Southern Africa Travel - Malaria

WHAT IS MALARIA?

Malaria is one of the world's most common diseases, caused by a parasite that is transmitted to humans by a female mosquito's bite. The discovery of this parasite in mosquitoes earned the British scientist Ronald Ross the Nobel Prize in Physiology or Medicine in 1902. In 1907, Alphonse Laveran received the prize for his findings that the parasite was present in human blood.

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-Zulu Natal, and the border areas of the Northern 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 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 (PROPHYLAXIS)

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, doxycycline, or atovaquone-proguanil as being the most effective anti-malaria tablets.
All of these drugs require a prescription.
Mefloquine 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 is best taken after a meal, and with liquids. The principal contra-indications to the use of mefloquine are a history of psychiatric problems or epilepsy, although there are a number of others.
Doxycycline is taken in an adult dosage of 100mg per day, starting a day or two before entering a malarious area. Like mefloquine 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.
Atovaquone-proguanil is taken daily, and can be commenced a day or two before entering the malarious area. It should be taken for seven days after leaving the malarious area.
A combination of chloroquine and proguanil can be used as prophylaxis against malaria. and is available without a doctor's prescription. This combination is more difficult to use than the simpler mefloquine, doxycycline, and atovaquone-proguanil regimes, is believed to offer less protection, and is not generally recommended by SAA-Netcare Travel Clinics.
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.

PROPHYLACTIC MEASURES TO PREVENT MALARIA

It is most important to note that no preventative measures are 100% safe. Should flu-like symptoms and signs of malaria like body pain, headache and fever develop 7 to 20 days or longer after visiting a malaria area, daily testing for malaria should be performed until you are better or another definite diagnosis is made.

It is a well-known fact that malaria is one of the most serious and common tropical diseases in the world. However, there is no reason why this disease should deter you from coming to the Kruger National Park if the necessary precautions are taken. Please note that if precautions are not taken and/or if the disease is not diagnosed and treated early, malaria is potentially fatal.

1. MALARIA CAN BE PREVENTED IN THE FOLLOWING WAYS

The most important and most effective way of preventing malaria is firstly to prevent mosquito bites. The following preventative measures can be taken:

§ Remain indoors from dusk to dawn if possible as malaria mosquitoes usually feed in the early evenings and mornings.

§ Cover your arms and legs towards evenings with light coloured clothing to cover exposed skin areas and especially the ankles. Wear long sleeved shirts, long trousers, socks and closed shoes.

§ Apply insect repellents to exposed skin areas every 4-6 hours.

§ Burn insecticide coils or electrically heated insecticide tablets in the bedroom at night.

§ Spray knock-down insecticide for flying insects inside the bedroom in the early evening with windows/doors closed if there are no window screens.

§ Screened mosquito proof windows and doors and mosquito nets guard against mosquito bites.

§ Clothes and nets impregnated with Pyrethroid could be used.

Another way of preventing malaria is to take additional preventative drugs when visiting an endemic malaria area, especially in the warm and rainy months from October to May.

The preventative medication of choice for visitors to the Kruger National Park and surrounding areas is a combination of CHLOROQUIN and PALUDRINE.

Chloroquin is taken on a weekly basis and Paludrine daily. The first dose of Chloroquine should be taken a week before entering a malaria area to see if there are no serious side effects. Paludrine can be taken 2 days before entering the malaria area.

It is important to continue to take the medication during your stay AND FOR FOUR WEEKS after leaving the malaria area.

It is advisable to take the medication at night with food to reduce side effects like nausea.

MEFLOQUIN is an alternative to the Chloroquin / Paludrine combination and it is the drug of choice when visiting other areas such as Zimbabwe and Mozambique if there are no contraindications for using mefloquin.

If the Chloroquine/Paludrine combination or Mefloquin cannot be used, DOXYCYCLINE on a once daily basis can be taken after meals as a preventative drug.

Please contact your general practitioner or chemist for the correct dosage according to age and weight. Discuss if any of the medications are contraindicated (i.e., in infants, young children, pregnancy, patients with psoriasis, porphyria or epilepsy).

2. MALARIA IN PREGNANCY, INFANTS, SMALL CHILDREN AND OTHER SPECIAL CASES.

Despite the fact that the South African National Department of Health recommends that pregnant women should preferably not visit a malaria area, many pregnant women do visit a malaria area and even live in the Kruger National Park. Extra care for preventing mosquito bites should be taken as malaria in pregnancy holds an increase in risk for both mother and child.

It is safe to use Chloroquin and Paludrine in pregnancy, even in the first three months of pregnancy.

Mefloquin and Doxycycline must not be used in pregnancy.

Because malaria has a faster and harsher effect in infants and small children, extra care should be taken to prevent mosquito bites.

Take chloroquin syrup weekly and paludrine tablets daily in dosages according to age and weight – the appropriate dosage can be obtained from your general practitioner or chemist.

Drug transfer in breast milk is insignificant and infants require full preventative medication.

It is important to take the medication during and for four weeks after leaving the malaria area.

The following people should, if possible avoid visiting malaria areas – or take extra care in preventing mosquito bites:

§ Cancer patients on chemotherapy

§ Persons on long term steroid therapy

§ Persons whose spleen have been removed

§ Persons with full blown aids – it is not contraindicated for an HIV positive person to visit a malaria area.

People suffering from porphyria must not use Doxycycline. In this case, the combination of Chloroquin and Paludrine is probably safe to use. The safety of Mefloquine in porphyria has not been established.

People with epilepsy should take care when using Chloroquin. Mefloquin is contraindicated in epilepsy.

Pilots and mountaineers should not take Mefloquin as it could impair balance.

3. MALARIA SYMPTOMS

If you develop influenza-like symptoms, such as body pains, headache and fever, 7 to 20 days after visiting a malaria area, you must have your doctor test you for malaria immediately.

Ensure a safe and care-free stay in the endemic Malaria area CALL THE 24 HOUR PHONE-IN LINE +27 82 234 1800 for information about the current Malaria status, prevention, prophylaxis, symptoms and signs.