QUESTION

Why do I suffer from constant malaria attack? The doctor has prescribed different prescriptions every time I get an attack but its still coming back. What could be the problem?

ANSWER

There are a number of possible answers to your question. First of all, your doctor might not be prescribing the right type of treatment for the type of malaria that you have. The World Health Organisation now recommends that all uncomplicated cases of malaria should be treated with artemisinin-based combination therapies (ACTs), such a Coartem. However, in some places, doctors still prescribe other drugs, such as Fansidar or chloroquine. This can be a problem, as in many areas, the local kinds of malaria have become resistant to these earlier drugs, and so you may not be cleared of the infection. This is called recrudescence—when a malaria infection is not cleared completely from the blood and so symptoms come back once the treatment has stopped.

Alternatively, if there is a longer time interval between your episodes of illness, you may be suffering from relapses. This occurs with two particular types of malaria: Plasmodium vivax and P. ovale. These types of malaria can form liver stages which remain dormant even after the treatment you take kills all the malaria in your blood. Therefore it will appear like you have been cured, but really you still have an infection in the liver.

These liver stages can re-activate and re-enter the blood, causing another episode of malaria symptoms months or even years after the initial infection. If your doctor finds that you are positive for one of these two types of malaria, you should talk to him/her about the possibility of taking primaquine. This drug kills the liver stages of the parasite, but is not appropriate for people with G6DP deficiency, so you should be tested for that first.

Finally, there is the possibility that you are continually being re-infected with malaria. In this case, you should take more preventative precautions. For example, sleep under a long-lasting insecticide-treated bednet, wear long-sleeved clothing (especially at night) and cover exposed skin with insect repellent. All of these measures will help prevent mosquito bites, which transmit malaria. In addition, you could consider indoor residual spraying, which coats the walls inside your house with insecticide to further eliminate the presence of mosquitoes.