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Introduction

The world is full of fantasies and every one wants to be a part of these fantasies. There are some factors involved which keep a person active and smart. Health is a state of physical activeness which keeps a person mentally and physically fit. According to the world health organization, a health can be defined as a positive concept which highly emphasizes on social and personal resources as well as it is also concerned as physical capacities. There are two aspects of health: mental and physical. Physical health can be maintained by preventions, interventions and different physical activities. Malaria is a common disease usually caused by virus. Malaria is a vector brone infectious disease causes by different parasites usually it is caused by protozoan parasites. It is commonly found in different parts of world, especially United States, Asia and Africa. Each year many cases are recorded of approximately 515 million of malaria from different parts of the world. 90% malaria cases led towards death in South Saharan Africa. Usually malaria found in underdeveloped countries where high poverty and literacy rate is low as compared to European countries. Malaria is usually associated with poverty and it is also highly associated with economic development. Malaria is very common and now it has become a challenge for underdeveloped countries to protect malaria. Malaria causes numerous deaths in different countries. This disease is caused by protozoan parasites and it can be protected by using different strategies and preventive measures. There are a number of parasites but only four parasites can inject human, the most serious forms of disease caused by Plasmodium falciparum. Other three types of parasites can also be injurious to human health but however preventions are available to prevent human bodies. Its a common phenomenon that people usually get affected from malaria by a female mosquitos bite.

Symptoms of malaria usually include fever, shivering, vomiting, anemia, and retinal damage. Symptoms of malaria may carry from person to person as it depends on human capability. There is no specification that who will be affected from malaria but usually children and pregnant women are likely to adopt malaria. Malaria can be diagnosed with the aid of different tests and technologies. Few diagnosis of malaria can be done by film tests, microscopic examination of blood films, field tests, molecular methods and laboratory tests. There are many drugs recommended by different doctors for malaria few of them are as follows: Artemether-lumefantrine (its a therapy and commercially known as Coartem and Riamet), Artesunate-amodiaquine (Therapy), Artesunate-mefloquine (Therapy), Artesunate-Sulfadoxine/pyrimethamine (Therapy), Atovaquone-proguanil, commonly known as Malarone (Therapy and prophylaxis), and Quinine (Therapy only), Chloroquine (Therapy and prophylaxis), Cotrifazid (Therapy and prophylaxis), Doxycycline (Therapy and prophylaxis), Mefloquine, trade name Lariam (Therapy and prophylaxis), Primaquine (Therapy), Proguanil (Prophylaxis), Sulfadoxine-pyrimethamine (Therapy; prophylaxis for semi-immune pregnant women) Hydroxychloroquine, common name Plaque nil (Therapy). Malaria is usually caused by bites of mosquitoes so its really easy to prevent yourself from malaria by taking some preventive measures. Symptoms of malaria in Guatemala usually appear after 10-15 days of mosquitos bite. Person usually feels weak and lazy after 15 to 20 days of mosquito bite. Malaria needs proper diagnosis and on time treatment if not treated properly than it could become a life threatening disease as it highly affect blood cells and blood circulation. There are some facts about malaria which are listed below:

• Malaria is preventable and curable disease
• After every 30 seconds a child dies due to malaria.
• More than one million people dies from malaria mostly infants and pregnant women and most of them found in underdeveloped countries and in Africa.
• Malaria is a kind of disease which can be transmitted in all ages.

Malaria is a kind of disease which is contiguous i.e. it can transmitted form one person to another. Malaria is usually caused by mosquitos bite. This disease has been recognized by thousand of years and it mostly not found in the most northern areas of the world. Its a serious problem in much of the tropical regions of the world.

Malaria Causes

Its a common phenomenon that malaria is usually caused by protozoan parasites. When a mosquito bites a person an infection begins after 10-14 days. Infection begins from infected mosquito. The parasite travels to liver from mosquitos bite where parasites start reproduction, then after some days parasite leaves the liver and travels to the blood stream where it infects red blood cells. The parasite usually infects the blood stream where it destroys the red blood cells and there it releases more parasites in bloodstream. If a mosquito bites an infected person than again if he bites another person, second person will also get infected with malaria. Basically there are four species which highly infect humans: Pvivax, Povale, P Malarie, P falciparum.

