Visiting a malaria-risk area and not sure what to do? You've heard that malaria has become drug-resistant, so is it worth taking prophylaxes? A friend said anti-malarials made her temporarily crazy; can that happen to you?
Know the enemy: what is malaria?
Malaria occurs when a parasite from the species Plasmodium infects a person's red blood cells. Malaria is endemic to areas where the Anopheles mosquito (that carries the disease) occurs – usually in hot humid climates.
The cycle of malaria starts when a female Anopheles mosquito bites a person with malaria and ingests blood containing malarial parasites. When the mosquito bites another person, the parasites are injected into the body along with the mosquito's saliva.
Once in the body, the parasites circulate in the bloodstream until they reach the liver, where they multiply and mature over an average of 1 to 2 weeks. Thereafter the parasites leave the liver and enter the blood stream and infect red blood cells, where they multiply and eventually cause the infected cells to rupture. The parasites released from the ruptured red blood cells infect even more red blood cells, setting off the cycle once more.
If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs.
What to look out for: malaria symptoms
The first symptoms usually appear between 7 and 10 days after the patient was bitten and are very similar to that of the flu – fever, chills, muscle pain and headaches. After a few days, the typical cyclical symptoms of malaria (or periodic attacks) may occur – chills, followed firstly by a high fever, and them by profuse sweating.
Malaria may also present with unusual symptoms such as abdominal pain and nausea. In rare cases there may not be the typical fever. Any symptom of illness after visiting a tropical country with malaria should therefore alert one to the possibility that one may indeed have malaria.
In severe cases the patient may experience convulsions or go into a coma.
The different types of malaria
There are four species of the parasite that cause malaria: Plasmodium vivax, Plasmodium ovale, Plasmodium falciparum and Plasmodium malariae. P. falciparum is by far the most deadly type of malaria infection and in Africa it is also the most common variety.
Medicine to prevent malaria
Before going to a malaria area, it is very important to get updated information on whether prophylaxis is required and what the current recommendations are.
It is best to seek advice from health professionals who specialise in the requirements of travellers. The individual choice of anti-malarials should be decided on in consultation with a health care professional who will take your past medical history, the side-effects of medications and the specific requirements of your itinerary into consideration before recommending the most appropriate anti-malarial.
The following anti-malarial medication is available in South Africa:
Brand names: Lariam or Mefliam
Dosage: One tablet a week, starting treatment one week before travelling to a malaria area and continue treatment for four weeks after your return.
About: Mefloquine is very effective in preventing all forms of malaria in most parts of the world. Due to its side effects it is recommended that people who have known psychiatric problems should not use this drug.
Side effects: Mefloquine may cause an upset stomach, drowsiness and dizziness, and could also have neuropsychiatic side effects such as unusual dreams, hallucinations, depression, anxiety, psychosis and seizures. It can also impair balance and fine motor co-ordination and is not to be used by pilots or scuba divers.
Brand name: Malanil
Dosage: Take one tablet daily starting one day before going to a malaria-risk area. Take this dosage while travelling and continue for seven days after you return.
About: This combination has been shown in various studies to be very effective in preventing malaria in areas where drug-resistance is a problem.
Side effects: The most common side effects are stomach pain, nausea, vomiting and headache.
Brand names: Doximal and Doxitab
Dosage: Take one tablet daily starting one day before travelling to a malaria-risk area. Continue taking Doxycycline throughout and continue for four weeks after leaving the region.
About: Doxycycline is particularly useful in areas where there is both chloroquine and mefloquine drug-resistance, or for people who cannot take either of the two drugs.
Side effects: It may cause an upset stomach, headache or skin irregularity. Doxycycline may also make your skin sensitive to sunlight and decreases the efficacy of some oral contraceptives. It should not be taken by pregnant women or children younger than 10 years, since it can interfere with growing teeth and bones.
Anti-malarial medicine and alcohol
"Moderate alcohol consumption should not affect malaria medication, says Dr Jaco Folmer, medical director for the Netcare Travel Clinics. However "excessive alcohol intake can cause problems with delayed emptying of the stomach and competition in the liver to metabolise medication and alcohol."
Folmer also warns that people under the influence may be slack about taking medication or using preventative measures from being bitten.
Anti-malarial medicine and contraceptives
Doxycycline decreases the efficacy of some oral contraceptives. Therefore additional forms of birth control, such as the use of condoms, are advised while taking this drug.
Alternatives to anti-malarial drugs
Although there are other products claiming to prevent malaria, none but those mentioned above have been scientifically proven to fight this disease. Remedies believed to counter malaria, such as garlic or vitamin B, can be used in addition to the prophylaxes, but should not replace anti-malarial drugs.
There are various preventative measures that may drastically reduce your risk of being bitten by the malaria-carrying mosquito. These include insecticides, mosquito nets, and protective clothing.
Children, babies and malaria meds
Children under the age of 5 are advised not to travel to areas at high risk of malaria. Complications and death due to malaria are high among children, pregnant women and people with compromised immune systems.
Mefloquine is prescribed to babies and children and are also available in syrup form, which makes it easier for children to take.
Doxycycline should not be taken by pregnant women or by children younger than 10 years, since it can interfere with growing teeth and bones.
Malanil is not licensed in South Africa for use in children, and the paediatric dosage is therefore not available in the country. However, Folmer advises that Malanil may be used by children weighing more than 40kg.
Paediatric doses should be prescribed by a medical professional, as an overdose of the medication can be fatal. The dose is calculated according to the weight of the child, and a medical history must be taking into account to determine contra-indications.
What do you do if you are in the middle of nowhere and suspect you might have malaria?
It is not advisable to enter a remote area with a high risk of malaria and not be prepared. If you do not want to use prophylaxes, you can get a malaria test kit and -medication that you can administer yourself. However, Dr Marcus Brauer from Medi-Travel International warns that one should not be lured into a sense of security if you have a test kit and medication. If you test positive for malaria, it is advised you make your way to the nearest medical facility, as complications may still arise requiring further medical help despite doing everything correctly.
Malaria, especially P. falciparum malaria, is a medical emergency requiring treatment - ideally monitored in hospital for 24 to 48 hours to ensure that complications do not occur.
Malaria test kits
A malaria home test kit can be used to test yourself for the disease if you are experiencing flu-like symptoms. The test is easy to perform and test results are accurate. If the tests are performed early on in the illness they may initially test negative and should be repeated every 12 hours if one remains unwell.
It is important to note that the test kits only test for P. falciparum, which is the deadly strain of malaria, and any other strains will test negative. However, says Brauer, the other strains are not as harmful and one will be able to seek further medical advice and testing should the malaria self test device continue to test negative.
Dr M Brauer – Medi – Travel International
World Health Organization
Netcare Travel Clinics
Mosquito nets save lives