What is malaria?
Malaria is a potentially fatal illness of tropical and subtropical regions.
The disease is caused by a parasite which is transmitted to human beings
bitten by infected mosquitoes. The disease is widespread in Africa,
and over one million people die of malaria every year on the continent.
Which areas harbour
malaria?
Within South Africa's borders the disease is encountered mainly in Northern
and Eastern Mpumalanga, Northern Kwa-ZuluNatal, and the border areas
of the Limpopo and North West Provinces. Considering South Africa's
neighbours, malaria is also considered to be a threat to travellers
visiting the lower lying areas of Southern Africa, such as in Swaziland,
while it is encountered throughout Mozambique and Zimbabwe, and much
of Botswana. Northern Namibia is also a malarious area.
Within South Africa's
borders, malaria transmission is at its highest during the warmer and
wetter months of November through to April. From May through to October
the risks of acquiring malaria are reduced.
How to avoid
malaria
Prevention of malaria relies upon adopting personal protection measures
designed to reduce the chances of attracting a mosquito bite, and the
use of appropriate anti-malarial medication. Both personal protection
methods and anti-malarial medication are important, and neither should
be neglected at the expense of the other.
Personal protection
measures
Personal protection measures against mosquito bites include the use
of an appropriate insect repellent containing di-ethyl toluamide (also
known as deet), the wearing clothing to conceal as much of the body
as practical, sleeping under mosquito nets, and the spraying of sleeping
quarters at night with a suitable pyrethroid containing insecticide,
or the burning of an insecticide laden coil. If at all possible avoid
being outdoors at night, when malaria carrying mosquitoes are more likely
to bite.
Anti-malaria
tablets (prophylactic)
There are a number of different types of anti-malaria tablets available.
Choosing one depends both upon the particular area being visited, and
the traveller's own medical history. Within south Africa's borders,
SAA netcare travel clinics recommend either mefloquine (mefliam) or
doxycycline as being the most effective anti-malaria tablets. Both of
these drugs require a prescription.
Mefloquine (mefliam)
is taken in adult dosage of one tablet per week. This should be commenced
at least one week before entering the malarious area and continued for
four weeks after leaving the malarious area. Mefloquine
(mefliam) is best taken at night after a meal, and with liquids. The
principal contra-indications to the use of mefloquine (mefliam) are
a history of psychiatric problems or epilepsy.
Doxycycline is taken
in an adult dosage of 100mg per day, starting a day or two before entering
a malarious area. Like mefloquine (mefliam) it should be taken for four
weeks after return. The drug should be taken after a meal, and washed
down with plenty of liquid. It should be avoided in pregnancy and children.
A combination of
chloroquine and proguanil can be used as prophylactic against malaria.
And is available without a doctor's prescription. This combination is
more difficult to use than the simpler mefloquine and doxycycline regimes,
and is believed to offer less protection. No method of malaria prevention
is one hundred per cent effective, and there is still a small chance
of contracting malaria despite the taking of anti-malaria medication
and the adoption of personal protection methods. This does not mean
that anti-malaria medication and personal protection measures should
be neglected, simply that any traveller developing possible symptoms
of malaria should seek medical advice despite having taken the prescribed
precautions.
Why is malaria
dangerous?
Most of the malaria found within southern Africa is of the falciparum
species. This is potentially the most dangerous species of malaria,
and can prove rapidly fatal. Symptoms may develop as soon as seven days
after arrival in a malarious area, or as long as six months after leaving
a malarious area. Symptoms of malaria are often beguilingly mild in
the initial stages, resembling influenza.
Malaria symptoms
Symptoms of malaria may include a generalised body ache, tiredness,
headache, sore throat, diarrhoea, and fever. It is worth emphasising
that these symptoms may not be dramatic, and can easily be mistaken
for an attack of influenza or similar non-life threatening illness.
Deterioration can then be sudden and dramatic, with a rapid increase
in the number of parasites in the victim's blood stream. A high swinging
fever may develop, with marked shivering and dramatic perspiration.
Complications of
a serious nature, such as involvement of the kidneys or brain (cerebral
malaria) may then follow. Cerebral malaria is extremely serious, with
the victim becoming delirious and entering a coma. Cerebral malaria
is frequently fatal, and it is extremely important that all suspected
cases of malaria should receive urgent medical attention.
All persons possibly
exposed to malaria who develop any influenza like illness or fever within
seven days of entering, or six months of departing a malarious area
should seek immediate medical attention, and have urgent blood tests
taken to check for possible malaria infection. It may be sensible to
have a second blood test taken if a first test is negative for malaria,
to be certain of excluding the disease.
Malaria summary
Malaria is a potentially fatal disease caught from biting mosquitoes.
Prevention relies on measures to reduce bites, and taking anti-malaria
medication appropriate both for the destination and the traveller. Any
traveller developing influenza like symptoms or fever within three months
of return from a malarious area should be tested for malaria, even if
taking preventive measures.
