Malaria

26th October, 2017
Dr Karen Koch MBCHB FCDERM

WHAT IS MALARIA?


Malaria is an infection (parasite) which is contracted through the bite of Anopheles mosquitoes. Malaria comes in different forms, but the commonest type usually attacks the red blood cells and liver. The entire circulatory system can be affected as well as the brain and kidneys.
 

WHAT ARE THE “HIGH RISK” MALARIA AREAS?


In South Africa:

Malaria is endemic in three of South Africa’s nine provinces: Limpopo, Mpumalanga and KwaZulu-Natal. According to the National Institute of Communicable Diseases, the areas of transmission are the north-eastern parts of Limpopo Province (along the borders with Mozambique and Zimbabwe), the lowveld areas of Mpumalanga Province (including the Kruger National Park but excluding Mbombela/Nelspruit District Municipality and immediate surrounds) and the far northern parts of KwaZulu-Natal Province.

Around The World:

High risk areas include Mozambique, Madagascar, Zanzibar, Central Africa, parts of India, Thailand, South America and South East Asia. If you’re going away on holiday, always check with your doctor or travel clinic whether you need to take malaria precautions.
 

HOW CAN YOU PREVENT MALARIA?


Keep Mosquitoes Away


If you don’t get bitten, you won’t get malaria! Avoiding getting bitten by mosquitoes is one of the most important tactics to stay healthy.

Cover up: Mosquitoes tend to be most active at dawn and dusk. It’s recommended to wear long, loose, light coloured clothing at these times. The less skin surface exposed, the lower are your chances of getting bitten.

  • Mosquito nets: Check whether the facility you are staying at has mosquito nets. Otherwise you can buy these at your local Dis-Chem store. Make sure you put nets up over your bed before evening, or you’ll be trapping mosquitoes on the inside of the net.
  • Spray away: There are a variety of insecticide sprays, roll-ons and lotions which can help keep mosquitoes at bay (such as Tabard®, Peaceful Sleep®, Baygone®). The majority of these contain the active ingredient DEET. Check the instructions on the package insert. Most DEET containing products are not recommended in children less than two months of age. In most cases, like sunscreen, you need to keep reapplying every few hours for maximum effectiveness.
  • Go natural: Citronella and lemon eucalyptus oil are natural remedies that can help keep mosquitoes at bay. Remember never to apply pure essential oil directly to your skin. Some handy ready to use natural remedies include Dis-Chem insect repellent wipes®, Citro-lotion® (containing both an SPF15 and citronella), Dis-Chem Go Green Insect repellent patch® and cream®, On Guard® insect repellent gel and Mylol® citronella roll-on.
  • Go technological: You can download an iPhone app which supposedly emits a supersonic frequency designed to keep bugs at bay. Reviews are mixed as to its effectiveness so don’t toss your creams and sprays just yet.
     

Take Preventative Medications


No matter how much you go out of your way to avoid being bitten, you cannot be certain that the above measures will keep you safe.

It is important to take malaria prophylaxis (preventative medication) if you are travelling to a malaria area. These medications all require a doctor’s prescription. Medication options include:

  • Mefloquine (e.g. Larium®, Mefliam®): This medication is taken weekly starting one week before entering a malaria area and ending four weeks after leaving the area. It can be safely used in children from the age of three months (or more than 5kg in weight). Mefloquine can cause loss of balance and coordination. It also should not be used if you suffer from a psychiatric condition or during pregnancy.
  • Doxycycline (e.g. Cyclidox®, Doximal®, Doxycyl®): This is an antibiotic which protects against malaria. It can be used in children over the age of eight. Medication is taken daily from a day or two prior to departure up until four weeks after leaving the malaria area. It can’t be used in pregnancy and can cause nausea and vomiting (the most frequent reason for people to discontinue the treatment). Like all antibiotics, it may interact with the birth control pill so you would need to take extra precautions whilst on this medication.
  • Atovaquone-Proguanil (e.g. Malanil®): An anti-parasite medication which is taken daily from the day before entering the malaria area and finishing seven days after leaving the malaria area. The medication needs to be taken with food and frequently causes nausea and vomiting. If vomiting does take place, you need to repeat the dose. It’s not recommended in pregnancy and can only be used in children weighing more than 11kg.
     