In most parts of the world people usually get affected from malaria by mosquito bites however some regions have other causes of malaria. In some regions of the world people get infected with malaria due to drug use, A large number of people get infected with malaria because of organ or kidney transplant, babies born to mother who did not know they are infected.

Malaria symptoms in Guatemala

Malaria symptoms involve fever, vomiting, anemia, retinal damage etc. A person develop a high fever which comes and goes every second day or after few days. In many people fever doesnt comes and goes so often but they frequently feel body aches. People also complain of frequent headache, nausea, raging, sweating and weakness. When infection progresses a person feels better and he seems to recovering. Some people also develop little immunity and develop disease without any symptoms. Malaria can also be transmitted from mother body to her infant. Malaria is usually carried by mosquitoes in temperate climate but usually the rate of malaria is less in winter seasons as parasites usually vanishes in winter season. The malaria disease is one of the basic and important problems in most parts of tropics and subtropics. The CDC estimates about 300-500 million cases of malaria each year. People who travel a lot are likely to get infected with malaria as they face different seasons. Use of drug resistance parasite is also a big cause of malaria a global health problem. The parasites usually stay in liver about 8 days or as long as months.

Risk Factors

There are number of symptoms of malaria as stated above. Signs and symptoms indicates the time that when a person needs a doctor. People who have little immunity and dont show any symptoms have high risk rate in malaria. When a person doesnt pose any symptoms, then gradually a parasite grows and at the last stage malaria identified which is always dangerous for persons health. Residents of a malaria region may show little immunity to the disease at some stage of life. People of serious disease poses high risk rate few of them are listed below:

Young children, infants and travelers coming from different region with no malaria, pregnant woman and an infant. An unborn baby also an ideal candidate who can affect with malaria. Poverty, lack of education contributes a lot in the increasing rate of malaria deaths worldwide. However, malaria can be reduced by taking some precautions and primitive measures.

Complications

Malaria is a preventable and curable disease and it can easily be controlled by medicine and different techniques (Mala, 1982). Some complications are involved in severe malaria cases, the most common complications are as follows: Anemia and Cerebral Malaria. Anemia usually caused due to the destruction of red blood cells. Cerebral Malaria is caused due to the parasite filled blood cells block blood vein to brain by which a brain damage can occur. There are number of complications is also involved in this case, other complications include: breathing problems, dehydration, liver failure, kidney failure, enlarged spleen. Other complications are: Cerebral malaria, Death, Mother-infant transmission, Low birth weight, Anemia, Jaundice, Enlarged spleen, Black water fever, Hematuria, Kidney failure, Liver complications, Brain complications, Enlarged liver, Hypoglycemia and Fluid imbalance. Disease database have another list of complication associated with malaria are as follows: Uveitis, Red cell abnormality on blood film, VDRL positive, Leuconychia Fits, Acute confusional state, Pyrexia of unknown origin, Haematuria, Aseptic meningitis, reduced level of consciousness.

Malaria can cause anemia and jaundice and if it rises to last stages it can lead to death, retinal damage and coma. Complications in malaria are secondary stages of malaria, symptoms and other disorders. In many parts of the world, doctors are not able to distinguish between symptoms and complication in some patients.

Misdiagnosis of Malaria in Guatemala

It has been observed from different surveys that malaria needs proper and on time judgment of disease. Proper on time treatment can safe persons life. In most of the underdeveloped countries doctors are not able to distinguish between malaria and other disease. Misdiagnosis of malaria is very common in Guatemala and other regions. Misdiagnosis of malaria is as follows: Brucellosis, Toxocariasis, Changes disease, Dengue fever, Leishmaniasis, Marburg virus, fever, Trypanosomiasis, Typhoid fever, Schistosomiasis and Yellow fever. Alternative Diagnosis of malaria is: Flu, Influenza,

Typhoid fever, Dengue, Visceral Leishmaniasis, Amebic liver abscess, viral hepatitis,

