Malaria: Risks and Prevention

Written by Jessica on May 3, 2011

What is Malaria?

Pop quiz. What is the deadliest animal in the world? Give you a hint, jelly fish are number three. Snakes are number two. The number one deadliest animal in the world? The female malaria carrying mosquito.

Malaria is a parasite, carried by mosquitoes. It has no vaccine, but if treated quickly can be cured. The parasite has evolved and exists in several strains. Certain strains have built up resistance to preventative drugs.

Who it Harms Most?

One million people die every year from Malaria. Most of them in sub-Saharan Africa. Most of them children. Adults build up a resistance to the disease throughout their lives and are much less likely to die from the parasite. Children however, are very susceptible.

As the illness progresses the chance of survival decreases. Families living in rural areas, who may be several days from a clinic, don’t have much time to obtain the drugs needed to cure the disease.

Symptoms

Fever, chills, headache, muscle pain, nausea, vomiting are all common symptoms of malaria. Sound familiar? Malaria’s symptoms are exactly like that of the flu. This disease is impossible to diagnose without a blood test.

Thankfully most pharmacies in countries where malaria is present sell cheap, but effective test kits. If you’re traveling in rural areas, it’s worth picking up one or two.

How to Assess your Risk

There are several considerations to take into account before determining if you are going to be at risk. Carefully consider your situation before deciding whether or not to take preventative medicine. This is not a decision to be taken lightly. Taking preventative drugs unnecessarily is a hassle and can be risky for some people, especially pregnant women. Not taking drugs while in malaria-prone area can result in a terrible trip, or worse, death.

Destination country

Risk is very high in India, parts of Indonesia, almost all of sub-Saharan Africa except some of South Africa and Namibia, parts of central America and anywhere near the Amazon rain forest.

Risk is lower, but still present for China, Southeast Asia and surrounding areas including the Philippines, Afghanistan and Pakistan. There’s also some risk on the western side of South America in Columbia, Peru and Bolivia, as well as most of Central America and parts of northern Mexico.

These locations change frequently, check out the CDC map for the latest warnings, and don’t forget to read the specifics for your destinations.

Time of year

Do you know why there isn’t a big Malaria problem in Namibia? The country is mostly a big dry desert. Know why the Malaria problem is increasing in the Amazon? It’s rainy and hot all year round. Mosquitoes love warm wet weather. Colder and drier times of year mean less mozzys. Less mozzys equals less malaria.

Time spent outside at night?

Planning to camp? Or planning to attend a lot of late night outdoor raves? The risk is higher. I’m not just talking about walking from your hotel to the restaurant. I mean actually being outside every night for hours. The more opportunities you give the bugs to bite you, the more likely you are to contract malaria.

Rural Areas or Cities

Mosquitoes generally have a harder time surviving in cities. Also, since there is a higher concentration of people, governments tend be more diligent about eradicating the disease. Cambodia is a great example. Phnom Pehn is virtually malaria free. But the jungles surrounding are very high risk. Except of course, Siem Reap, home of the Angkor temples. Where the tourists visit, malaria will be controlled.

Prevention

The easiest way to avoid malaria is to prevent mosquito bites. Use a bed net, wear long pants and long sleeve shirts. Use repellent. Avoid being outside at night.

The Pills

There are several different types of preventative drugs. No malaria pill is 100% effective. Even if you do take it properly.

Most pills have to be taken either once a week or once a day. And you usually have to start the regime before you leave and continue several weeks after returning home.

Drug Resistance

Certain strains of the malaria parasite have built resistance to the preventative drugs. The CDC site has a convenient list of what countries have these particular strains of malaria and which drugs should be avoided.

Where to buy

Malaria meds in the first world (especially in the US) are ridiculously expensive, and are never covered by health insurance. Consider seeing a doctor and picking up drugs in your destination country. Beware of counterfeit medicine! (See warnings below).

Drug Types

There are 5 types of malaria meds. If you are taking other prescription drugs, be sure to consult a doctor about potential risks. When several drugs are recommended for your destination, consider the following. More information is available on the CDC site.

Drug Name	Frequency	Pros and Cons
Atovaquone/Proguanil (Malarone)	Daily	Cons: Cannot be used by pregnant women Tends to be more expensive Pros: Very few side effects Good for shorter or last minute trips- you only need to start 1-2 days in advance and continue 7 days after the trip.
Chloroquine	Weekly	Cons: In many countries malaria has built up resistance to this drug. Needs to be taken 1-2 weeks before starting travel and 4 full weeks after returning. Pros: Can be used in all trimesters of pregnancy You only have to take it once a week
Doxycycline	Daily	Cons: Increases your sensitivity to sun May cause nausea Cannot be taken by pregnant women or children under age 8 Most be taken for 4 weeks after returning from travel Pros: It’s usually the cheapest option Only needs to be started 1-2 days before travel
Mefloquine (Lariam)	Weekly	Cons: Many areas have built resistance against this drug Cannot be used by people with certain psychiatric conditions, or seizure disorders Most be started 2 weeks in advance Has very strange side effects- like crazy vivid dreams (trust me, it’s weird) Pros: Taken once a week Can be used in 2nd and 3rd trimesters of pregnancy
Primaquine	Daily	Cons: A test must be done to make sure you are not glucose-6-phosphatase dehydrogenase (G6PD) deficient. Cannot be used by pregnant women Can cause nausea Pros: Only has to be started 2 days in advance and for 7 days after returning home. Most effective for preventing the malaria strain P. vivax.

 

Warnings

Length of Time

Most malaria medicine can only be taken for a certain number of months. Plan accordingly for how long your trip may be.

Counterfeit Medicine

Costs of malaria medicine in the US are outlandish -- upwards of $15 per tablet. In South Africa they are a little less than $2 a pack. If you have the opportunity, buy the medicine in the country where malaria is prevalent. It will be cheaper. But be warned, there is a growing market of counterfeit drugs, and it is NOT easy to tell when you are being ripped off.

A recent CDC test showed that 30% of malaria meds sold in Cambodia had NO active ingredients. Not cool. Check out the warnings on the CDC site, and buy from a reputable source. If the package looks cheaply printed, tampered with, or doesn’t contain a list of ingredients, then don’t buy it!

Pregnant women

As you can tell from the list above, most of the malaria pills on the market are NOT ok for pregnant women. Unfortunately, those that are safe, often are the same drugs that are not effective in some countries.

If you are visiting a country with resistant strains of malaria, be very careful. And consider rescheduling your trip. Taking non-recommended malaria pills can cause serious health problems in newborns.

Resistance

Resistance to malaria wears off very quickly. Just because you were raised in an area with malaria, or lived there for several years, doesn’t mean you will still have that built up resistance. Follow the same warnings as everyone else.