How to avoid malaria on your next trip abroad?

Let us be under no illusions, malaria is one of the biggest killers on earth and ensuring that you do not catch the disease is a serious matter. Around 2000 British people come home every year from their travels abroad having contracted the disease. It is very sad that on average, nine of these people will die and others will become seriously ill from having become infected with a disease that is completely preventable.

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What causes malaria?

Malaria is caused by a parasite called the Plasmodium parasite. It is carried around by a particular type of mosquito, the female Anopheles mosquito; this mosquito tends to bite in the late evening and early morning, peaking around midnight. When the mosquito bites, it feeds on human blood which it needs to feed its eggs. Whilst the bite is taking place, the Plasmodium parasite enters the human bloodstream and heads straight for the liver. Here, it will quickly reproduce and then re-enter the bloodstream where it attacks the red blood cells. The incubation period after having been bitten is between one week and one year.

Where can I catch malaria?

Malaria is a very widespread disease and is present in over 100 countries. For this reason, it is important that you investigate the countries you will be travelling to in order to establish if there is any risk that you can contract the disease.

The areas which are affected the most are those nearer the equator which are warm and wet; wherever you are travelling it is worth seeking advice on the risk of malaria before you leave. The main risk areas include:

Large areas of Africa and Asia
Central and South America
Haiti and the Dominican Republic
Some parts of the Middle East
Some Pacific islands

How can I avoid catching malaria?

There are two main approaches to take in avoiding malaria, the first is to not be bitten in the first place and the second is antimalarial medication which is effective in preventing you from contracting the disease should you be bitten by an infected mosquito.

How to prevent being bitten by a mosquito?

Mosquito nets - these are a very effective barrier method of keeping mosquitoes away from people and if the net is sprayed with an insecticide first, they are even more effective. It is important that you regularly inspect your net as any small rip can allow a mosquito to pass through
Insecticide vapourisers - these can come in the form of coils or sticks that you set light to and as they burn they emit vapour which acts as an insecticide. There are however some concerns over their efficacy and safety as they have been shown to cause coughing, eye irritation, headaches and asthma attacks. The plug in vapourisers are less likely to cause the irritation issues mentioned above
Insect repellants - chemical insect repellants are a must when travelling in malaria risk areas and those containing a minimum of 50% deet are the most effective. They come in many forms including sprays, roll ons, liquids, lotions and impregnated wristbands.
- Tips on the best way to apply repellants include:
- Avoid using the repellant around the eyes, nostrils, lips and mouth
- If you are using a spray, do not spray directly onto the face but spray the hands and use the hands to rub the liquid onto the face
- Do not use on damaged or sunburnt skin
- Do not exceed the recommended dose
- Use as soon as dusk falls and do not forget to reapply as per directions
- If you find that the repellant you are using irritates your skin, discontinue use and consider natural alternatives such as citronella, lemongrass or neem oil
- Wash hands after use
Protective clothing - during the evening when mosquitoes are most active, it is a good idea to cover as much exposed skin up as possible. Long sleeved tops and long trousers with socks are ideal although the fabric will need to be thick enough to prevent the mosquito from biting through it. To increase the protection it is worth spraying clothing with insect repellant and also, light coloured clothing is less attractive to mosquitoes
Air-conditioning - this will very much depend on the sort of budget at your disposal whilst on holiday but if at all possible, staying in accommodation which has air-conditioning is well worth the investment. They do not like the cool air and you will be able to close all windows preventing their entry
Keeping them outside - as just mentioned, this is possible and comfortable if you are staying in air conditioned accommodation but even if you are travelling on a budget, it is important to keep all windows and doors closed to stop mosquitoes from entering.

Antimalarial medication

Antimalarial medication is taken as a prophylactic to prevent your contracting the disease should you be bitten by an infected insect. However, it is important to remember that anti-malarial medication is not 100% effective, even if you have taken them as per the instructions and if you become unwell, you should seek medical attention as a matter of urgency.

There are many antimalarial drugs on the market, but they are not available on an NHS prescription, so you will have to pay full price for them. A range of antimalarials is available from Dr Felix. Speak to your GP or Dr Felix to find out which antimalarial you will need to take. Do this in plenty of time before you travel, because you may need to start taking the medication up to eight weeks before you leave. Once you arrive at your destination, you will continue taking them regularly, as per the instructions. This will continue for a period of time after you return from the region on account of the incubation period associated with malaria. Antimalaria medication may have some side effects, but as you will be taking them before you leave any issues you may have can be addressed before you leave.

Common side effects and the drugs which can cause them includes:

Temporary blurred vision - chloroquine
Photosensitivity (greater likelihood of your skin burning on exposure to the sun) - doxycycline
Nausea - proguanil and chloroquine
Mouth ulcers - proguanil
Rashes - chloroquine
Thrush - doxycycline
Anxiety, mood changes and depression. There may also be other psychological disturbances and are more likely if these types of symptoms have been experienced in the past - mefloquine
Sleep disturbances - malarone

It is easy to be tempted to wait and buy your antimalarial medication when you arrive at your destination. This is not recommended, partly because treatment should begin before you leave but also, in many of these countries, there is no guarantee that the medication you are being sold is not counterfeit or up to the correct standard. Do you really want to risk your life?

How do I know that I have contracted malaria and what should I do?

As mentioned, the incubation period for malaria can range from one week to one year but the more common timeframe is 10 days to 1 month. There are many symptoms of malaria but some of the early ones include:

Headaches
Fatigue
Nausea
Chills
Fever
Shaking
Vomiting
Diarrhoea
Muscle pain
Joint pain

As time progresses, symptoms become more serious and can include:

Confusion
Severe anaemia
Breathing difficulties
Neurological damage
Convulsions
Kidney damage
Neurological damage
Coma

Generally speaking, if you have been or are travelling in a malaria region and you develop flu-like symptoms, seek medical attention immediately.

Diagnosis and early treatment

Early diagnosis of malaria is critical if the infected person is going to survive. The World Health Organisation strongly advises that the presence of the parasite is confirmed by laboratory testing under the microscope or rapid diagnostic testing if the facilities are available. Malaria symptoms are not sufficient to diagnose a case as they are so similar to symptoms that can be a result of other causes

Early treatment of the disease is crucial and it aims to eliminate the Plasmodium parasite completely from the bloodstream of the sufferer. The WHO recommends ACT or artemisinin based combination therapy to treat uncomplicated malaria. Artemisinin comes from the plant Artemisia annua, also known as sweet wormwood. Its action has the effect of rapidly reducing the concentration of Plasmodium parasites in the bloodstream. It is normal practice to use the ACT to reduce the concentration of parasites and partner drugs to eliminate the rest.

The worldwide access to ACT treatment has reduced the impact of malaria but the disease is becoming resistant to it. Where this is the case, the partner drug must be effective

Conclusion

The WHO has said that there are no alternatives to ACT on the horizon as yet and so prevention of the disease is becoming more and more important.

If you are travelling abroad, be it in 5 star hotels or backpacking, it is important to remember that everyone is vulnerable and are exposed to the same risks so should be taking the same precautions in order to prevent catching this deadly disease.