Malaria is a serious, sometimes fatal, illness. It is endemic in sub-Saharan Africa and causes over 1 million deaths every year. Malaria is particularly dangerous for pregnant women and children under 1 year.
Malaria is an acute disease caused by protozoa/parasites of the genus Plasmodium. Four species cause human malaria. Plasmodium Falciparum is the most dangerous of the four parasites as it can cause the complicated, severe form of malaria which is fatal if not treated promptly.
Transmission of Malaria to humans is via the bite of an infected, female, Anopheles mosquito (although infection can occur through direct inoculation of infected red blood cells via blood transfusion, needle contamination or congenitally)
The Anopheles mosquito feeds on human blood usually between dusk and dawn. Once the parasite carried by the mosquito, is injected into your body it lives and replicates inside red blood cells and sometimes lies dormant in the liver. Malaria often presents as a flu-like illness. Symptoms may include high fevers, sweating, headaches, chills, muscle aches and gastrointestinal upsets.
The question of how to avoid contracting Malaria becomes less clear cut with duration of time spent abroad. This is due to lack of research data on the long-term effects of anti-malarials and their unpleasant side effects.
New developments to combat malaria are on the horizon. However, the basic principals remain unchanged.
- ASSESS THE RISK
- AVOID MOSQUITO BITES
- TAKE SUITABLE CHEMOPROPHYLAXIS
- SEEK EARLY DIAGNOSIS AND CORRECT TREATMENT
- ASSESS THE RISK
Indigenous people, if frequently exposed to malaria, can acquire immunity during the first five years of life. However immunity is lost after approximately six months away from a malarious area. This is why malaria is much more severe and often life threatening in expatriates.
The decision to take long term antimalarials involves a risk-benefit assessment. Those who travel to rural areas where the incidence of malaria is high, are at a much greater risk than those who remain in air-conditioned, urban settings, close to reliable medical facilities. Pregnant women and children under 1 year are at increased risk of developing severe complicated malaria.
BITE AVOIDANCE MEASURES
Humans can be either very attractive to mosquitoes or appear never to get bitten at all. However, some people may not realise they have been bitten particularly if they do not react to the bite.
Why do some people appear to be bitten more than others are?
Mosquitoes have a finely tuned homing instinct to find their prey, hence their survival for the past 3 million years. We all give off individual chemical, visual and heat sensors; mosquitoes can detect these up to 100 feet away.
What can you do to make yourself distasteful to the mosquito?
Wear light coloured clothing, which preferably covers your bare arms and legs.
Avoid wearing sweet perfume or aftershave.
Cover any exposed skin with insect repellent. Be careful with babies hands and faces.
Wash your socks! Apparently research has shown that the mosquito loves cheese which smells like rotting feet.
Burn a spiral mosquito repellent coil or a citronella candle.
Drape your bed and childrens’ cots with a permethrin impregnated bed net.
Remember attraction can be fatal!
CHEMOPROPHYLAXIS
This is the term given to the drug treatment that helps to prevent malaria if taken regularly. Anti-malarials buy you time to seek definitive treatment. THEY DO NOT MASK SYMPTOMS OR PREVENT DIAGNOSIS VIA A BLOOD TEST. Chemoprohylaxis will modify the disease and slow down its progress. There will be fewer parasites in the body, the intensity and progress of the disease will be reduced and your chances of recovery following prompt diagnosis and suitable treatment are greatly enhanced.
In West Africa there is a high rate of resistance to Chloroquine. Newer anti-malarial drugs such as Mefloquine, Doxycycline, and Malarone, are around 90% effective. One in five people will experience some side effects.
Paludrine (proguanil) and chloroquine (nivaquine) together, offer approximately 70% protection. They are the only safe option during pregnancy and must be combined with an increased folic acid supplement.
The pros and cons of each anti-malarial should be discussed individually with a doctor or travel nurse.
PROMPT DIAGNOSIS AND TREATMENT
Considerable training and experience is required to interpret blood samples for malaria diagnosis. Where reputable laboratories are not accessible the new Immuno-chromatographic (ICT) finger prick test is acceptable. However even if the test is negative you may still be treated for malaria on your symptoms alone. The important point is to seek professional advice when your symptoms commence (ie within 24 hours).
DO NOT DELAY! Malaria can be fatal.