Malaria happens to be one of the diseases causing much sickness and deaths in tropical countries. People are aware of the common manifestation of malaria, i.e. a fluctuating fever with feeling of chills and rigors with body pain. But not all are aware of the most serious affection of malaria, i.e. of the brain, known as cerebral malaria,which is caused by the species of the malaria parasite called Plasmodium falciparum.

The appreciable   efforts made by government of Rwanda have started showing their fruits. Already it is way ahead of other African countries in controlling this deadly disease and the prevalence has been brought down to a considerable extent. In fact Rwanda stands out as a model for the world as to how good planning and implementation can help in controlling a disease like malaria.

Still people need to be continuously sensitized about malaria, particularly the cerebral one so that they do take precautions against mosquitoes; because the few people, who are affected mostly due to travelling to neighboring countries, do suffer much.

The parasite passing through its asexual phase of multiplication in the human body tends to parasitize the red blood corpuscles in the blood vessels. They multiply there and rupture the blood cells, releasing parasites in the blood stream. Through blood it can pass on to and affect the brain.

The typical   intermittent pattern of fever of malaria may not be always present in case of cerebral malaria. Sometimes very high continuous fever may occur. Very high fever can be deleterious for brain, particularly in case of children. 

A person with cerebral malaria can become unconscious suddenly, go in to coma and die suddenly with no high fever before. Slight cough, flu like symptoms and or mild diarrhea and vomiting may   be present at the beginning. Acute anemia can develop due to rupture of blood cells, necessitating blood transfusion at times.

The affected person may develop acute hypoglycemia (i.e. deficiency of glucose in the blood), which adds on to the unconsciousness. Compression and irritation of the brain substance can lead to convulsions which pose a risk for respiratory arrest and death.

Acute renal failure and liver failure are yet other complications of cerebral malaria, which occur due to damage of blood vessels supplying these parts.

Acute fluid retention can occur in the lungs in cerebral malaria causing respiratory distress.  This is further aggravated by metabolic acidosis. A bed ridden very sick person is also at risk of   aspirating water drunk or his own saliva or expectoration as he is unable to bring it out. The resultant aspiration pneumonia also leads to breathing difficulty and cyanosis.

All these complications are potentially fatal. But if diagnosed and treated promptly cerebral malaria is a curable condition and the person recovers fully.

Diagnosis is established as per W.H.O. criteria of thick and thin blood films. This disease needs to be differentiated clinically from other infections causing coma and neurological complications like typhoid fever, meningitis, HIV encephalopathy, e.t.c. Treatment is by anti malarial drugs. Chemoprophylaxis for cerebral malaria is the same as for other forms of malaria.

But over all, prevention is much better than chemoprophylaxis. This includes using insecticide sprayed mosquito nets, insect repellants both for the house and local application on body to prevent mosquito bites.  The environmental factors causing malaria like ditches and cess pools in cities that provide breeding ground for mosquitoes have been very well controlled by the Government of Rwanda. 

Cleanliness of Kigali and other cities is exemplary. But when people travel outside and do not take precautions against mosquito bites, they expose themselves to high risk of malaria, including cerebral malaria. Hence people need to be aware of this deadly form of malaria and be on alert always.