Malaria

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 malarious 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.(368K)

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
 toluamide (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
 pyrethroid 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 traveller's 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 doctor's
 prescription. Mefloquine (Mefliam) can only be obtained with a
 doctor's 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 malarious area. Proguanil may be started twenty-four
hours before entering the malarious area, and two tablets must be taken
every day. Both chloroquine and proguanil should be taken for four
weeks after departing the malarious 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 malarious area and continued for four weeks after
 leaving the malarious 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 malarious
 area, or as long as three months after leaving a malarious
 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 victim's 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 malarious 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 malarious area should be tested
for malaria, even if taking preventive measures.