Anti Malaria Tablets – When to Start

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QUESTION

I am due to travel to South Goa on 27th October 2012. It is 9th Oct now. It says I should start taking my tablets 1 week before traveling, however I was wondering if it was okay to start taking them now so my body can get used to the side affects before I travel. I do not want to be ill all the time whilst I am away.

ANSWER

Yes, you do need to take preventive medicine against malaria when visiting India and it is best to follow instructions given by your doctor or the drug insert. For India,  the US Center for Disease Control (CDC)  recommends Malarone (Atovaquone/proguanil), Doxycycline and Mefloquine as drugs to prevent malaria.

Malarone  needs to be started 1-2 days before travel to a malarial area, taken daily and continued for 7 days after leaving the area.

Doxycycline needs to be started 1-2 days before travel, is taken daily and needs to be continued for 4 weeks after leaving malarial areas.

Mefloquine needs to be started 2 weeks before travel, is taken weekly, and needs to be continued for 4 weeks after leaving.

Chloroquine is NOT recommended for India because of resistance, so it is not effective.

What measures can local people take to limit malaria infection?

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QUESTION

What measures can local people take to limit malaria infection?

ANSWER

People living in malarial areas can do a lot to protect themselves from getting malaria.  There are community programs for vector control (to control or eliminate mosquitoes) that include draining swamps to remove mosquito breeding habitat, spraying with insecticide, and using biological control techniques. In addition, to prevent  people from getting mosquito bites,   communities can educate families to screen their windows (if possible), to sleep under long lasting insecticide treated bednets, to cover their arms and legs with clothing  and to avoid being outdoors during dawn and dusk when mosquitoes are biting. Communities can also educate people to identify signs and symptoms of malaria and to seek early treatment to avoid serious disease and possibly death.  See Malaria Prevention and Control for more information.

Symptoms of Malaria

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QUESTION

What are the symptoms of malaria?

ANSWER

This is a frequently asked question.  Please see Malaria Symptoms and Causes for more information. The most common symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness.  If you think you may have malaria because you have these symptoms you should seek help including a blood test to identify the malarial parasite.

Malaria Prophylaxis and Getting Pregnant

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QUESTION

I will be traveling to the Ivory Coast for two weeks. I will be staying with my in-laws in the city in very clean conditions with a/c etc. I am a strict vegetarian so I will be bringing most of my food and will have access to clean water. I myself grew up in an undeveloped nation so I am used to precautions needed to prevent illness. However, mosquitoes do seem to love to bite me.

I sadly just had a miscarriage and want to try to conceive again within the next month. My doctor has prescribed Atovaquone-Proguanil for me. I am concerned about taking the drug since my body is recovering and as I said I want to try to conceive upon returning. How long will this drug stay in my system? Does it effect fertility or a fetus? Do the benefits outweigh the risks? How likely it is that I wouldn’t show signs of malaria until much later after potentially conceiving? I am also concerned of the emotional side effects of the medicine coupled with my recent loss.

Thank you for any information.

ANSWER

Firstly I am very sorry for your loss.    Your doctor prescribed Atovaquone-Proguanil  which is a first class  drug to prevent malaria.  Some people do experience  side effects but many do not. It is recommended to take the pill at the same time each day and with food or a milky drink.  Start taking the drug 1-2 days before you arrive and continue for a week afterwards. The drug should be out of your system within a few days after stopping it. Don’t try to conceive until after that.  While I do not know how long ago you had the miscarriage, WHO and UNICEF recommend waiting around 6 months before trying again, so that your body (and emotions) can recover fully.

Besides taking Atovaquone-Proguanil, be sure to protect yourself from mosquito bites; protect you legs and arms by wearing long sleeves and trousers/long skirt, avoid being out during dawn and dusk when mosquitoes like to feed, use an insect repellent (you can try citronella if you are worried about chemicals), and if the house isn’t screened (or even if it is), sleep under a long acting insecticide treated bed net.   Enjoy your trip and take care.

