Diet Therapy for Malaria?

by

QUESTION:

Is there any tested and proven diet therapy for acute malaria? What food nutrients are essential for prevention of malaria?  And what are their food sources?

ANSWER:

Thanks for your question, Ekuma. I am not aware of any proven and scientifically tested diet therapy for acute malaria, apart from that which is recommended for all severe fevers, which is to hydrate regularly and thus increase intake of water and diluted juices. Some doctors advise to steer clear of solid food during the worst of the fever, but I am not sure whether this is actually to speed recovery or just because patients tend to lose their appetite during this phase anyway.

In terms of nutritional prevention of malaria, again I don’t think there are any dietary supplements as such which have been proven to prevent all malarial episodes. However, quinine is a natural chemical which has anti-malarial properties and so including quinine-rich foods in one’s diet may in this way reduce incidence of malaria. Tonic water is a good example of an everyday foodstuff which contains quinine; the soda known as “bitter lemon”  likewise contains quinine, which is partially why both were popular with colonial expatriates living in malarial countries over the last hundred-odd years.

Finally, there are reports that grapefruit contains a quinine-like substance, and so might help prevent malaria or indeed increase recovery from malarial episodes, but I am not sure if this has been scientifically established as fact. There are a number of other plants, herbs and fruits which advocates of traditional, home remedies suggest may help prevent or treat malaria, but I can’t find ANY solid scientific basis for these claims, nor any reports of trials where these remedies have been shown to be effective.

Overall, the best thing to do if you think you have malaria is to get diagnosed (either at the doctor, a hospital or using a self-diagnosis kit) and then seek medical treatment. Local clinics will be able to tell you what kind of malaria you have, and therefore what treatment is recommended.

For prevention while in malarial areas, sleep under an insecticide treated bednet and try not to get bitten by mosquitoes. If you’re a visitor to a malarial zone, look into getting prophylaxis (preventative medicine) before you travel, and make sure the type of medication you are prescribed is appropriate to the types of malaria found in the regions to which you are going.

In terms of what malaria parasites themselves eat, they infect red blood cells in the human body and use the cells’ own hemoglobin (the protein we need to carry oxygen around our bodies) for energy. This why one of the reasons why malaria sufferers can become anemic; as such, it is important to maintain iron levels after a malarial attack, to prevent any further side effects of the infection.

 

What will happen if malaria is not controlled?

by

QUESTION:

In the future, if malaria is not controlled, what will happen?

ANSWER:

This is actually a really important question. Malaria already kills more than one million people each year, with probably around 3.3 billion people at risk from infection. This number will just increase as the world’s population grows, unless successful control measures are implemented.

Moreover, climate change will likely change the areas which are affected by malaria. Certainly, as temperate areas, such as the Mediterranean and the southern USA, get warmer due to climate change, there will be more risk of greater malaria transmission in these regions. Similarly, high altitude areas in tropical regions, which currently have low or no malaria transmission, may find that transmission of malaria becomes possible and even frequent. This may be the case for some of Africa’s major cities, such as Nairobi and Johannesburg, which are currently at a high enough altitude to limit high malaria transmission, but may be negatively affected by climate change with respect to malaria.

Similarly, there are some regions in the world which are currently too dry during parts of the year to allow the larvae of malaria mosquitoes to develop; this results in only seasonal transmission of malaria, after the rains. If climate change affects the patterns or the amount of rain that falls in these areas, transmission risk of malaria will also change, and perhaps in unpredictable ways.

On the other hand, there may be some areas which become more dry with the onset of climate change. These areas may see reduced malaria transmission, but increases in other problems, such as lack of water to grow crops and therefore higher levels of food insecurity and malnutrition.

Therefore, overall it is expected that without control measures, the number of cases of malaria worldwide will continue to increase. As such, it is crucial that we all work together to implement successful measures for prevention, diagnosis and treatment of malaria, and especially in the countries, such as in sub-Saharan Africa, where the burden of the disease is the greatest.

Is there malaria in Papua New Guinea?

by

QUESTION:

Is Papua New Guinea infected of malaria?

ANSWER:

There is malaria in many parts of Papua New Guinea, and especially in the coastal regions. Chloroquine-resistant malaria has been reported from PNG so if travelling to malarial zones in the country you should ask your doctor about getting a prescription for another form of prophylaxis (preventative drugs), such as Malarone, Lariam or doxycycline. it is also recommended to sleep under an insecticide-treated bednet.

