M D In d ia Healthcare Services (TPA) Private Limited ISO 9001:2000 Certified

1. MDIndia Healthcare Services (TPA) Private Limited ISO 9001:2000 Certified Pre Insurance Medical Malaria …… Health Checkups & Pre Insurance Medical Services Team Dr. Sachin Kasat MBBS, AIII, FIII MDI Confidential Proprietary Information

2. What is it ? • Malaria is an infectious disease caused by a parasite(Plasmodium) that's transmitted by mosquitoes. • The illness results in recurrent attacks of chills and fever, and it can be deadly in some cases • Malaria is usually a 'rainy season disease'; coinciding with increased mosquito abundance MDI Confidential Proprietary Information

3. Problem Statement • Malaria remains the world's most devastating human parasitic infection. Malaria affects over 40% of the world's population. WHO, estimates that there are 350 - 500 million cases of malaria worldwide, of which 270 - 400 million are falciparum malaria, the most severe form of the disease. • Malaria kills in one year what AIDS kills in 15 years. For every death due to HIV/AIDS there are about 50 deaths due to malaria. • To add to the problem is the increasing drug resistance to the established drug. • Every 30 seconds, a child dies from malaria. • Nearly one million people die from malaria every year. • About one half of the world’s population is at risk of malaria. • Malaria also hurts the economy • In India we have a medical dictum • Any fever unless proved otherwise has to be considered to be of Malaria and treated accordingly • Deforestation, population migration and changes in agricultural practice have profound effect on malaria transmission. Urban malaria is becoming an increasing problem in many countries. • Epidemics are caused by migration (i.e. Introduction of susceptible hosts), the introduction of new vectors, or changes in the habits of the mosquito vector in the human host. Epidemics have occurred in North India. MDI Confidential Proprietary Information

4. Spread …. 8/9/2014 MDI Confidential Proprietary Information MDI Confidential Proprietary Information 4

5. Where do mosquitoes breed? Irrigation water Tire tracks Any place there is water! Rice paddies MDI Confidential Proprietary Information

6. Risk Factors ! • Malaria spread depends on: • Rainfall pattern • Types of Mosquito in the area • Proximity of residential area to mosquito breeding sites • Young children and pregnant women are at highest risk in these areas • With frequent exposure, adults develop some immunity to malaria MDI Confidential Proprietary Information 6

7. Signs & Symptoms …. • Main Symptoms: • Fever • Headache • Chills • Vomiting • These usually start about 10 to 15 days after the mosquito bite. MDI Confidential Proprietary Information

8. Signs & Symptoms …. • Initially symptoms resemble those of a minor viral illness. These include: • Lack of sense of well being • Headache • Fatigue • Abdominal discomfort • Muscle aches followed by fever • Nausea/ vomiting • These may be followed by typical malaria picture: • Fever spikes (sudden rise and fall in temperature) • Chills • Rigors MDI Confidential Proprietary Information

9. Disease progress…. • COLD STAGE: • As the temperature begins to rise, there is intense headache and muscular discomfort. The patient feels cold, clutches blankets, and curls up shivering and uncommunicative. (The chill) . • Within minutes the limbs begin to shake and teeth chatter, and the temperature climbs rapidly to a peak. The rigor usually lasts 10-30 minutes but can last upto 90 minutes. • HOT STAGE: • By the end of rigor there is peripheral vasodilatation and the skin feels hot and dry. The temperature is high. • SWEATING: • Profuse sweat then breaks out. It lasts for 2-4 hours. The patient is soaked in sweat and the temp falls. The blood pressure is relatively low. The patient feels exhausted and may sleep. Defervescence usually takes 4-8 hours. Fever is irregular at first with temperature exceeding 39 degrees centigrade. It may rise upto 40 C • If the infection is left untreated • Fever recurs every third day in P.vivax and ovale infection establishing a 2-day cycle (tertian) • Spike occurs every three days (Quartan) in P.malariae infection i.e. fever recurs every fourth day • The pattern of fever in P. falciparum infection is erratic • Paroxysms with rigors are more common in P. vivax & P. ovale than in P. falciparum and P. malariae malaria. True rigors are unusual in naturally acquired falciparum malaria. • As the infection continues the spleen and liver enlarge and anemia develops. • The patient loses weight. • If no treatment is given the natural infection stabilizes for several weeks or months and then gradually resolves IF No complications arise and immunity is good MDI Confidential Proprietary Information

