Malaria - Precautions Recommended Source: "Botswana Focus - 2000"

PRECAUTIONS RECOMMENDED

Although most parts of Botswana and Southern Africa are low-risk areas, this disease 'known as the silent killer ' can reach epidemic proportions in parts of sub-Saharan Africa, with annual fatalities as high as one million victims per year, although these figures are generally considered to be conservative estimates.

PARASITES

Malaria in humans is caused by four species of the plasmodium parasite, all transmitted through the bite of an infected female mosquito of the Anopheles species. The P.falciparum is the parasite found in 95 percent of South Africa's malaria areas. Some of these species have become drug-resistant, which periodically gives rise to claims that new strains of malaria have been discovered.

PROPHYLAXIS AGAINST MALARIA

Visitors can reduce the risk of contracting malaria by avoiding high-risk areas, by visiting endemic malaria areas when rainfall is low, or during the dry season. Prophylaxis against malaria may be divided into two categories, namely precautionary measures to avoid mosquito bites, and the taking of anti-malarial drugs. Since the latter is not always completely effective, measures against mosquito bites should always be taken in addition to drugs. Contact with the mosquitoes that carry malaria, which feed indoors and outside between dawn and dusk, can be minimized by observing the following measures:

Wear clothing which covers as much of the skin as possible - especially at night.
Apply insect repellant to exposed skin.
Manufacturer\'92s recommendations should be followed.
Screens should cover bedroom doors and windows.
Mosquito nets are a must. Ensure that the net is not torn and that its comers are tucked under the mattress. Also ensure that there are no mosquitoes inside the net when going to bed.
Aerosols should be sprayed indoors, preferably with the doors and windows closed, in the early evening.
Burning mosquito mats and coils is a fairly effective means of keeping mosquitoes at bay during the night.

PREVENTATIVE DRUGS

In chloroquine-resistant areas, like South Africa, chloroquine should be used in conjunction with proguanil or mefloquine. Coxycycline is recommended for people with certain medical conditions.

Chloroquine should be taken once every day, starting one day before entering the malaria area and weekly for four weeks after leaving the area.

Proguanil should always be taken in conjunction with chloroquine. It should be taken daily, starting one day before entering the area, daily while in the area and daily for four weeks after leaving the area.

Mefloquine should be taken every seven days, starting a week before entering the area, weekly while in the area and weekly for four weeks after leaving the area.

Doxycycline should be taken once daily, starting two days before entering the area, daily while in the area and daily for four weeks after leaving the area.

OTHER POINTS TO REMEMBER

Finishing one's course of medication is important for maximum effectiveness.

Start your prophylaxis course preferably a week before entering the area.

Continue the course for a minimum period of four weeks after leaving the area.

Symptoms can appear up to six months after leaving a malaria area. A medical practitioner should be consulted as soon as the following symptoms appear: fever, rigors, headache, sweating abdominal pain, diarrhea, loss of appetite, nausea, slight jaundice, cough and enlarged liver and spleen.\

With the correct precautions, conscientiously applied, visits to even high-risk tropical areas are statistically safe. Most tourist areas in Southern Africa, if visited at the right time of year, are relatively low-risk, but it is always sensible to take precautions.