Togo - West Africa - page 1018

C - Chemical prevention (ie antimalarial drugs) is usually needed in malarial areas. Expert advice is needed as
resistance patterns can change, and new drugs are in development. Not all antimalarial drugs are suitable for
everyone. Most antimalarial drugs need to be started at least a week in advance and continued for four weeks
after the last possible exposure to malaria.
D - Diagnosis. If you have a fever or flulike illness within a year of travel to a malarial area, malaria is a possibil-
ity and immediate medical attention is necessary.
If you are planning a journey in a malarial area, particularly where falciparum malaria predominates, consider taking
standby treatment . Standby treatment should be seen as emergency treatment aimed at saving the patient's life and not
as routine self-medication. It should be used only if you will be far from medical facilities and have been advised about
the symptoms of malaria and how to use the medication. Medical advice should be sought as soon as possible to confirm
whether the treatment has been successful. The type of standby treatment used will depend on local conditions, such as
drug resistance, and on what antimalarial drugs were being used before standby treatment. This is worthwhile, because
you want to avoid contracting a particularly serious form such as cerebral malaria, which affects the brain and central
nervous system and can be fatal in 24 hours. Self-diagnostic kits, which can identify malaria in the blood from a finger
prick, are also available in the West.
The risks from malaria to both mother and foetus during pregnancy are considerable. Unless good medical care can
be guaranteed, travel throughout Africa when pregnant - particularly to malarial areas - should be discouraged unless
essential.
Meningococcal Meningitis
Meningococcal infection is spread through close respiratory contact and is more likely in crowded situations, such as
dormitories, buses and clubs. Infection is uncommon in travellers. Vaccination is recommended for long stays and is es-
pecially important towards the end of the dry season, which varies across the continent. Symptoms include a fever,
severe headache, neck stiffness and a red rash. Immediate medical treatment is necessary.
The ACWY vaccine is recommended for all travellers in sub-Saharan Africa. This vaccine is different from the men-
ingococcal meningitis C vaccine given to children and adolescents in some countries; it is safe to be given both types of
vaccine.
Onchocerciasis
Also known as 'river blindness', this is caused by the larvae of a tiny worm, which is spread by the bite of a small fly.
The earliest sign of infection is intensely itchy, red, sore eyes. Travellers are rarely severely affected. Treatment in a spe-
cialised clinic is curative.
Poliomyelitis
Polio is generally spread through contaminated food and water. The vaccine is one of those given in childhood and
should be boosted every 10 years, either orally (a drop on the tongue) or as an injection. Polio can be carried asympto-
matically (ie showing no symptoms) and could cause a transient fever. In rare cases it causes weakness or paralysis of
one or more muscles, which might be permanent. The WHO states that Nigeria and Niger are polio hotspots following
recent outbreaks.