Health - Vietnam, Cambodia, Laos and Northern Thailand - page 1068

WEIGHING THE RISKS OF MALARIA
For such a serious and potentially deadly disease, there is an enormous amount of misinformation con-
cerning malaria. You must get expert advice about whether your trip will actually put you at risk.
Many parts of the Mekong region, particularly city and resort areas, have minimal to no risk of mal-
aria, and the risk of side effects from the prevention tablets may outweigh the risk of actually getting
the disease. For most rural areas in the region, however, the risk of contracting the disease far out-
weighs the risk of any tablet side effects. Remember that malaria can be fatal. Before you travel, seek
medical advice on the right medication and dosage for you.
There are two strategies to malaria prevention: avoiding mosquito bites and taking antimalarial
medication.
Mosquito Prevention
Travellers are advised to take the following steps:
» Use a DEET-based insect repellent on exposed skin. Wash off at night, as long as you are sleeping
under a mosquito net. Natural repellents such as citronella can be effective, but must be applied more
frequently than products containing DEET.
» Sleep under a mosquito net that is impregnated with Permethrin.
» Choose accommodation with screens and fans (if not air-conditioned).
» Impregnate clothing with Permethrin in high-risk areas.
» Wear long sleeves and trousers in light colours.
» Use mosquito coils.
» Spray your room with insect repellent before going out for your evening meal.
Antimalarials
Most people who catch malaria are taking inadequate or no antimalarial medication. A variety of med-
ications are available.
Derivatives of Artesunate Not suitable as a preventive medication. They are useful treatments under
medical supervision.
Chloroquine and Paludrine combination Limited effectiveness in most of the Mekong region. Com-
mon side effects include nausea (40% of people) and mouth ulcers. Generally not recommended.
Doxycycline Broad-spectrum antibiotic, ingested daily, that has the added benefit of helping to pre-
vent a variety of tropical diseases, including leptospirosis, tick-borne disease, typhus and meliodosis.
Potential side effects include photosensitivity (a tendency to sunburn), thrush in women, indigestion,
heartburn, nausea and interference with the contraceptive pill. More serious side effects include ulcer-
ation of the oesophagus. You can help prevent this by taking your tablewt with a meal and a large
glass of water, and never lying down within half an hour of taking it. It must be taken for four weeks
after leaving the risk area.