Babesiosis, Typhoid fever, Leptospirosis and Relapsing fever. Now the basic question arises, why does misdiagnosis occurs in Guatemala? There are many ways by which a misdiagnosis can go in wrong directions. Usually disease player contributes a lot in misdiagnosis of malaria, patient, doctor, specialist and test. Patient plays a great role in misleading the doctor by not examining his body and symptoms properly. Patient can do misdiagnosis by wrong self diagnosis and not reporting symptoms, failure to complete ordered tests. Doctor play a pivotal role in wrong treatments and diagnosis of malaria since the doctor has to make a diagnosis, there are many ways by which a wrong diagnosis may occur some of them are as follows: doctor may familiar with only common diseases, over publicized disease, doctors skill levels, doctor bias, saving money and time, lack of time, dont have a grip on an organ examination and sometimes in patients physical and mental behavior are hard to diagnose. Laboratory test can also led doctors to misdiagnosis of malaria if there is any human error, error margins, and false positive and false negative. These all factors play an important role in misdiagnosis of malaria in Guatemala. Malaria is a hot and critical disease in hot climate areas however it also occurs in temperate climate regions.

Prevention

Every thing needs proper diagnosis and proper judgment. On time decisions and proper management of any task help in immediate recovery. Health is a very important issue in the world but unfortunately, in underdeveloped countries there is a lack of education and treatment options which usually convert disease in severe cases. Malaria is a preventable and curable disease and it can be treated well by adopting some preventive measures and precautions. Self examination has of great significance and helps a lot in recovery. Patient has some duties to perform rather than depending upon doctor and other paramedical staff. Doctors usually recommended every one to examine body after every 5 days and if any abnormal thing appears so he must consult a doctor at his earliest. Only proper judgment and diagnosis can bring back a person from a disease. Malaria is a curable disease and first symptoms appear in form of fever. Unfortunately millions of people do not consider fever a dangerous thing; they take normal medicines for treating fever meanwhile malaria resides on bloodstream and damage red blood cells due to which a person feels sick and weak. There is a strong need to educate people and create awareness in them about malaria. Patient has some responsibilities which are as follows: Patient must note down all symptoms what a patient experiences, must note down key personal information, make a list of all medication patient is taking, must take a family member or friend with you etc. Patient must have complete information about malaria in order to recover from it soon. For better recovery patient must know the answers of following questions:

• What are the symptoms faced by patient?
• What are the possible causes of malaria?
• What kind of tests does the patient need?
• Is patient condition chronic or temporary?
• Are there any restrictions which patient needs to follow?
• Should the patient needs to visit a doctor?
• What websites should patient visit for better knowledge?

Malaria in Guatemala

Malaria is very common in Guatemala and has become a great challenge in Guatemala for health providers. Malaria is a very common disease found in 1500 meters The risk of infections are more likely in the provinces like Alta Varapaz, Baja Varapaz, Ixcan, Petén and San Marcos and to a lesser extent in the provinces of Esquintla, Huehuetenango, Izabal, Quiché, Retalhuleu and Suchitepequez of Zacapa. There is no risk of malaria below 1500 meters. In past few years, medicine field has gained so much success and still many researchers and scientist are working in this field in order to make better and effective drugs of different diseases. Guatemala is raising lots of funds in order to fight against malaria. Children are more likely to adopt malaria and negative behaviors. However every disease has its precautions and medicines. If disease is diagnosed at earlier stage then its always easy to fight against it in limited time. But due to the lack of knowledge millions of people do not consider any unusual symptoms as a serious matter. Thousands of people do not feel good to visit a doctor in some cases like fever, cough, sneezing etc. Self medication is a good approach but sometime it causes unbearable damages to human health and life. Many people in Guatemala consider self medication as a complete treatment of their disease.