Parts of the country which are above 1800 metres of altitude (5900 ft) are considered free of transmission but you should consult with local doctors before travelling to specific areas to see what they recommend in terms of preventative measures you can take.

Safety of Bed Net Insecticides

by

QUESTION:

Are the insecticides used on the bed nets safe? What are the brand names and chemical names of those insecticides, and can you point me to any studies that have been done to determine their safety?

ANSWER:

The short answer is yes, the insecticides used in bednets are safe under the conditions in which people are exposed to them through using bednets.

Most standard bednets are treated with a chemical known as a pyrethroid, and usually permethrin or deltramethrin. Both of these chemicals have low toxicity to most mammals and are poorly absorbed by the skin, making them safe for treating bednets. There are some studies on mice which suggest that pyrethroids such as permethrin can be carcinogens when ingested, though once bound to the fibre of a bednet the chemical is not ingested by the person sleeping under the net so this is not a danger.

The World Health Organisation maintains a comprehensive set of specifications (PDF) for maintaining quality and safety in insecticide treated bednets.

There is another WHO report on the safety of pyrethroids (PDF) for public health use, which gives more details about conditions under which these compounds are considered toxic and the risk of exposure through bednet use.

Reduce Risk of p.falciparum

by

QUESTION:

I am laboratories man. My question is the risk of P. falciparum especially for mother and children is very high.  How can we reduce this risk?

ANSWER:

That’s a crucial question for malaria control. Certainly, as you say, the risk of severe malaria is much greater for young children and for pregnant women. As such, these high risk groups should be targeted during prevention campaigns, as well as for diagnosis and treatment.

There are several methods of prevention, which are suitable for all types of malaria, including P. falciparum. Probably the most effective, and also the most simple, is through the proper use of insecticide-treated bednets. These are often handed out at antenatal clinics to pregnant women, but ensuring that the nets are used properly is more difficult. Proper training, and emphasising that children and pregnant women will benefit most from reduced exposure to mosquitoes, is required. For more on the difficulties and challenges of bednet distribution, you can see Hugo Gouvras’ comment on an earlier question in this Q&A forum – see here: http://www.malaria.com/questions/free-malaria-bednet

The other main method for malaria prevention is through the use of prophylactic drugs, although these have to be taken every day, and so the cost is usually prohibitive for residents of malarial areas. In these areas, there have been successful trials of so-called SP IPT, which stands for sulfadoxine-pyrimethamine intermittent protective treatment. In this regime, malaria in pregnant women is prevented by administering intermittent doses of sulfadoxine-pyrimethamine; usually two doses during the pregnancy (one in the second and one in the third trimester), but monthly doses have also been tested. More frequent doses may be better for women who are also HIV positive, some studies have shown.

Intermittent preventative treatment has also been trialled on young children as a way of reducing the severity and frequency of malarial episodes when the child is most vulnerable. I’m not up to date on the most recent studies on this work, so will ask another one of our experts to comment on the efficacy of IPT, both in children and pregnant women.

Thanks for the question!

Is there Malaria in Naboomspruit, South Africa?

by

QUESTION:

Is Naboomspruit in South-Africa a malaria area?

ANSWER:

Naboomspruit (also known as Mookgopong) is located in Limpopo province in South Africa; malaria is endemic in parts of this province, namely the eastern border of South Africa (next to Mozambique and Swaziland), and including popular tourist areas such as Kruger National Park. In these regions, precautions against malaria, such as sleeping under an insecticide-treated bednet and taking preventative (prophylactic) medicine against malaria are highly recommended.

However, regions further away from the border, such as Naboomspruit, are generally considered zones of low to no transmission. However, transmission may still occur at some points in the year (particularly after rains) so some precautions would be advisable, although medication against malaria is probably not necessary. Instead, if visiting, or indeed if living in the area, it would be recommended to avoid getting bitten by mosquitoes by using insect repellant, wearing long-sleeved and dark clothing at dawn and after dusk and if being particularly cautious, by sleeping under an insecticide-treated bednet.

Bear in mind also that these are simply recommendations, and things may change over time and with variations in local climate; it would be worth asking a local doctor or hospital what the immediate risks of malaria are before travelling to a particular location.

Malaria – Free Bednets?

by

QUESTION:

Why do people have to pay for the bed nets?  I think that is mean to the people and they should get them for free.

ANSWER:

You have hit on a very important and on-going debate in the malaria control community. In many places around the world, organisations such as UNICEF have distributed free, insecticide-treated bednets, and especially to mothers—pregnant women and children under five are the groups most at risk from dying from malaria.

