10 December 2001

Take care against malaria

Adequate protection against mosquitoes, that's what most South Africans, who intend spending Christmas in certain neighbouring countries should pack.

Adequate protection against mosquitoes, that's what most South Africans, who intend spending Christmas in certain neighbouring countries should pack.

Those who will be visiting traditional malaria areas in South Africa, including KwaZulu-Natal (KZN) can however, take it easier thanks to beefed up efforts to curb the disease.

Malaria is one of the most commonly reported diseases in South Africa according to the South African Yearbook 2000/1. In 1998, for example, 26 440 cases and 198 deaths were reported - of which 13 575 occurred in KZN.

In 1999 the figure was 50 000 with 393 deaths. Last year the figure climbed to 62 000 reported cases (the most ever) and 423 deaths.

This alarming increase compelled the government to take drastic steps including spraying houses with the controversial agent DDT. Health Department deputy director for vector-carrying diseases, Dev Moonasar, said that the department has laid down a new treatment protocol, as malaria parasites have developed resistance to existing products.

The decision to start using DDT again, following its ban in 1996, was taken last year since malaria mosquitoes developed a resistance to peritroid sprays.

DDT has been used in South African since the 1940s when malaria control was first introduced in South Africa. Before that time the disease was common in KZN, the Northern Province and in Mpumalanga. Epidemics were recorded as far south as Durban and Pretoria.

Malaria generally occurs in tropical areas and at least one million people die annually in Africa of malaria, says SAA Netcare Travel Clinics (SAA/NTC). The parasite is transmitted to the victim when they are bitten by contaminated mosquitoes.

The parasite develops in the liver. When mature it is released in the blood stream where it penetrates red blood cells and multiplies. Eventually red blood cells explode and the parasites are once again released in the blood stream, repeating the cycle. Cold fever and sweats are associated with malaria and occur when red blood cells explode.

Anaemia, an enlarged spleen, renal failure and blood surges in the brain follow.

Malaria in South Africa is carried by at least three mosquito species, of which the falciparum species is the most dangerous, says Dr Andrew Jamieson SAA/NTC medical director.

The disease mainly occurs in low lying areas of the Northern Province (including Messina, Thohoyandou, Letaba and Punda Maria), Mpumalanga (particularly the Kruger National Park, Malelane, Komatipoort) and in the north-east of KZN. The highest risk area is in a 100km belt along the Zimbabwean, Mozambican and Swaziland borders.

In Africa the disease is endemic to Mozambique, Zimbabwe, Botswana, Angola, Zambia, Swaziland and parts of Namibia. Moonasar notes that contamination reaches a peak during hot summer months from October to May and that people should take precautions during this period.

Jamieson says the frequent rains recently is cause for concern. "Malaria is on the increase in the northern areas of Zimbabwe and in Botswana. In addition South Africans are increasingly choosing holiday destinations in countries including Zambia, Malawi, Tanzania and Kenya. Resorts in southern Angola are becoming ever more popular and Mozambique remains a popular destination."

"We predict a normal distribution season with no serious outbreaks. Rain mainly occurred in higher-lying areas. But we are prepared, should cases increase drastically," Moonasar said.

Visitors to St Lucia in KZN have fewer concerns this year. The Medical Research Council (MRC) says no cases among local residents were reported for the past two years. Although the area has been declared "malaria free" Moonasar notes it would be safest to watch the area for another season.

"However, it is true that the incidence of malaria dropped drastically. Areas in the province still carrying a high risk alert include border areas with Mozambique - with Ndumo, Manguzi and Ubomob in particular."

The incidence of the disease fell by 76 percent in KZN over the past year and in Swaziland by 64 percent it was announced earlier at a media briefing.

In Mozambique figures reduced by 40 percent.

This does not mean that visitors to KZN risk areas should not take care, Jamieson maintains. "Travellers are often at greater risk to contract malaria since they do not have natural immunity. We recommend taking steps to avoid mosquito bites. This applies to people whose spleen has been removed, and whose immune system is under pressure, such as pregnant women.

Malaria prevention depends on avoiding mosquito bites and using prophylactics.

  • Use an effective insect repellent when spraying rooms;
  • Wear clothes that cover as much of the body as possible - specially at dawn and dusk
  • Sleep under a mosquito net at night, particularly those soaked in insect repellent, and burn insect repellent candles

  • Avoid being outdoors in the evening when malaria-bearing mosquitoes are most likely to strike.

Various antidotes are available on the market - depending on the area to be visited and your medical history. You should start taking these drugs at a set time ahead of your departure and should continue with them for a period after leaving the malaria area.

The fact that malaria-bearing mosquitoes have developed resistance to certain agents, including chlorine quinine is cause for great concern in the battle against the disease. Another problem occurs when patients fail to take the medicines for the prescribed period since they start feeling better.

Certain medicines can be bought over the counter. Jamieson, however, notes that people should be alert to the fact that some of these drugs are less effective in certain areas in Africa.

"Rather consult your travel clinic or doctor for a prescription. Pharmacists are also likely to aid you. Your chances at contracting malaria are 10 to 50 time greater without precautionary measures."

SAA/NTC says symptoms include an aching body, fatigue, headaches, sore throat, diarrhoea and fever. The patient's condition could deteriorate suddenly as a result of the increase of parasites in the bloodstream. Cerebral malaria could be fatal and it is therefore essential to attend to suspected malaria immediately.

Symptoms can emerge within seven days after arriving in a malaria area and up to six months after leaving it.

The problem is that symptoms are often inconsequential initially, manifesting itself a flu.

Home tests are available and very accurate, as long as they are well attended to and implemented correctly, Jamieson says. They are particularly handy when you are likely to visit an area far from facilities where blood can be tested. The results are available within 10 minutes.

The disease has a quicker and more severe effect on babies and small children and special precautions should be taken in protecting them.

Jamieson adds that it would be better for children under five years of age and pregnant women to stay away from malaria areas. - Thalyta Swanepoel, Beeld


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