Control and prevention is necessary for parasites disease as they are contiguous so there is always a strong need to diagnose malaria at its early stages in order to prevent patient from severe conditions. Preventions and control of parasites disease highly depends on adequate knowledge of interaction among factors and related issues for instance human behavior, environment, lifecycles of parasites. Socio culture behaviors contribute a lot in preventions of malaria in Guatemala. Socio culture factors in large parts determine transmission and persistence of parasites cycle. The significant determinants of malaria in large parts are poverty, lack of education, deficiency in home technology, high level of demographic density and ruralism (Muela, & Ribera, 2000). Above stated interventions has of great significance and play a pivotal role in reducing increasing rate of malaria in an isolated manner. Number of different interventions is implemented in order to control the increasing rate of malaria in America. Holistic approach has proved one of the best approach in control and preventions of parasitic infection in different parts of the world. Holistic approach emphasizes on educating people about malaria, causes, and symptoms so that people can deal with malaria effectively. Holistic approach combines awareness along with society infrastructure helps in producing favorable results. If all these actions implemented properly than they surely help in improving quality of life. In order to improve quality of life every person must take precautionary measures to keep his health and safe and disease free. Control and prevention of parasites disease usually depends on an adequate environment and available knowledge about any disease.

Population highly affects rise in malaria in certain parts of the world. There are number of preventive measures which can help in reducing high rate of malaria. The use of insecticide impregnated mosquitoes nets and other material in America is considered as the best primitive measure against mosquitos bites (Voorham, 1997). Most of the researchers proved that wrong health indicators always misguides patient to take precautionary steps. Specifically, low incidence of malaria, the high prevalence of Pvivax malaria along with relapsed cases in America and the relationship between human behavior patterns biting patterns of malaria vectors allow easy implementation of precautionary measures. The use of mosquito nets has increased a lot and millions of people are using this as primitive measure against malaria. However, it is highly recommended by doctors that only well organized large scale trails and intervention is considered when they are based on through understanding of dynamics of malaria transmissions (Voorham, 1997).

Children are most likely to adopt malaria and are affected by mosquito bits soon (Bill, 2007). A Number of parents use different tools and medication in order to keep safe their child form mosquitos bite. Immunization programs have contributed a lot in this domain. The role of intervention is really important in order to control increasing rate of malaria in children. Finance and other issues are really important and have of great significance in dealing with malaria in Guatemala. Finance plays an important role in controlling malaria. Pregnant woman needs strong care against malaria as there are high chances of infecting malaria form mother to unborn infant. Malaria posses serious health consequences for both mother and infant and now have become a great challenge for pregnant women. By taking some primitive measures this can be controlled effectively and by implementing different precautionary steps a public health challenge can be resolved. Roll Back malaria (RBM) is widely known as supportive agency of world health organization helps in reducing burden of different health issue by taking some precautionary steps (Karen Glanz,2007). For malaria RBM usually recommend use of following tools as precautionary step against malaria: use of bed nets and insecticide treated nets, effective case management, intermittent preventive therapy etc. in many parts of America, a comprehensive national malaria program is in progress for the production of malaria free America. Component of national malaria program are specifically designed in order keeping in mind the strategy to reduce the burden of malaria from WHO which include integration of malaria control with the aid of general health services and use of indoor spraying (World Health Organization. 1999).

Spraying strategies are beneficial as they help in reducing overall malaria exposure both for general population and pregnant women (Res, 2008). Pregnant women needs more care and attention same in case of malaria than general population as any infection can be dangerous to her infant. Beside malaria control program there are several issues and challenges faced by RBM in different regions of world. There is a strong need of implementing measures against malaria and to focus on social culture issues, drug policy which helps in implementing highly centralized malaria control program. RBM and WHO needs to take strong steps in malaria domain (Indian, 2008).

Economics of Malaria Control interventions

Numerous countries are following different strategies to fight against malarias. Usually human behavior and patient patterns are the main hurdles in the proper treatment of malaria. Usually, many patient do not feel good while treatment so they usually avoid to take treatments in start. The economic rate of government intervention in controlling malaria is highly based on balance of equity and market failure. Poverty is the second hurdle mostly comes in way of effective interventions (Kachur, 2001). Market failure is also a big issue which comes in the way of effective interventions. Malaria treatment is widely available and numerous doctors are treating malaria by their own ways. Treatment in both public and private sector is hanged by low quality of care, lack of proper care and attention, inefficiency in service delivery and lack of adequate care. Demand is always influenced by prices, lack of proper information usually makes situation critical and dangerous. Poorly trained staff and in propitiate prescription by health workers are also main hurdles in the way of proper treatment of malaria. In Guatemala, health workers are also suffering from lack of information about equipments and propitiate treatment. Improving malaria case needs some changes in order to make it more protective and effective. In order to improve malaria case management, there is a need of changing whole structure of health system as a whole, as in many places malaria cases pose a significant share of total utilization.

