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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 malicious 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. For a full size map and a list of game parks follow this link. (368 K) 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 tolu amide (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 pyrethrin 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. The exact choice of which to use depends both upon the particular area being visited, and the travellers own medical history. Within South Africa's borders either a combination of chloroquine with proguanil, or Mefloquine (Mefliam) alone are the commonly used anti-malaria tablets.
Chloroquine and proguanil are available without a doctors prescription. Mefloquine (Mefliam) can only be obtained with a doctors prescription. Because of the emergence of chloroquine resistant strains of malaria in South Africa, chloroquine should not be taken alone but should always be combined with proguanil. The adult dosage is two chloroquine tablets per week, starting one week before entering the malicious area. Proguanil may be started twenty-four hours before entering the malicious area, and two tablets must be taken every day. Both chloroquine and proguanil should be taken for four weeks after departing the malicious area, and both are best taken at night after a meal.
Mefloquine (Mefliam) is taken in adult dosage of one tablet per week. This should be commenced at least one week before entering the malicious area and continued for four weeks after leaving the malicious area. Like chloroquine and proguanil, Mefloquine (Mefliam) is best taken at night after a meal, and with liquids. The principal contra-indications to the use of Mefloquine (Mefliam) are a history of treatment for psychiatric disorder or epilepsy. 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 malicious area, or as long as three months after leaving a malicious 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 victims 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 medical attention as soon as is possible. All persons possibly exposed to malaria who develop any influenza like illness or fever within seven days of entering, or three months of departing a malicious area should seek medical attention, and have blood tests taken to check for possible malaria infection. It is preferable for such blood tests to be taken during a bout of fever.
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. CONCLUSION 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 malicious area should be tested for malaria, even if taking preventive measures.
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