Surviving Malaria: compiled by epg

In the 1950s and 1960s, clouds of  DDT dust and chloroquine, a synthetic derivative of quinine, seemed to be the final solution to malaria. But the ancient scourge has made a lethal comeback. Over the last 30 years, chloroquine resistant malaria as spread west from Asia to Africa and is also found in South America. 

The mosquito borne disease is the biggest single disease hazard to tropical travelers. The number of malaria cases "imported" into western countries has doubled over the the last decade, largely because of mass tourism. Worldwide, about 1.6 billion people are at risk. Each year, about a million infants and children die from malaria in Africa alone. 
A survey by The Hospital for Tropical Diseases in London, revealed that some people thought a few days in bed would see it off, and such an ignorance cost lives. Number of deaths will only be reduced when travelers to endemic areas understand the importance of regular chemoprophylaxis. 
In fact, this is not always enough. In October 1992, Richard Huges, had died of natural causes, contributed to by lack of care after he had contacted malaria. His example, perhaps part of the growing number, highlights the fact that time is of the essence, and also how a doctor's misdiagnosis or lack of speedy treatment can end in tragedy. Mr Hughes, 57, became ill six weeks after honeymooning in Kenya. His family said that he had taken the prescribed dose of anti-malarial tablets before, during and after his holiday. He developed a flu-like symptoms and fought a fever for four days, but the disease was not diagnosed initially. Doctors realized he may have contacted malaria when his sight failed. The coroner, Nigel Neville Jones, accepted that malaria was difficult to diagnose, but said that Mr Hughes should have had a blood test. 
Time is everything in treating malaria. The disease can rapidly become severe and kill within 48 hours of the first symptoms. 

Dr. Penelope Phillips Howard, of the World Health Organization, recalls one couple who had returned for Europe from Uganda. When their flight arrived, she was immediately admitted to hospital with malaria. Her partner felt unwell, but returned home. A week later, she was discharged, only to find her husband dead at home. He too had contacted malaria, but had been unable to seek medical advice. 

Don't hesitate: 
Contact your doctor immediately if you feel under par in the weeks or even months after returning from the malaria zone - and emphasize just where you have been. The incubation period following a mosquito bite is at least 5 to 10 days, but it may be up to a year before symptoms appear. One problem, is that many people ignore their symptoms, or they don't even know they have been bitten. All cases of febrile (feverish) disease in persons who have recently visited malarious areas should be examined by microscopy of the blood for presence of malaria parasites. I f a first examination is negative, it should be repeated several times. 

Symptoms: 
The first symptoms of malaria are usually a vague feeling of being unwell and feeling week, followed by fever, and sometimes headaches and muscular aches and pains. Nausea, vomiting and abdominal pain may occur. At this stage, the symptoms may be indistinguishable from mild flu - and therein is the danger. 

The dangerous falciparum malaria may develop in several ways. The most common sign of severe infection is unconsciousness (cerebral malaria), from which one in five sufferers die. Other signs are jaundice, in which the eyeball look yellow, and occasionally, dark colored urine. Falciparum malaria may not start with a fever, but just a feeling of being unwell. Diarrhea, abdominal pain and headache may occur. 

The problems are increased by drug resistant strains of malaria, although travelers are still advised to take antimalarial drugs as before. If they develop malaria, they may be less severely affected than if they had taken none at all. 

Special Care: 
Certain groups of people are strongly advised to avoid malarious areas. These include young children, people with chronic disease such as liver, kidney and heart disorders, and pregnant women. The disease is more frequent and more severe in pregnant women. The unborn baby is also at risk. 

Peak Protection: 
There is no 100% guarantee against protecting malaria. The best the travelers can do is minimize the risk by taking a number of avoidance measures, this means by using drugs as prescribed, together with the method of bite prevention, including insect repellents, insecticides and actual physical barriers. 

Medical Advice:  
contact your doctor or a specialist institution, such as a vaccination centre, preferably at least  two weeks before departure. Find out if there is a malaria risk where you are going, the drugs to take, how you take them, and their side effects. Different areas in the world present different risk levels; different anti-malarials are prescribed according to the region you will be traveling in - including places for stopping over. 

Drug compliance: take the drug/ drugs in the exact dose prescribed, starting a week before departure. You must continue the drug/ drugs for four weeks before leaving the area. It is imperative to do so - even if you feel well - because malaria parasites may still be in the body. Parasites pass through the blood stream to the liver where they usually incubate for between 10 to 28 days before mounting an attack. 

Repellents: 
insect repellents are available in aerosol sprays, lotions, sticks, creams and gels. The most effective is diethyltoluamide (DEET). Clothes can be impregnated with an aerosol or by making a suspension of concentrated DEET in water and pouring it over the garment ( 1 ml DEET and 8 ml water per 4g cotton). Clothing note: Keep arms and legs covered after sunset. Peak biting hours: 4pm-8pm and 4am-7am. Applied to skin, DEET is only effective for a few hours; but when impregnated into cotton material, it remain effective for several weeks if the material is stored in  a tin or plastic bag when not in use. 

Additionally, chemical repellents provide the best outdoor protection. Electric mosquito killers, pads containing the insecticides allethrin or bio-allethrin, are very effective in enclosed areas, such as a hotel room. Insect coils also work well. You light this at one end and they smolder for about eight hours to give indoors protection throughout the night. Some mosquitoes feed through the night, so a coil that burns too fast or goes out will leave you at risk. Insecticide-treated nets offer the best protection.