Malaria

A CASE OF  MALARIA

Specific history taking points  in a case of Malaria.

Occupation:

Some occupations increase the risk of infections. 

Working as a Construction worker, or as an agricultural worker. 

Migrant/ Native:

Important if the patient has migrated from any other state recently, as the person could have caught the infection in that particular statement. The treatment of falciparum malaria varies according to the state.                                  

Chief Complaints with Duration:

State the reason for which the patient was admitted. 

For all the chief complaints reported by the patient, take a detailed history.

Present History: 

1. Fever 

• Since how long? 

• Is the patient currently having a fever?

• When was the last fever - day and time? 

• Is fever associated with chills and rigors? 

• Does the fever come down with sweating?

• Does patient have extreme weakness or fatigability (severe malaria)

• Is fever present throughout the day, or does it fluctuate. 

• How long is the afebrile period and febrile periods.

2. Nausea  

3. Vomiting - episodes  (severe malaria)

4. Abdominal pain

• Type of pain - dull aching or colicky

• Site of pain

• Relieving or aggravating factors

5. Headache 

• Type of pain

• Site of pain

6. Arthralgia 

7. Myalgia

8. Fits/convulsions  (severe malaria)

9. Inability to sit

10. Loss of consciousness

11. Difficulty in breathing (severe malaria)

12. Inability to drink (severe malaria)

13. Dark or limited urination  (severe malaria)

14. Ask about treatment taken prior to coming to OPD/admission. Details of treatment taken.

15. Is there a history of burning micturition?

16. Is there any history of cough, breathlessness?

17. While assessing patients, keep in mind if there is a current outbreak of malaria.

Past History: 

1. History of Malaria in the past.

2. Any chronic illness like hypertension, Diabetes, for which treatment is being taken.

3. History of blood transfusion.

Personal History: 

1. Is there a history of mosquito bites?

2. Has the patient recently been exposed to flood waters, mud or rivers?

3. Has the patient walked or waded through accumulated water? 

4. Has the patient eaten at a new restaurant, attended a large social event?

5. History of recent travel to north eastern states (P. Falciparum Malaria infections acquired in North Eastern states are treated with different ACT regime)

Family History: 

1. Are there any other family members who are sick or anyone having similar symptoms.

Menstrual History: 

1. Important to know if a patient is pregnant. (Malaria leads to IUFD, premature labour, and abortion, so it is important to determine pregnancy.The  treatment will be different as certain drugs are contraindicated in pregnancy.)

Environmental history:

1. Locality where patient lives:

   • Urban slum / Urban Non slum/  Rural 

   • Living at construction sites

2. Housing: 

   • Type of house i.e. kaccha / pucca /semi pucca, area of house, etc

   • Screening of doors and windows. 

   • Any site on the roof where water accumulates and serves as a potential breeding site.

3. Lighting & Ventilation

   • Whether any ill lit or dark corners are present in the house.

4. Water supply

   • Continuous/ Intermittent

   • Storage of water 

   • Are containers containing water covered with lids.

   • Are these containers regularly emptied, and dried out.

5. Sanitation

   • Drainage facility . Open drains near the house.

   • Mosquito breeding places in and around the house (discarded tins, broken bottles, fire buckets. Coconut shells, disposable containers, unused tyres, unused grinding stones, overhead tanks, etc)

   • If rural area cattle shed separate or in the house 

   Socio-cultural Practices:

1. Sleeping outdoors, 

2. Not sleeping inside mosquito bednet

3. Use of mosquito repellent creams

4. Use of measures to protect against insects like coils, vaporisers, electronic devices etc..

5. Refusal to accept spraying of houses 

6. Use of local remedies like herbs etc

7. Seeking treatment from traditional healers / Delaying treatment

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