Name of Malaria Parasite

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QUESTION

What is the parasite of malaria?

ANSWER

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. There are four main types of malaria which infect humans: Plasmodium falciparum, P. vivax, P. malariae and P. ovale. P. ovale additionally can be split into two  sub-species, P. o. curtisi and P. o. wallikeri. Each of these five kinds has a subtly different life cycle which results in slight variations in symptoms and also in treatment, so knowing which one a person has is important for choosing the most appropriate treatment.  For more information on this, see our website http://www.malaria.com/overview/malaria-symptoms-causes.

 

Can my 14 day old daughter have malaria?

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QUESTION

My 14 day old daughter has a body temperature of about 38.3 C and breathes a bit rapidly.  Can it be a sign of malaria?

ANSWER

In newborns, it is sometimes difficult to tell exactly what is wrong.   The majority of newborns who get sick after delivery,  get an infection (from bacteria, not malaria).  WHO and UNICEF have identified the following “danger signs.” If the baby has  one or more of the following signs, take the baby to a hospital with qualified personnel and drugs immediately. Once there, the staff can treat the baby and test for malaria if indicated.

 

  1. Not feeding since birth or stopped feeding
  2. Convulsions
  3. Respiratory rate of 60 or more
  4. Severe chest indrawing
  5. Temperature ≥ 37.5 C
  6. Temperature ≤ 35.5 C
  7. Only moves when stimulated, or not even when stimulated

or        Yellow soles (sign of jaundice)

Signs of local infection:

  1. Umbilicus red or draining pus, skin boils, or eyes draining pus

All newborns, infants and young children in malarial areas  need to be protected from malaria and should sleep under an long acting, insecticide treated bed net.

 

Malaria and Impact on Society

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QUESTION

Where malaria is occurring, and what is the impact on society?

ANSWER

Malaria takes a huge toll, personally as well as in the larger society.  It has been estimated that malaria costs Africa $12 billion USD every year, including the cost of health care, days off school and work, decreased productivity, and loss of investment and tourism. Malaria in Africa slows economic growth and development and perpetuates the vicious cycle of poverty. Malaria is truly a disease of poverty — afflicting primarily the poor who tend to live in malaria-prone rural areas in poorly-constructed dwellings that offer few, if any, barriers against mosquitoes. Close to a million people die each year from malaria; over 90% of those live in Africa, and the great majority (86%) are children under five years of age.

 

Malaria Symptoms and Diagnosis

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QUESTION

My husband is currently working in Mozambique, and is sick with a fever, headache, and pain in his joints. Can this be malaria?

ANSWER

It could be. Your husband should go to the clinic and get tested.  The standard diagnosis for malaria  depends on the demonstration of parasites on a blood smear examined under a microscope.  In some settings, where microscopic examination is not possible, or as a quick response,  clinics can use an RDT or rapid diagnostic test on a drop of blood.  If your husband is in a place without any available testing methods, the health worker may treat him on his symptoms alone (this is called presumptive treatment). It is important to seek care early because if it is malaria it can get serious very quickly.

Malaria: When is Lab Testing Not Recommended

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QUESTION

When is parasitological confirmation not recommended?

ANSWER

It is always best to get a laboratory or rapid diagnostic test for malaria (parasitological confirmation) to make sure the person actually has malaria before giving treatment, and to make sure the treatment is appropriate. 

There are four main types of malaria which infect humans: Plasmodium falciparum, P. vivax, P. malariae and P. ovale. P. ovale additionally can be split into two  sub-species, P. o. curtisi and P. o. wallikeri. Each of these five kinds has a subtly different life cycle which results in slight variations in symptoms and also in treatment, so knowing which one a person has is important for choosing the most appropriate treatment.  For more information on this, check out the Q&As on Malaria Symptoms and malaria treatment.

