Malaria

Malaria kills over one million people each year, most of whom are children under 5, and almost 90% of whom live in Africa, south of the Sahara. Each year there are over 300 million clinical cases of malaria, that is five times as many as combined cases of TB, AIDS, measles and leprosy. Malaria is responsible for one out of every four childhood deaths in Africa.

These may seem like frightening statistics and may make you think twice about visiting Africa, however, with the proper precaution and awareness as to the presence of malaria, it can be successfully avoided and there is very little risk of visitors to the area contracting the disease if they follow the following general guidelines:

1.Avoid being bitten by mosquitoes

The best prevention is personal protection against the mosquito. Malaria mosquitoes generally bite after dark. Wear long sleeves and trousers in the afternoon and evening; stay in-doors if possible. Use insect repellent on exposed skin. Sleep under a bednet or in a netted tent or hut or in a house or caravan with screens. Close windows and doors at night. Spray insecticide aerosol and/or burn mosquito coil at night.

2.Take prophylaxis in malaria risk areas

Get good advice before you plan your holiday. The appropriate prophylaxis for a given malaria area depends on several factors including:

The parasite’s resistance to drugs in this area.
The safety of the drug.
The efficacy of the drug.
The degree of malaria risk in the area.(See map of risk areas in south Africa)
The risk of resistance to (or reducing the efficacy of) the drug, in the future, due to inappropriate use.
Take the pills same day each week when weekly, or at the same time of the day if daily.
Continue prophylaxis for 4 weeks after your return. Complete the course.

(a) Mefloquine

Mefloquine (Lariam®) has been taken by people up to 12 months without side effects, is highly effective and has a simple weekly dosage. However, it has a number of contra-indications and requires a doctor’s prescription. It also has been known to have rare but severe neurological side effects.
Start a week or two before, to check for possible side-effects and continue for 4 weeks after leaving the area. Mefloquine should be taken on a full stomach.

(b) Doxycycline

This drug is highly effective in SE Asia where there is multi-drug resistance, and resistance is rare. However, it is for short term use only and can cause light sensitivity. Doxycycline should only be taken if other drugs are unsuitable. It has been known to render birth control pills ineffective when taken at the same time.

(c) Proguanil/Chloroquine combination

This combination should be used with caution as resistance has developed in Mozambique and other regions. Proguanil (Paludrine®) every day; Chloroquine (Daramal® / Nivaquine® / Promal®) once a week. This combination can be taken safely up to 3 months, very cautiously for 6.
Start a day before entering the malaria area, and continue for four weeks after you leave the area. It is generally well tolerated and is available without prescription. Disadvantages are poor compliance due to the complicated regime and widespread resistance particularly in SE Asia.

3. Carry your own malaria test

Test yourself immediately on first malaria symptoms.
There are several good rapid tests available now . Don’t leave home without one.

4. Carry your own alternative medicationWhen travelling in Africa, make sure you have everything with you.

When you get malaria head for the nearest doctor. Show your test and ask to be treated.
If you have contracted malaria in spite of prophylaxis you will need Lumafantrine-artemether or quinine. Sulfadoxine-Pyrimethamine (Fansidar«) may suffice. But be aware that Sulfadoxine-Pyrimethamine resistance exists. Refuse chloroquine treatment.

5. Carry a do-it-yourself treatment

For the worst-case scenario, take along some Lumafantrine-artemether. If you get stuck and cannot get to a doctor, treat yourself.
This is for emergency situations only.Always seek medical help if at all possible.

6. Cancel / postpone your holiday if necessary

If you are pregnant or have small children, avoid a holiday in a high-risk malaria area / season.

There is also an alternative option to the allopathic/ drug based options above and originates from a plant called Artemesia that has been used historically in China to cure Malaria and many other severe illnesses. Artemesia (also known as wormwood), contains Artemisinin which acts as a blood schizontocide and therefore kills malaria parasites.

Artemisinin is the product extracted from the dry leaves of Artemsisia Annua (sweet wormwood).

Vodka (40%) can be used to create Artemisinin extract – herbal tincture.

This plant has to be grown each year starting from seeds. The plant is peculiar in its behaviour. Nicely grown-up plants may be devoid of Artemisinin. In order that this product is synthetised by the plant special agricultural and climatological conditions must be respected. The plant can grow in many places but it may not contain Artemisinin.

For example: Visitors of the ancient palaces in the Forbidden City in Beijing can find nice artemisia annua plants pushing left and right as weeds, but these plants do not contain artemisinin.

Best results have been obtained in plantations (North Vietnam, mainly in the vicinity of Hanoi) or in wild plants (the plants collected from the steep hills around You Yang in the Chongqing province in China where the best plant grows at altitudes above 1000 m).

The highest yields per ton dry leaves comes from cultures in Tanzania.

Artemesia can most readily be found in a product called Coartum and is used frequently by residents living within malaria areas to treat the parasite on first diagnosis.