Health Belief Model

HBM is highly based on persons action that he will take care if he feels any abnormality in his body. The core assumptions of HBM are listed below:

Perceived susceptibility, Perceived severity, Perceived barriers, Perceived benefits, Perceived cost, Demographic variables (for example age, gender, ethnicity, occupation)

Socio-psychological variables (for example social economic status, personality) Perceived efficacy, Health motivation, Perceived control, Perceived threat (Health belief Model, 2008).

Literature Review

HBM is a physiological model for promoting uptake of services offered by social physiologist. It attempts to explain physical and mental behaviors of a person infected with any disease. HBM model was constructed in response of failure of Tuberculosis (TB) health screening program, since than HBM has been adopted in number of regions. It is widely used in exploring a variety of long and short health behaviors including HIV aids. Core elements of HBM: perceived susceptibility is ones opinion abut getting affected with any abnormal behavior, Perceived severity is ones opinion how the condition is critical, perceived benefits are expected benefits from taken action, Perceived barriers are tangible and intangible hurdles, Self efficacy is ones own ability to adopt positive behavior.

Critique

Health issue is one of the challenges face by todays world. Program implemented by government in Guatemala are good but there are some weaknesses. Drug providers are of great significance and there is nothing properly implemented in order to promote them to provide reliable and authentic product. Nurses and Para medical staff spends more time with patient than a doctor so there is nothing advised for paramedical staff training. HBM is a good enough model for understanding the needs and requirements of changing behavior but it also needs development and testing for applicability in order to understand human behaviors (Journal of Advanced Nursing, 2008). Accessibility to health center and reliable drug is not easily available in Guatemala so there should be some governmental strategy for making it easy and approachable. Self efficacy is not easy as many people do not posses any knowledge of disease so there must be something to promote education and awareness programs in Guatemala. Perceived benefits must be in result of surveys and feedback from care seekers. Providing reliable products and safety drug products are the main issue in controlling malaria. Spraying and use of bed nets can cause other health issues as sometime they posses strong chemical which harm human skin and can cause breathing issues (Qingjun, 1998). There is a need to promote time to time clinical visits so that proper check up can be done accordingly. Negative behaviors usually occur due to the lack of information and unnecessary fear of getting affected. Governmental strategy is important to be implemented properly in this domain for effective and long lasting results. Many critiques are at level of HBM and HBM was reviewed with the aim of modifying it as there is nothing for nurses and paramedical staff education (Janet, 2008). It was reviewed to be focus on young families. Malaria is not incurable disease but on time care and proper diagnosis with proper medication is important in order to receive long lasting results. Health awareness and malaria intervention must be provided to young families so that self medication could not make situation worst. There must be some strategy to stop fake medicine supply in market. Health related behavior has been a great challenge for health providers. Understanding and being able to predict correct diagnoses is necessary in order to create smooth relationship with patient. A clear understanding is really important to identify the cause of behavior in order to judge the change (Davidhizar, 1983).

Current situation of malaria treatment

Antimalarias drugs are widely used method of malaria control in symptomatic cases. Usually people seek treatments from different places like private clinics, modern health providers, nongovernmental organizations, traditional healers, private dealers, shops and markets (Snow, 1992). Most often people seek fever medication which appears as a symptom associate closely with malaria. In sub Saharan Africa and Guatemala usually people seek for medication from shops and dispensaries. Diagnosis is highly based on clinical symptoms alone. Dispensaries usually do not offer advanced treatment of malaria required by sever cases of malaria. Outside Africa transmission rates in treating malaria is less intense (Kara and Catherine, 2004). In Asia and Latin America people usually seek treatments form general medical facilities, in Latin America laboratory test are also used for the diagnosis of malaria. In some regions of the world lab treatments are not available people usually given presumptive treatment for their immediate symptoms. Informal sector is widely used for treating malaria worldwide. Its one of the commonly used methods for treating malaria. Around 60% malaria cases are treated initially by private providers mainly by purchasing medicines for fever from shops (Taylor, 2001).

