Travel Reference
In-Depth Information
5
Health and Safety
Dr Jane Wilson-Howarth and Dr Felicity Nicholson
BEFORE YOU GO
MALARIA PREVENTION
Take advice from a travel clinic, your GP or the website
www.fitfortravel.nhs.uk
.
Malaria (including cerebral malaria) is a risk in Madagascar, in-
cluding in the
hauts plateaux
, and it is crucial to protect yourself by
avoiding bites
espe-
cially between dusk and dawn and also by taking tablets. There is chloroquine resistance so
itisimportanttotakeoneoftheprescribedkindsofantimalarial tablets.Seekcurrentadvice
on the best antimalarials to take: usually mefloquine, Malarone or doxycycline. If meflo-
quine (Lariam) is suggested, start this two-and-a-half weeks (three doses) before departure
tocheckthatitsuitsyou;stopitimmediatelyifitseemstocausedepressionoranxiety,visu-
al or hearing disturbances, severe headaches, fits or changes in heart rhythm. Side effects
such as nightmares or dizziness are not medical reasons for stopping unless they are suffi-
ciently debilitating or annoying. Anyone who has been treated for depression or psychiatric
problems, has diabetes controlled by oral therapy, or who is epileptic (or who has suffered
fits in the past), or has a close blood relative who is epileptic, should probably avoid meflo-
quine.
In the past doctors were nervous about prescribing mefloquine to pregnant women, but
experience has shown that it is relatively safe and certainly safer than the risk of malaria.
That said, there are other issues tobeaware of,soifyouare travelling toMadagascar whilst
pregnant, seek expert advice before departure.
Malarone (proguanil and atovaquone) is as effective as mefloquine. It has the advantage
of having few side effects and need only be continued for one week after returning.
However, it is expensive and because of this tends to be reserved for shorter trips. Malarone
may not be suitable for everybody, so advice should be taken from a doctor. The licence in
