How is Malaria Prevented?

by

QUESTION

What are the methods to prevent malaria?

ANSWER

Malaria prevention consists of a combination of mosquito avoidance measures and chemoprophylaxis. Although very efficacious, none of the recommended interventions are 100% effective.

Mosquito Avoidance Measures

  • Because of the nocturnal feeding habits of Anopheles mosquitoes, malaria transmission occurs primarily between dusk and dawn.
  • Contact with mosquitoes can be reduced by remaining in well-screened areas, using mosquito bed nets (preferably insecticide-treated nets), using a pyrethroid-containing flying-insect spray in living and sleeping areas during evening and nighttime hours, and wearing clothes that cover most of the body.
  • All travelers should use an effective mosquito repellent.
  • The most effective repellent against a wide range of vectors is DEET (N,N-diethylmetatoluamide), an ingredient in many commercially available insect repellents. The actual concentration of DEET varies widely among repellents. DEET formulations as high as 50% are recommended for both adults and children older than 2 months of age (see the Protection Against Mosquitoes, Ticks, and Other Insects and Arthropods section later in this chapter). DEET should be applied to the exposed parts of the skin when mosquitoes are likely to be present.
  • In addition to using a topical insect repellent, a permethrin-containing product may be applied to bed nets and clothing for additional protection against mosquitoes.

Chemoprophylaxis

  • All currently recommended primary chemoprophylaxis regimens involve taking a medicine before travel, during travel, and for a period of time after leaving the malaria endemic area. Beginning the drug before travel allows the antimalarial agent to be in the blood before the traveler is exposed to malaria parasites.
  • Presumptive antirelapse therapy (also known as terminal prophylaxis) uses a medication towards the end of the exposure period (or immediately thereafter) to prevent relapses or delayed-onset clinical presentations of malaria caused by hypnozoites (dormant liver stages) of P. vivax or P. ovale. Because most malarious areas of the world (except the Caribbean) have at least one species of relapsing malaria, travelers to these areas have some risk for acquiring either P. vivax or P. ovale, although the actual risk for an individual traveler is difficult to define. Presumptive anti-relapse therapy is generally indicated only for persons who have had prolonged exposure in malaria-endemic areas (e.g., missionaries, volunteers).
  • In choosing an appropriate chemoprophylactic regimen before travel, the traveler and the health-care provider should consider several factors. The travel itinerary should be reviewed in detail and compared with the information on where malaria transmission occurs within a given country (see the Malaria Risk Information and Prophylaxis, by Country, section later in this chapter) to determine whether the traveler will actually be traveling in a part of the country where malaria occurs and if significant antimalarial drug resistance has been reported in that location.
  • The resistance of P. falciparum to chloroquine has been confirmed in all areas with P. falciparum malaria except the Caribbean, Central America west of the Panama Canal, and some countries in the Middle East. In addition, resistance to sulfadoxine–pyrimethamine (e.g., Fansidar) is widespread in the Amazon River Basin area of South America, much of Southeast Asia, other parts of Asia, and in large parts of Africa. Resistance to mefloquine has been confirmed on the borders of Thailand with Burma (Myanmar) and Cambodia, in the western provinces of Cambodia, in the eastern states of Burma (Myanmar), on the border between Burma and China, along the borders of Laos and Burma, and the adjacent parts of the Thailand–Cambodia border, as well as in southern Vietnam.
  • Additional factors to consider are the patient’s other medical conditions, medications being taken (to assess potential drug–drug interactions), the cost of the medicines, and the potential side effects.
      The medications recommended for chemoprophylaxis of malaria may also be available at overseas destinations. However, combinations of these medications and additional drugs that are not recommended may be commonly prescribed and used in other countries. Travelers should be strongly discouraged from obtaining chemoprophylactic medications while abroad. The quality of these products is not known, and they may not be protective and may be dangerous. These medications may have been produced by substandard manufacturing practices, may be counterfeit, or may contain contaminants. Additional information on this topic can be found in an FDA document

Purchasing Medications Outside the United States

    .

 

Community Based Management for Malaria

by

QUESTION

what are the methods for community based management for malaria?

ANSWER

Community-based management of malaria revolves around three main principles: prevention, diagnosis and treatment.