Its a common practice that usually person starts treating malaria by self medication. There is no effective malaria vaccines are available however spraying method is widely used to prevent malaria. Use of bed nets, clothes, curtains and hammocks are also very common. Government in many regions promotes the idea of using ITN as one of the malaria control objective. House holds also prevent Malaria. Malaria is a disease which needs proper and on time care and it can only be happen when seeker posses care some knowledge and reliable information about malaria and must know its treatment options.

Weaknesses in malaria treatment

There are some weaknesses in malaria treatment program in both private and public sector in Guatemala (Bitran, 1995). The three most significant weaknesses are as follows: low quality care, inefficient service delivery and lack of proper utilization of adequate care.

Low Quality Care

Malaria needs special care and attention in early stages to prevent it. Malaria is a curable disease and precautions can prevent it at early stages. Self medication is a good approach but still it needs to be done along with doctors advice. Low quality care lies in both private and public sectors: quality can be measured by two aspects: Technical Quality and perceived quality.

Technical Quality: both private and public sectors face numerous technical equipments in malaria treatment. Various technical difficulties are related to malaria diagnosis. Sometime a surgeon also finds difficulty in diagnosing malaria. Many essential drugs including antimalarias are frequently out of stock in health care centers and even in number of lower health care centers most medicine and anti malarial drugs are not available. Inappropriate and unauthentic prescription and use of unreliable drugs are very common. Its a common practice that people in Guatemala usually save their money by purchasing low cost medicine for the treatment of fever (a first symptom of malaria). In Malawi 74% of malaria affected children attend clinic and only 17% took the correct dose. Over dosing causes number of complications in severs cases, and over dosing is common practice in Guatemala. Usually people take medicine from different shops and dispensaries where they ask for medicine by name rather than a service including diagnosis and service.

Poor quality drugs are also easily available in different drug stores and shops. Poor drug quality is usually caused by lack of quality control in manufacture and degradation during storage. In Guatemala fake drugs are easily available and it has now become a major concern for responsible authorities.

Taking behavior into account

Both public and private sector has responsibility of dealing effectively with malaria. However the public sector role in fighting against malaria goes beyond private sector. In order to ensure delivery of effective service in public sector, its really important to consider different determinants involved in the behavior of patients and health workers. For effective interventions it is necessary to recognize the role played by the private sector and there is also a strong need to target government interventions at changing the behavior in adopting different measures (Ault, 1994). Negative behaviors usually appear in result of poor knowledge and unreliable information and it can only be prevented by providing better information to care seekers.

Changing the behavior of care seekers in Guatemala

In Guatemala number of services is provided, they will fail to create an impressive impact on health outcomes if not properly implemented and if are not used by care seekers (Baume, 1998). First of all policies are required to be revised keeping in mind the changing mind of care seekers. Secondly, policies must have elements for the patient to take proper medicine and proper dose on time. Interventions usually influence by demand and supply behaviors and are affected by a wide range of factors which includes income level, accessibility information, perceived quality, cost and quality of treatment. Care seekers must have complete information about disease and its interventions. Pre-packaging drugs are also helps in changing behavior of care seekers.

Behavior of NGO and public sector provider

Public sector in Guatemala is providing health services to different health care center and NGO has also of great significance but the crucial behavior of providers has a great impact on effectiveness of health program by accurate diagnosis, drug recommended and the advice seek by the care seeker. Behavior can be changed by providing quality education, training and job aids.

What can be done?

Malaria has now become a challenge and government is failed to control in Guatemala. Malaria grows very soon but government failure also needs to address. By following ways treatment of malaria can be improved:

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