“South Africa has made considerable strides in the fight against malaria by cutting mortality rates by an impressive 85% over the past twelve years,” says Dr Pete Vincent of Netcare Travel Clinics and Tokai Medicross Family Medical and Dental Centre.
Speaking on the eve of the Southern African Development Community(SADC) Malaria Day, (8 November), he added that government’s work to combat the disease has delivered excellent results with statistics* indicating that a total of 70 individuals died in the country in 2012, when compared to 460 deaths during 2000.
Dr Vincent says much progress has been made in reducing the malaria threat in the northern parts of South Africa through the use of spraying and other measures. “Our country is well on its way towards becoming malaria-free, but the disease appears to be gaining momentum in other parts of Africa and the world. According to the New England Journal of Medicine, drug-resistant malaria parasites have spread to critical border regions of South-east Asia, seriously threatening global malaria control and elimination programmes.”
“While the South African government has done a phenomenal job to stem the tide of malaria, the general public still needs to be aware that this is a potentially life-threatening disease. As members of the public we need to become more mindful of the dangers posed by malaria and learn how to protect ourselves against it. Prevention is key in saving lives when it comes to malaria. It is also important to understand that malaria can be cured with a timeous diagnosis and appropriate treatment,” asserts Dr Vincent.
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Dr Vincent warns travellers to take every precaution as the coming holiday season is also malaria season in certain parts of South Africa, such as the north-western parts of Mpumalanga, Limpopo and Maputaland in KwaZulu-Natal. These malaria areas have been divided up into low risk, where only non-drug measures to prevent mosquito bites are recommended, and moderate risk areas where antimalarial drugs are recommended from September to April. Your local travel clinic will be able to advise you on measures you should be taking in line with your itinerary.
Countries such as Mozambique, Malawi, Angola, the DRC, Sudan and Uganda and all the West African countries have particularly high rates of malaria which occur throughout the year and visitors to these regions should be especially careful. Seasonal malaria is also found in parts of Zimbabwe, Botswana and Namibia.
Dr Vincent explains that people who were brought up in a malaria area acquire a passive immunity to the illness that is developed by being exposed to it. This can offer some protection, which is lost fairly quickly after one moves away from the malaria area. Those who intend heading home to a malaria area during the festive season after being away for some time should therefore visit their travel clinic to see whether they should take prophylaxis prior to travelling. Our immigrant population from Africa is particularly vulnerable and they need to be educated about the importance of visiting a travel clinic prior to departure for the December holidays.
“Those who travel to malaria areas in December and January are urged to be on the lookout for flu-like symptoms, including chills, fever and sweats, feelings of weakness, lethargy and dizziness, muscular, body and abdominal pains, headaches, nausea and diarrhoea. Anyone displaying these symptoms should seek immediate medical attention, request a blood test to exclude malaria as a cause and should follow up on the results of the blood test.”
“Keep an eye out for the symptoms of malaria even if you are not aware that you were bitten by any mosquitoes on your trip and have taken your prophylaxis as indicated, as no tablet is 100% effective in preventing malaria,” cautions Dr Vincent. “Although malaria usually presents with flu-like symptoms, it can present in a number of different ways. It is therefore imperative to report any health problems to your doctor and state that you have visited a malaria area.”
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The symptoms of the disease can appear from a week to two weeks, after being first bitten by a malaria-carrying mosquito, when the infected red blood cells begin to burst. Very occasionally it may even take a few months before symptoms become evident. Dr Vincent therefore advises those who have been in malaria areas to remain vigilant for some months after they return home. “Regard any fever as malaria until it is proven otherwise,” he cautions.
“Always follow up on the results of blood tests. One of the most infectious and lethal forms of the disease, namely Plasmodium falciparum malaria, which is predominately found in Africa, can be fatal within hours if not treated promptly,” warns Dr Vincent.
Children below the age of five and women who are pregnant should avoid travelling to areas where they will be exposed to the risk of malaria. They tend to have more severe and life-threatening infections as their immune systems are compromised by immaturity and pregnancy respectively. People suffering from other illnesses and medical conditions that can impact the immune system, such as HIV/AIDS, are also highly vulnerable when it comes to malaria.
Dr Vincent says prophylaxis plays a very important role in the fight against malaria, but does not necessarily afford complete protection. A multiple-pronged approach to the prevention of the disease is therefore necessary. “Do everything possible to avoid getting bitten by mosquitoes while also taking your prophylaxis if your doctor or travel clinic has prescribed them. While prophylaxis does not always completely prevent malaria, it does tend to considerably reduce the severity of the illness and can be lifesaving,” he points out.
“Using repellents and sleeping under a permethrin-treated mosquito net can help a great deal. A DEET- based repellent keeps mosquitoes at bay for 300 minutes while a citronella-type repellent needs to be re-applied every 20 minutes. Wrist bands offer no protection. Be cautious about gimmicky products claiming to offer protection against mosquito bites,” cautions Dr Vincent.
“According to the World Health Organization, the complexity of the malaria parasite makes the development of a malaria vaccine a very difficult task. However, a new vaccine for children, which has been successfully trialled and is under development, may well be released by the end of 2015. This is an exciting step forward in the fight against the disease. However, the threat remains very real and should never be underestimated,” concludes Dr Vincent.
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