Medication Tips

 

  • All of these preventative medications require a prescription and can have interactions with other medications or medical conditions you may have. So make sure you speak to your doctor about your requirements.
  • It’s important not to share malaria medications with other people and only take those which have been prescribed for you.
  • Try and take your malaria medication at the same time each day as this makes it more effective (set a reminder).
  • Take medication with food.
  • Start your medication before leaving SA. If you do find yourself having a serious reaction or unable to keep the medication down, speak to your doctor before leaving.
     

HOW DO YOU KNOW IF YOU HAVE MALARIA?


Malaria normally takes seven to 25 days after getting bitten by the malaria-carrying mosquito to develop. The commonest symptoms of malaria are fever, sweating, shivering, vomiting, muscle and joint aches.

If you have fever and flu-like symptoms, then malaria is a real possibility. The actual diagnosis of malaria is made on blood test or a rapid diagnosis kit assessment. Sometimes it takes several tests to actually identify the parasite. In high risk areas, most locals will start taking treatment as soon as the first signs of malaria develop.
 

WHAT TO DO IF YOU THINK YOU MAY HAVE MALARIA


It is important to seek medical attention as soon as you develop the first signs of malaria. The sooner it is treated, the better are your chances of a full recovery.

Malaria is a preventable disease which claims thousands of lives each day. Take the necessary preventative steps and don’t become a statistic of malaria.
 

Pregnancy And Malaria


Pregnant women are three times more likely to develop severe malaria than non-pregnant women. The exact mechanism for this is poorly understood, but it’s thought that pregnant women have a reduced immune response and therefore less effectively clear malaria infections. In addition, malaria parasites sequester and replicate in the placenta.

Malaria infection during pregnancy can lead to miscarriage, premature delivery, low birth weight, congenital infection, and/or perinatal death.

Malaria prophylaxis during pregnancy is difficult. Chloroquine or mefloquine are the only safe medications to use during pregnancy. It’s very important to cover up and avoid being bitten by all means possible. It’s really safest for pregnant women to avoid malaria areas altogether.
 

Children And Malaria


Malaria is more likely to be fatal in young children, particularly those less than five years old. Malaria can develop rapidly in children with high levels of parasites in the blood.

Initial symptoms of malaria in children may mimic many other common causes of childhood fever – resulting in delayed diagnosis and treatment. Overall children are at increased risk for severe complications of malaria, including shock, seizures, coma, and death.

Children under eight years of age cannot use doxycycline and infants cannot use Atovaquone-Proguanil or Mefloquine. Crushed chloroquine can theoretically be used but chloroquine-resistant malaria is an issue.
 

FAQs


Is it better not to take any preventative medication, as it masks the symptoms of malaria, making the diagnosis of malaria more difficult?

No. It is very dangerous to visit a malaria area without taking preventative medication. While preventative medication cannot always entirely stop malaria infection, it massively reduces the severity of the infection, protecting you from life-threatening sepsis.

If you have malaria, you will develop symptoms. Fever, sweating, headache, muscle ache, nausea and vomiting are all possible signs of malaria. Malaria often requires more than one test to be diagnosed as the parasites are not always immediately detectable in high numbers in the blood. This is true whether you have or have not taken malaria prevention medication.

Is it true that if you take preventative medication, you can’t get malaria?

No. If you take preventative medication you are less likely to get malaria and the more severe complications thereof. If you develop any of the symptoms of malaria while in a malaria area or upon leaving a malaria area you should be tested for malaria.

Can You Catch Malaria From Somebody Who Is Infected?

No. You can’t get infected directly from somebody else who has malaria. You can only get malaria if a malaria-carrying mosquito bites you. Someone who has malaria can turn non-carrying mosquitoes into malaria-carrying mosquitoes.
 

Malaria Treatment


Malaria is a serious disease and is generally treated in hospital. The exact treatment you receive also depends on your strain of malaria, how sick you are and whether you are pregnant or breast-feeding. Complications of malaria such as bleeding tendency, kidney failure and cerebral malaria require ICU care. The most commonly used drugs for malaria include: chloroquine, co-artem, doxycycline and quinine. In addition, someone with malaria will need supportive care including fluids, pain killers, supplemental oxygen, kidney and even ventilation support if needed.

With prompt and correct treatment early malaria can be treated in two weeks. Treatment may take longer in cases of severe disease. In general once your malaria is cured – you’re cured. Two types (species) of parasites, Plasmodium vivax and P. ovale, can cause relapsing illness over months or years. These forms of malaria need specific and ongoing treatment to ensure the malaria is properly removed from the body.

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