Malaria prevention

Malaria is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito, which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills and flu-like symptoms. Although malaria can be deadly, illness and death from malaria can usually be prevented.

Luckily for us, malaria is only endemic in three provinces of South Africa: Limpopo, Mpumalanga and north KwaZulu-Natal. It becomes a health issue when we decide to vacation in areas where malaria is known to occur.

The malaria parasite has two hosts: humans and female Anopheles mosquitoes. In humans, the parasites grow and multiply first in the liver cells and then in the red blood cells. Successive broods of parasites grow inside the red blood cells and destroy them, releasing daughter parasites that continue the cycle by invading other red cells.

These blood stage parasites are those that cause the symptoms of malaria. When certain forms of blood stage parasites are picked up by a female Anopheles mosquito during a blood meal, they start another, different cycle of growth and multiplication in the mosquito.

“If you are pregnant or have a child under 11kg, you are far safer not going to a malaria area at all.”

After 10 to 18 days in the mosquito, the parasites are found in the mosquito’s salivary glands and when the mosquito takes a blood meal on another human, these parasites are injected with the mosquito’s saliva, where they will start another human infection. This is what makes the mosquito a carrier of malaria from human to human, and it is for this reason that prevention of mosquito bites is fundamental to preventing the spread of malaria.

How to prevent mosquito bites

• Avoid the outdoors at dawn or dusk, as the Anopheles mosquito is most active in twilight periods and in the evening after dark.
• Taking preventive actions such as using repellent during peak biting hours may reduce risk.
• When accommodation is not adequately screened or air-conditioned, bed nets are essential in providing protection and reducing discomfort caused by biting insects. If bed nets do not reach the floor, they should be tucked under the mattress.

Is it safe to use repellents on my child?

According to the CDC (Centers for Disease Control), most repellents can be used on children over the age of two months. Products containing OLE (oil of lemon eucalyptus) specify that they should not be used on children under the age of three years.

Some general guidelines for application of repellents include:

• Only apply repellents to exposed skin or clothing, as directed on the product label. Do not apply repellents under clothing.
• Never use repellents over cuts, wounds, or irritated skin.
• When using sprays, do not spray directly on face. First spray on the hands and then apply to face.
• Do not apply repellents to eyes or mouth, and apply sparingly around ears.
• Always wash hands after application to avoid accidental ingestion or exposure to eyes.
• Children should not handle repellents. Instead, adults should apply repellents to their own hands first, and then gently spread on the child’s exposed skin. Avoid applying directly to children’s hands.

Consult your local travel clinic when it comes to choosing malaria prophylaxis (preventative measures). Based on fluctuations in weather and resistance to medications, the recommendations may change from season to season.

What if I don’t want to use these products on my child?

There are some parents who maintain they would rather not use an anti-malarial and deal with it if the child becomes sick. This is a very dangerous attitude. Firstly, malaria is deadly and according to the WHO, more than two-thirds of all malaria deaths occur in the under-five age group.

Secondly, young children have a higher rate of acquiring infection associated with fever (upper respiratory tract infections, a multitude of viruses, etc.). Should your child run a fever up to one month after exiting a malaria area having not taken adequate prophylaxis, it will be necessary to expose them to painful blood tests in order to rule it out.

In the South African private sector, the most commonly prescribed anti-malarial for children is Malanil (atovaquone and proguanil). It is well tolerated, provides a high level of protection and can be used in children from 11kg and up – the dose calculated according to weight. If you are pregnant or have a child under 11kg, you are far safer not going to a malaria area at all. Why risk it?

Malaria symptoms

All travellers should be alert for flu-like symptoms and fever during and up to one month after the end of their vacation. These symptoms include:

• Sudden onset of fever
• Chills and/or sweating
• Headaches
• Nausea and vomiting
• Muscle pain
• Fatigue
• Symptoms in children include fever, poor feeding and lethargy.

There are other subtypes of malaria that may present after a longer latent period, but they are fortunately far less deadly. Always remember, your family doctor is on call to answer questions or concerns you may have about malaria or any other travel illnesses you may be exposed to on your journeys. Safe travels!