine. From the findings, both the traditional and modern methods of treatment proved to be effective in reducing two malaria symptoms including pain and fever. While Cinchona bark was effective in reducing fever of patients diagnosed with malaria, Cosmos Sulphureus was effective in reducing pain related to malaria. For this, medical professional should consider the use and modification of traditional treatment of malaria such as Chinchona bark. However, future research needs to extensively study the effect of the Chinchona bark in reducing other symptoms of malaria such as fever.