10. Complications Malaria can give rise to following complications: • Coma • Breathing problems • Anemia • Jaundice • Kidney failure • Shock • Death MDI Confidential Proprietary Information

11. Diagnosis The diagnosis of malaria rests on the demonstration of asexual forms of the parasite in peripheral blood smears stained with Giemsa’s stain. Clinically, any patient suffering from fever with rigors in an endemic area should arouse a suspicion of malaria Malaria is diagnosed by microscopic examination of the blood. Thick and thin blood films are made on clean, grease – free glass slides. Rapid Malaria Test is a newer test which enables to look for malaria antigens directly. MDI Confidential Proprietary Information

12. Care of Malaria Patient • Patients with severe malaria or those unable to take oral drugs should receive parenteralantimalarial therapy. • If there is any doubt about the resistance status of the infecting organism, then quinine or quinidine should be given. • If the temperature is high on admission (greater than 38.5oC) then symptomatic treatment with antipyretics and tepid sponging brings symptomatic relief, and also reduces the likelihood that the patient will vomit the oral antimalarials. This is particularly important for young children. • Several drugs are available for oral treatment, and the choice of drug depends on the likely sensitivity of the infecting parasites. • Chloroquine remains the treatment of choice for the benign human malarias. • Patients should be monitored for vomiting for 1 hour after the administration of any oral antimalarial drug. • Symptom based treatment with tepid sponging and acetaminophen administration lowers fever and thereby reduces the patient’s propensity to vomit these drugs MDI Confidential Proprietary Information

13. Control ….. The main strategy for malaria control: Attack the adult mosquitoes, or prevent them from biting people. Indoor residual spraying work • Some risks: • Toxicity of DDT • Resistance of mosquitoes MDI Confidential Proprietary Information

14. Prevent mosquito bites? • Use mosquito repellants. • Wear long pants and long sleeves. • Use bed nets.. • Wear light-colored clothes. • Use window screens MDI Confidential Proprietary Information

15. Travellers …. • Chloroquine alone is used to prevent malaria for travelers going to specific geographical regions where malaria is rampant. • The adult dosage is 500 mg once weekly. • The drug should be taken one week before entering a malarious area, weekly while there, and weekly for 4 weeks after leaving a malariousarea. • Rare side effects to chloroquine include upset stomach, headache, dizziness, blurred vision, and itching. Generally these effects do not require the drug to be discontinued. 8/9/2014 MDI Confidential Proprietary Information MDI Confidential Proprietary Information 15

16. Thank You MDI Confidential Proprietary Information

17. Founded in November 2000……. IRDA TPA License (No. 005) Headquartered in Pune, Maharashtra Exclusive focus on Healthcare Insurance vertical, providing TPA (Third Party Administration) Services Financially Stable since inception, with FYE 2009: 4.6+ million members; annual premiums of 550+ Crores INR ; Health tests of over 50000 lives FYE10 Forecast: 6.0 million members; annual premiums of 900+ Crores INR Health tests for over 2 lac lives Pan India footprint 1200 + Employees strong End to End TPA Solution Suite Backed by solutions development arm ‘MDI Technologies’ Support across channels Voice, Email, Web Based Services ISO standards, Six Sigma and proactive Business Analytics Providing Health checkups (annual, pre employment) to corporates & Insurers. About MDIndia MDI Confidential Proprietary Information

18. Contact us For Health Checkups ( Pre Employment, Annual or Pre Policy ) pims@mdindia.com For Third Party Administration Services for corporates and Corporate Policies bd@mdindia.com For General queries on Health insurance claims and enrollment customercare@mdindia.com Toll Free Number : 1800 11 233 11 66 MDI Confidential Proprietary Information