In 2010, UNICEF reported that together with its partners (WHO, the EU and the World Bank, to name a few) 5.5 million free bednets have been distributed in DR Congo alone. Similarly, in Mozambique, the Malaria Consortium has been working in a partnership with DFID and the public sector to distribute 400,000 bednets to pregnant women as part of an ante-natal service, again targeting some of the most at-risk people.

However, you are right to say that in some cases, people have to pay for bednets; in some of the poorest countries in the world, this can seem like an unjustifiable expense. However, there are some arguments in favor of having people buy their bednets.

For example, some people argue that a purely public donation initiative is unsustainable, and in order to have an on-going distribution campaign, the private sector has to be involved at some level, and this usually means charging a fee for each bednet. Moreover, forcing people to buy their own nets would free up donor funds for other purposes. Similarly, it is thought in some circles that having payment encourages suppliers to continue producing and selling nets. Finally, there are suggestions that purchasing a bednet increases their value to the recipient, who subsequently uses their net more frequently and more reliably in the manner in which it is intended (and not, for example, as a spare fishing net, as I’ve seen in parts of Uganda!).

I believe a study in Malawi showed that by asking people in urban areas, who have a bit more disposable income, to purchase full-price bednets, the program was able to generate sufficient funds to offer bednets at a highly subsidized cost in rural, poorer areas of the country; by asking people to purchase the nets, the program believed bednet usage among its recipients was higher overall, than if the nets had been given out for free.

I think the organization that tried this approach was called PSI (Population Services International)—they also offered nurses a small monetary incentive to sell bed nets (at the small sum of 50 cents each) to the rural women who attended pre-natal clinics, thus encouraging them to offer the nets widely to pregnant women.

As the final word, a study in Kenya recently showed that as costs for services such as bednets increased, demand for the service among the poorest sectors of the population declined sharply. Instead, it seemed most economical and efficient to target high-risk groups with free bednets, who are also incentivized to use the product properly and value the protection it confers, such as pregnant women in ante-natal settings, rather than doling them out to the community at large.

So we’re back to where I started with this response; the great job that many organizations out there are doing in distribution insecticide-treated bednets to the people who need it the most, and who can’t afford to buy them themselves, although it is worth bearing in mind that alternative models of bednet funding and distribution might prove equally beneficial and potentially more sustainable, at least in certain areas.

I’m also going to ask Hugo Gouvras to weigh in on this one—he works for Malaria No More, an organization that has recently launched an innovative mechanism for accelerating funding provision for bednet distribution to Africa. Hopefully he can update anything that I have said which is old news, and provide additional information!

Malaria in Brazil

by

QUESTION:

Is there Malaria in Brazil? If so, what pills do I need to take?

ANSWER:

Yes, there is malaria in many parts of Brazil, and more than one type: about 75% of cases in Brazil are caused by Plasmodium vivax, whereas the rest are from infections with P. falciparum, the more acute and dangerous species of malaria. Brazil does have good information as to the distribution of malaria across the country; in terms of affected states, the full list is as follows:

Acre, Amapa, Amazonas, Maranhao (western part), Mato Grosso (northern part), Para (except Belem City), Rondonia, Roraima, and Tocantins.

This includes cities within the above districts, such as Boa Vista, Macapa, Manaus, Maraba, Porto Velho and Santarem, and particularly on the outskirts where transmission is highest. It is worth noting that malaria is not considered to be a problem in the region of Iguassu Falls.

In terms of malaria prevention, the CDC recommends Larium (mefloquine is the generic name), Malarone (atovaquone or proguanil are the generic names) or doxycycline, due to the presence of chloroquine-resistant P. falciparum in some areas. Deciding between which of these to take depends on a number of factor, including cost, known side-effects, and, not least of all, personal preference. For a discussion on the pros and cons of these various form of prophylaxis, check out the discussion “Malaria Prophylaxis” on this website.

Malaria Prevention

by

Photo by Matthew Naythons, MD

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. [Read more…]

Malaria Prevention and Control

by

Malaria Prevention

Prevention of malaria can aim at either:

  • preventing infection, by avoiding bites by parasite-carrying mosquitoes, or
  • preventing disease, by using antimalarial drugs prophylactically. The drugs do not prevent initial infection through a mosquito bite, but they prevent the development of malaria parasites in the blood, which are the forms that cause disease. This type of prevention is also called “suppression.” [Read more…]