Early treatment of malaria is essential to saving lives, so in communities that do not have ready access to simple lab testing, international agencies like WHO and UNICEF have developed standardized algorithms, to guide community health workers in early identification and treatment of malaria (particularly in children) without laboratory  confirmation. While this approach has been taken to save lives, where possible, laboratory confirmation of malaria is recommended.

URGENT HELP ON MALARIA

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QUESTION

I 25 yr old male from Lagos, Nigeria. I have been having frequent malaria since 2006 till present. My symptoms are always weakness of the body, feeling cold sometimes not always and also my mouth got better most cases. I have been to the hospital several times and the doctor told me my frequent malaria is because my blood genotype is AA and also am having a malaria parasites. I was given drugs and injection in most cases. It got to a stage I had to stop consulting the doctor and start making use of self description because the malaria goes and comes back and its cost me much money in going to the hospital every time.

The weakness is always my problem because will be restless and unable to study well even during my exams. I remember there was a period I sat down in front of my house and started crying cos I was fed up on getting weak during Xmas period while my mates were having fun. I also remember cases where I walked into one of the biggest pharmacy in my area and ask the guy which malaria drugs is the most expensive cos I was thinking the most expensive should be the most effective. He brought out some drugs which I paid some money.

I was free from malaria for the past 4 months not of recent I started having heavily symptoms mentioned above. I have taken several drugs like chloroquine 2-2-1 and Combisunate(arthmeter and lumefactrine),still yet no positive response.The Cold had stopped but my body is till getting weaker. I am just confuses don’t know what to do. I even thought of going for a HIV test soon cos I believe am not the only AA that stays in House. Others, I mean some of my family and neigbours do have often and it disappears immediately after taking some drugs.

I am fed up seriously and really don’t know what to do again.I hope you can help.

ANSWER

Thanks for your question. Getting infected with malaria doesn’t have anything to do with whether you are blood type A or O or anything else. Some people do have natural resistance to some types of malaria—for example a lot of people in sub-Saharan Africa are “Duffy negative” which means they are resistant to Plasmodium vivax malaria; other people carry the sickle cell gene, which also provides some protection.

However, it is not common to have so many repeated attacks of malaria. The first thing to do is to make sure you are protecting yourself sufficiently from mosquito bites. You can’t get malaria if you aren’t bitten by mosquitoes, and the type of mosquitoes that transmit malaria usually bite at night. As such, it is crucial to sleep every night under a long-lasting insecticide treated bednet. If you have one, it might need to be re-dipped in insecticide to make sure it keeps working effectively. Also, you should make sure all your windows and doors are properly screened to prevent mosquitoes from coming in; many people also do something called “indoor residual spraying” where they spray insecticide on the walls inside their house to kill any mosquitoes which might come in. If you live in an urban area, this might not be necessary if you can get good screens, or indeed if you have air conditioning (mosquitoes do not like cooler environments). Finally, you should try to wear long-sleeved clothing in the evenings and at night, again to stop mosquitoes from biting.

Finally, I think it is important to make sure that you are diagnosed properly. In many places I have been to, hospitals don’t do a proper check, but if someone has even a few of the symptoms of malaria, they just give them treatment. This is not good—you need a proper diagnosis, both to see what kind of malaria you have (so you can get appropriate treatment) and also to make sure you actually have malaria, and not something else which is being ignored because they think you have malaria!

In fact, your symptoms of fatigue, weakness and cold are not very typical of malaria, which is usually characterized by very high fever interspersed with chills, nausea and body aches. As such I think you might want to talk to a doctor about other possible explanations for your symptoms, especially since they are so persistent.

Finally, in Nigeria, you should NOT be given chloroquine to treat malaria, unless your case is confirmed as not being caused by Plasmodium falciparum. Virtually all the Plasmodium falciparum in Africa is resistant to chloroquine, and so it is no longer an effective treatment. Instead, first-line treatment for malaria is recommended as an artemisinin-based combination therapy, such as Combisunate which you mention above.