Travel Reference
In-Depth Information
within 24 hours, particularly if falciparum malaria is the parasite: jaundice, then reduced
consciousness and coma (also known as cerebral malaria) followed by death. Treatment in
hospital is essential and the death rate might still be as high as 10% even in the best
intensive-care facilities.
Many travellers are under the impression that malaria is a mild illness, that treatment is
always easy and successful, and that taking antimalarial drugs causes more illness through
side effects than actually getting malaria. This is unfortunately not true. Side effects of the
medication depend on the drug being taken. Doxycycline can cause heartburn and indiges-
tion; mefloquine (Larium) can cause anxiety attacks, insomnia and nightmares, and
(rarely) severe psychiatric disorders; chloroquine can cause nausea and hair loss; pro-
guanil can cause mouth ulcers; and Malarone is expensive. The side effects are not univer-
sal and can be minimised by taking medication correctly (eg with food). Also, some
people should not take a particular antimalarial drug (eg people with epilepsy should
avoid mefloquine, and doxycycline should not be taken by pregnant women or children
younger than 12).
If you decide that you really do not wish to take antimalarial drugs, you must under-
stand the risks and be obsessive about avoiding mosquito bites. Use nets and insect repel-
lent, and report any fever or flu-like symptoms to a doctor as soon as possible. Some
people advocate homeopathic preparations against malaria, such as Demal200, but as yet
there is no conclusive evidence that this is effective and many homeopaths do not recom-
mend their use.
People of all ages can contract malaria and falciparum causes the most severe illness.
Repeated infections might result eventually in less serious illness. Malaria in pregnancy
frequently results in miscarriage or premature labour. Adults who have survived child-
hood malaria have developed immunity and usually only develop mild cases of malaria;
most Western travellers have no immunity at all. Immunity wanes after 18 months of non-
exposure, so even if you have had malaria in the past and used to live in a malaria-prone
area, you might no longer be immune.
If you will be away from major towns, it's worth considering taking standby treatment,
although this should be seen as emergency treatment only and not as routine self-medica-
tion. It should be used only if you will be far from medical facilities and have been ad-
vised about the symptoms of malaria and how to use the medication. If you do resort to
emergency self-treatment, medical advice should be sought as soon as possible to confirm
whether the treatment has been successful. In particular you want to avoid contracting
cerebral malaria, which can be fatal in 24 hours. Self-diagnostic kits, which can identify
malaria in the blood from a finger prick, are available in the West and are a worthwhile in-
vestment.