Prevention mainly revolves around stopping mosquitoes from biting people. Methods for this include distribution of long-lasting insecticide treated bednets (and teaching people to use them properly!), indoor residual spraying to stop mosquitoes from living in houses, screening houses properly and removing sources of stagnant water from the community to stop mosquitoes from breeding. Collectively, these methods are considered “vector control”. They have benefit for the individuals who practice the methods, as well as collective benefit at the community level from reduced transmission. Within the community, pregnant women and young children, who are most at risk of severe infection, are often targeted for preventive measures. In addition, transmission of malaria from a pregnant mother to her unborn child can be prevented through chemoprophylaxis, administered usually twice during pregnancy, in a process known as intermittent preventive therapy (IPT).

Diagnosis and treatment involves educating people about the symptoms of malaria so that if they suspect they are infected, they know how and where to seek appropriate medical care. The community therefore has to provide a clinic or hospital that is sufficiently equipped to do accurate diagnosis, which requires blood testing. Clinicians should also be able to identify which type of malaria the patient is infected with, since this determines treatment. Identification of the type of malaria is usually done via looking at the blood of the patient under a microscope, a process which requires a significant amount of training. The type of treatment depends on the severity of infection as well as the type of parasite they are infected with.

All of the above interventions depend on sustained investment in community health care, training of local health workers and clinicians and education the community about the transmission of malaria and how this can be interrupted.

Free Medical Care for Malaria

by

QUESTION

Can you get free medical help for someone In Nigeria that has malaria?

ANSWER

Theoretically, the Nigerian government should provide basic services, including malaria diagnosis, through primary care clinics which are administered by local government. In addition, Nigeria has recently instituted a National Health Insurance program, which again should assist in providing health care to many sectors of the population. However, in practice, public health care in Nigeria is still hugely underfunded and not very comprehensive—the World Health Organization (WHO) recently ranked it 187 out of 191 country health systems worldwide!

As such, I would be wary of the quality and accuracy of malaria diagnosis and treatment if you obtained it for free in Nigeria—while you might get perfectly decent care, the statistics suggest the chances of this are slim. You would probably be better off looking for a private clinic, where I imagine the cost will still be quite reasonable (especially if you are part of the National Insurance program there) and the quality of care might be more reliable. Having said this, I have no personal direct experience with health care in Nigeria, public or private, so if other readers of this site have other information, please share it in the comments section below.

Is Malaria Contagious Between Humans?

by

QUESTION

If someone has malaria, is it contagious?

ANSWER

No. Malaria cannot be transmitted via touching or saliva or air. In virtually all cases, it is only transmitted by the bite of an infected mosquito, and so cannot be passed from one person to another. There are a few exception—because the parasite lives in certain organs and in the blood, it can sometimes be transmitted via blood transfusion or organ transplant. It can also pass via the placenta from a mother to her unborn child, or to the child during childbirth.

Malaria Diagnosis

by

QUESTION

How to identify malaria? My son has fever and headache for the past three days and also vomiting. Is treatment is necessary and what type of treatment he needs?

ANSWER

You need to take your son to the doctor or to a clinic where they can do a blood test to look for malaria. They will either look at his blood under a microscope or use his blood in a “rapid diagnostic test” (RDT), both of which can identify the presence of the malaria parasites in his blood. If he is positively diagnosed with malaria, then your son should receive treatment, probably a type of artemisinin-based combination therapy (ACT) – common brands include Coartem, Lonart and Alu (though there are many others). These are what the World Health Organisation recommends as first line treatment against non-severe malaria.

Given your son’s symptoms, you should certainly go for a malaria test, just in case. However, vomiting is not usually a symptoms associated with malaria, so it is also possible he has another infection, such as an intestinal parasite, or even a bacterial or viral infection. Unfortunately, the symptoms of malaria are very general, so you really need to have one of the blood tests I mention above in order to be sure that your son has malaria.

Which Medication to Take for Malaria Treatment

by

QUESTION

Which medicion should we take during malaria?

ANSWER

Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

  • chloroquine
  • atovaquone-proguanil (Malarone®)
  • artemether-lumefantrine (Coartem®)
  • mefloquine (Lariam®)
  • quinine
  • quinidine
  • doxycycline (used in combination with quinine)
  • clindamycin (used in combination with quinine)
  • artesunate (not licensed for use in the United States, but available through the CDC malaria hotline)

In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How to treat a patient with malaria depends on:

  • The type (species) of the infecting parasite
  • The area where the infection was acquired and its drug-resistance status
  • The clinical status of the patient
  • Any accompanying illness or condition
  • Pregnancy
  • Drug allergies, or other medications taken by the patient

If you have or suspect you have malaria, you should contact your doctor immediately.

