Malaria Prevention
- Awareness – be aware of the risk
- Bite prevention – avoid being bitten by mosquitoes, take the necessary precautions
- Chemoprophylaxis – use prophylaxis to protect yourself against malaria when necessary
- Diagnosis - insist on diagnostic tests if fever develops a week or more after exposure to malaria
- Effective – malaria treatments are available and it is important to get the appropriate treatment specific to your circumstances
A: Awareness of malaria risk: what is my risk of getting malaria in South Africa?
Malaria risk is not evenly distributed within South Africa. The risk of being bitten with an infected mosquito depends on the time of year you are travelling, where you are travelling to, if you will be in the area between dusk and dawn, and if you are in a high risk group (refer to below table). This table provides information on the malaria risk in South Africa and the recommended precautions.
Summary of malaria risk periods and recommended precautions
Type of Malaria Risk Area
Low risk when malaria transmission is low
Moderate risk when malaria transmission is higher
Time of Year
End of May to beginning of September – cold dry months
September to May – wet summer months.
Recommendation
No chemoprophylaxis recommended.
Take precautions against mosquito bites.
Recommended chemoprophylaxis includes mefloquine, doxycycline or atovaquone-proguanil or Artemesia (natural herb prophylactic - see www.nordman.co.za).
High risk people should avoid malaria risk areas if at all possible. People at high risk are elderly people, babies and children under 5 years, pregnant women, splenectomised patients and immunocompromised people
B: Avoid mosquito bites: what precautions can I take when entering a malaria endemic area?
These are some of the precautionary measures you can take to avoid being bitten by mosquitoes:
- Mosquitoes which carry malaria generally bite between dusk and dawn.
- Close windows and doors and remain indoors during this time.
- Use insect repellent on exposed skin. Lotions and spray options are available.
- Spray your accommodation with an aerosol insecticide.
- Wear long-sleeved, light-coloured clothing, long trousers and socks.
- Use screens on windows to prevent mosquitoes from flying in, and keep outside doors closed.
C: Compliance with Chemoprophylaxis, when indicated: what should I do about chemoprophylaxis?
Chemoprophlyaxis are medicines which help to reduce the chances of getting ill with malaria. These medicines must be taken according to the instructions given by your local medical practitioner/pharmacist.
- If a person travels to a malaria area, it is important to find out if they require chemoprophylaxis.
- Chemoprophylaxis should be used in conjunction with personal protection measures against mosquito bites.
- There are different types of chemoprophylaxis available which have different modes of action. The choice of drug to take should be tailored to the individual (South African Department of Health, 2009; Baker, 2009).
- You should always consult your local travel doctor or general practitioner for advice on chemoprophylaxis well in advance before travelling. The South African Department of Health has listed the available chemoprophylaxis in their Guidelines for the Prevention of malaria in South Africa (Department of Health (2009) Guidelines for the Prevention of Malaria in South Africa). These include mefloquine, doxycycline and atovaquone-proguanil. Artemesia (a natural herb prophylactic / treatment - see www.nordman.co.za ) has been known to work well with less side effects, although not supported by all Medical Practitioners.Malaria symptoms may only develop 10-14 days after an infective mosquito bite.
D: Early Detection of malaria
- If a person has taken chemoprophylaxis, this period might be even longer. This can reduce suspicion of malaria to the detriment of the patient, especially as many people believe that prophylaxis is a guarantee against malaria.
- Non-specific flu-like symptoms are common presenting symptoms of malaria. Some of these include: fever, rigors, headache, sweating, fatigue, myalgia (back and limbs), abdominal pain, diarrhoea, appetite loss, nausea and vomiting, cough. In young children, malaria may present with fever, lethargy, poor feeding and vomiting.
- You should seek immediate medical attention if you have flu-like symptoms for up to six months after visiting a malaria area.There are drugs to treat malaria and it must be treated as a medical emergency. A high index of suspicion must be practiced. High-level resistance precludes the use of chloroquine for falciparum malaria (Department of Health, 2009).
E: Effective treatment
- If you have flu-like symptoms, inform your doctor that you have visited a malaria area, so that prompt diagnosis can be made.
- Stand- by treatment: If you are planning on travelling to remote locations outside South Africa where there is limited access to proper medical care, the World Health Organisation advises carrying appropriate malaria treatment medication for self-administration (WHO, 2010).This is called stand-by emergency treatment. You should consult your medical doctor about this.Malaria is a notifiable disease in South Africa. According to the South African Department of Health (2009), the current recommended treatment for uncomplicated malaria in South Africa (Department of Health, 2009) is as follows:
- Malaria treatment in South Africa
- For patients over one year of age and non-pregnant patients: fixed dose artemisinin-based combination, artemether + lumefantrine. If artemeter + lumefantine is not available, quinine + doxycycline is recommended while patients are under observation;
- For children ≤ 1 year and all pregnant patients: quinine + clindamycin.