Zebra

What is malaria?

Malaria (meaning ‘sick air’ because initially it was thought to be caused by swamps) is a microscopic bug, a one-cell parasite called plasmodium, carried by only one type of mosquito, the Anopheles mosquito, and only the female. There are four types of the plasmodium parasite but only one, falciparum, is what doctors call malignant. That means deadly. It’s this parasite that causes the deaths and the bad news is, it’s the one we specialise in down here in sub-Saharan Africa.

 

How do you get it?

When an infected Anopheles female bites you, she injects plasmodia into your blood, which then embark on a series of changes as part of a complex life-cycle. They attack red blood cells and invade the liver, multiplying through their cycle. This initial process generally takes between eight and 14 days. Left unchecked to keep multiplying, the plasmodia can kill by infecting and destroying the red blood cells (causing anaemia) and by clogging the capillaries that carry blood to the brain (causing cerebral malaria) or other vital organs. Black water fever (so named because the urine turns dark from all the blood in it) is the result of a dead liver.

Where does it occur?

Malaria occurs across the globe in the tropical and sub tropical regions. In South Africa, malaria is largely confined to the northeastern Lowveld. Mozambique, Zimbabwe and Zambia are heavily infested. Swaziland is a partial risk and Namibia is too dry except in the far north for malaria. Botswana’s malaria problem is also in the north. Bear in mind that malaria is highly seasonal and that wet weather followed by warm spells will significantly increase the chance of malaria occurring. Check www.malaria.org.za for guidelines on when areas are high risk. Click here to get latest update

What drugs to take?

This can get confusing. The problem is lots of different protective (prophylactic) drugs with all sorts of trade names and the fact that resistance to some of them is a very real problem, especially here in Southern Africa. Realistically you shouldn’t bother with chloroquine or Paludrine by themselves anymore. More useful is Doxycycline. You start taking it daily a week before you leave and for four weeks after you return. Mefloquine (also known as Lariam) is effective but but about 1 in 140 people taking the drug will have bad hallucinations. The latest drug is Malarone, (called Melanil in South Africa) which seems to have few side-effects. Doctors recommend it for short trips because you don’t need to take it more than 24 hours in advance to get protection and you can stop taking it seven days after you get back. You take it daily.

Finally, Artemisinin is the drug everyone is talking about. This curative drug (rather than preventative) is often found in chemists in African countries north of South Africa. It’s kind to your system, but little formal research has been done on it. Many regular travelers into Africa swear by it, but doctors suggest it’s effective mainly for locals who’ve built up a partial resistance to malaria from years of exposure. For safe-area-urbanites (such as most of us) it’s supplemented with something else, such as Riamet (below).

And if I get malaria?

Don’t panic. There are curative treatment drugs to help, even if you are far advanced. If you’re out of range of special medical treatment, quinine, readily available in rural clinics, three times a day will curtail malarial multiplication. Riamet is now popular for treatment in areas reporting malignant malaria. You take six doses of four tablets given over a period of 60 hours.

Did you know?

You can buy a rapid diagnostic test from your pharmacy. Small pin prick, a drop of blood and presto, you can self-test. Carried with a dose of Riamet, it allows you to look after your own health while out there enjoying yourself or working.

Pregnant women are at an increased risk of contracting malaria. They attract more mosquito bites, though no one is quite sure why. Perhaps they produce higher concentrations of 4-methylphenol. A combination of changed insecticides, drug cocktails and a dry year mean that it is a very low-risk year.

So much so that St Lucia and Kosi Bay – traditionally major malaria hotspots – are being touted as malaria free by the council – for now. Malaria cases in KwaZulu-Natal have dropped from 40 000 to 3 500 in two years. Major sorties across the borders into Mozambique and Swaziland have also reduced the numbers of potential parasite carriers coming into the country dramatically.