Malaria Prevention During Pregnancy

by

QUESTION

I am emigrating (moving permanently) to Mozambique – Vilanculos in October after my marriage, I want to fall pregnant.

What medicine can I take to prevent malaria during my pregnancy in Mozambique? I am afraid of getting malaria while I am pregnant. I am from South Africa, will the doctors here have a remedy for me to take before I am moving to Vilanculos? Do you know of any malaria prevention during pregnancy medicine?

ANSWER

Certain drugs commonly used to prevent malaria are not appropriate for
pregnant women. Those which can be taken by pregnant women are
chloroquine and mefloquine (the latter is commonly sold as Lariam).
Unfortunately, the type of malaria found in Mozambique is resistant to
chloroquine, and so this drug is not recommended for people living in
this area. As such, mefloquine remains as the likely first choice
preventive drug for you when you get pregnant. Some studies suggest
mefloquine should not be taken in the first trimester of pregnancy,
but in high malaria transmission zones, the dangers of malaria may
outweigh these early risks. You can talk to your doctor about the pros
and cons of this. There are also no problems with taking it long term
(i.e. for the 9 months of pregnancy), and the Centers of Disease
Control in the US also state it is safe for infants to consume small
amounts of mefloquine, so it can be taken during breast feeding as
well. It is important to note that mefloquine is not recommended for
people with a history of certain psychiatric disorders, so you should
consult with your doctor before taking it if you have a history of
mental illness.

Throughout your pregnancy, you should also be aware of other methods
for preventing malaria, such as sleeping under a long-lasting
insecticide treated bednet, and making sure your house is fully
screened to prevent mosquitoes from entering. Wearing long sleeved
clothing in the evening and at night when you’re outside, and insect
repellent on exposed skin, can also help prevent mosquito bites.

Malaria Test – Can Malaria Return?

by

QUESTION

I am working in Tanzania. I felt sick about 10 days ago and I went for a test for malaria and the test was positive. The doctor gave me some pills and said I must come back in one week for a test again. I went back and it was negative but now I don’t feel too good. Is it possible for the malaria to come back after 10 days?

ANSWER

It is unlikely that the malaria has come back, and if your malaria test is negative, then you probably don’t have malaria any more, and you can be confident the treatment worked. It sometimes takes a few days or even a couple of weeks to fully recover from the infection, since it takes quite a toll on the body’s immune system. Also, the medication you take to treat malaria can also have side effects, such as nausea and headaches, which actually seem similar to the symptoms of malaria itself.

Paracetamol to Control Fever

by

QUESTION

If I take paracetamol to help control my temperature will it affect my blood test results— can they fail to detect the plasmodium?

ANSWER

No—taking paracetamol (also called acetaminophen, and sold variously as Tylenol, Panadol and other brand names) is a good way to control your temperature during malaria infection, and it won’t affect your blood test results. If you haven’t done this already, if you think you have malaria you should go to a doctor or clinic to get a blood test for diagnosis. Once you have been positively diagnosed, you can be given appropriate treatment, probably one of a number of available artemisinin-based combination therapies (such as Coartem, Alu, Lonart, etc).

Long Term Health Effects of Malaria

by

QUESTION

Ten years ago, at the age of 21, I contracted both forms of malaria. I was severely unwell with falciparum, losing around 15kgs over the course of a week, and I suffered one relapse. I had ongoing vivax for 2 and a half years. I would like to know if there are any known long term complications, or possible health problems I may encounter in the future as a result of having had malaria.

ANSWER

There is a discussion going on about the question of possible long-term consequences of malaria infection based on an earlier question in this forum. You can follow the discussion here: Long Term Health Effects of Malaria When Young.

In summary, there is little evidence of any long term effects on health from having single or relatively few malaria infections; however, this may partly be through lack of concerted research on this topic. Most research looks at the impact of chronic or very frequent malaria infections, such as that experienced by young children living in holo-endemic areas (i.e. sub-Saharan Africa).