Exam-Oriented 5-Marker Short Notes

1. Malaria - Epidemiology, Clinical Manifestations, and Control Measures

Etiology / Causative Species

• P. falciparum - most dangerous, causes cerebral malaria
• P. vivax - most common worldwide
• P. malariae
• P. ovale
• P. knowlesi (zoonotic, Southeast Asia)

Epidemiology

• Globally, approximately 229 million malaria cases were estimated in 2019 across 87 endemic countries.
• Sub-Saharan Africa bears the highest burden (~94% of global deaths).
• In India, cases declined from ~20 million (2000) to 5.6 million (2019) - the largest absolute reduction in the SEAR region.
• About 21.98% of India's population lives in high transmission areas (≥1 case/1,000 population).
• High-burden Indian states: Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh, North-east states.
• Transmission is seasonal, intensified during and after monsoon rains.
• Six primary vectors in India: An. culicifacies (main rural vector), An. stephensi (urban), An. fluviatilis, An. minimus, An. dirus, An. sundaicus.
• Drug resistance (especially P. falciparum to chloroquine and sulfadoxine-pyrimethamine) is a major challenge.

Clinical Manifestations

• P. vivax / P. ovale - tertian (every 48 hrs, fever every 3rd day)
• P. malariae - quartan (every 72 hrs, fever every 4th day)
• P. falciparum - irregular/quotidian (can be daily)

Control Measures

• Use of insecticide-treated bed nets (ITNs/LLINs)
• Protective clothing (long sleeves/trousers at dusk)
• Insect repellents (DEET-based)
• Mosquito-proofing of houses (wire mesh screens)

• Indoor Residual Spraying (IRS) - with DDT, malathion, synthetic pyrethroids
• Larval control - anti-larval measures (source reduction, drainage of stagnant water, oiling, larvivorous fish like Gambusia)
• Biological control - Bacillus thuringiensis israelensis (BTI)

• Chloroquine (areas without resistance): 300 mg base weekly
• Mefloquine / Doxycycline / Atovaquone-proguanil for resistant areas
• Primaquine for radical cure of P. vivax (eliminates hypnozoites)

• Early diagnosis with microscopy (thick and thin blood smears) or Rapid Diagnostic Tests (RDTs)
• Artemisinin-based Combination Therapy (ACT) is first-line for P. falciparum
• Passive and active surveillance

• National Vector Borne Disease Control Programme (NVBDCP) in India
• RTS,S/AS01 (Mosquirix) - first WHO-recommended malaria vaccine, now recommended for children in sub-Saharan Africa

2. Difference Between Maternal Mortality Rate and Maternal Mortality Ratio

• Adult lifetime risk of maternal death - probability that a 15-year-old girl will die from a maternal cause
• Proportion of maternal deaths among women of reproductive age (PM) - maternal deaths / total deaths in women aged 15-49 years

3. Disaster Management Cycle

Three Fundamental Aspects of Disaster Management:

1. Disaster Response (during/immediately after disaster)
2. Disaster Preparedness (before disaster)
3. Disaster Mitigation (before and after disaster - risk reduction)

The Disaster Cycle (4 Phases)

[Mitigation/Prevention] → [Preparedness] → [Response] → [Recovery/Reconstruction]
         ↑_______________________________________________|
                     (continuous cycle)

• Measures taken to reduce impact and prevent disaster occurrence
• Land use planning, building codes, flood embankments
• Community education and awareness
• Structural and non-structural measures

• Planning and training before a disaster strikes
• Developing emergency plans, disaster response teams
• Stockpiling emergency supplies (food, medicines, equipment)
• Drills and simulations, early warning systems
• Establishing communication networks

• Search, rescue and first aid at disaster site
• Triage - the four-colour code system:
  • Red = Immediate/high priority (life-threatening but salvageable)
  • Yellow = Delayed/medium priority
  • Green = Ambulatory/minor injuries (walking wounded)
  • Black = Dead or expectant/moribund
• Field care, hospital treatment, patient redistribution
• Relief phase: Distribution of food, water, shelter, medicines
• Epidemiological surveillance for communicable diseases
• Care of the dead (identification, mortuary management)

• Rehabilitation of affected population
• Reconstruction of damaged infrastructure
• Restoration of health services and livelihoods
• Psychological/mental health support
• Long-term monitoring and lessons learned

Key Principles in Disaster Response:

• Triage: "Maximum benefit to greatest number" - NOT first come, first served
• Safe drinking water and excreta disposal remain the most practical disease control strategies
• Mass vaccination (typhoid/cholera) is NOT routinely recommended by WHO after disasters
• Tetanus booster for wound cases if immunization >5 years ago

4. Essential Medicines and Counterfeit Medicines

A. Essential Medicines

• Introduced in 1977 by WHO
• Currently contains ~500+ medicines
• Updated every 2 years by an expert committee
• India's National List of Essential Medicines (NLEM) - first prepared in 1996, subsequently revised in 2003, 2011, and 2015.

1. The medicine must be approved/licensed in India
2. Should be useful for a disease that is a public health problem in India
3. Must have proven efficacy and safety based on valid scientific evidence
4. Must be cost-effective
5. Should be aligned with current treatment guidelines
6. Must be stable under Indian storage conditions
7. Price of total treatment (not unit price) is considered
8. Fixed-dose combinations are generally not included unless they offer unequivocal advantages in efficacy, reduced side effects, or improved compliance
9. Medicines are categorized by level of healthcare: Primary (P), Secondary (S), Tertiary (T)

• Ensures equitable access to quality medicines
• Guides rational prescribing
• Basis for procurement under national health programs
• Reduces healthcare costs

B. Counterfeit / Spurious / Substandard Medicines

• Substandard - Authorized medical products that fail to meet their quality standards or specifications
• Spurious/Falsely-labelled/Falsified - Deliberately/fraudulently misrepresent identity, composition, or source
• Falsified - Misrepresentation of identity, composition, or source
• Counterfeit - Unauthorized copies with trademark infringement

• May contain no active ingredient, wrong ingredient, or toxic substances
• Wrong dosage of active ingredient (too high or too low)
• False or misleading labelling (wrong manufacturer, expiry date)
• Substandard packaging

• Treatment failure and disease progression
• Drug resistance (e.g., counterfeit antimalarials contributing to artemisinin resistance)
• Direct toxicity and patient deaths
• Loss of public trust in healthcare systems

• Stringent drug regulatory frameworks (CDSCO in India; FDA in USA)
• Track-and-trace systems, barcoding, holographic labels
• WHO IMPACT (International Medical Products Anti-Counterfeiting Taskforce)
• NAFDAC (National Agency for Food and Drug Administration - Nigeria model)
• Consumer awareness and reporting mechanisms
• Strengthening supply chain integrity
• Criminalizing production and distribution of counterfeits

Exam Tip: For 5-mark answers, use headings, a comparison table where applicable, and include at least one formula/definition, one enumerated list, and a brief conclusion line. All four notes above are structured for direct exam use.