Malaria and Malaria Prevention

What is Malaria?: Malaria is a disease caused by a parasite called plasmodium. There are four types of plasmodium: falciparum, vivax, ovale, and malariae. Plasmodium enters the bloodstream and destroys red blood cells and affects the liver, kidneys, spleen and other organs.

Death can occur from cerebral malaria, when the plasmodium arrives to the brain causing inflammation of the brain tissue, meningitis. Severe anemia and kidney impairment can also lead to death.

The most dangerous type of malaria is that caused by the plasmodium falciparum which can lead to complications and is resistant to some malaria drugs.

How Could I Get Malaria?: Female Anopheles mosquitoes carry the plasmodium parasite in their saliva and transmit the parasite to animals and humans when the female mosquito bites. The female mosquito is seeking warm blood to incubate and nourish her eggs.

The Centers for Disease Control in Atlanta also states that occasionally a person can get malaria through blood transfusions, organ transplants, needle sharing or congenitally, from mother to fetus.

Who Gets Malaria?: Anyone can get malaria in malaria endemic areas. Risk factors are:

• Living in, working in, or traveling through malaria endemic areas.
• Sleeping without a mosquito net.
• Malnutrition.
• Immunosuppression (for example, caused by HIV/AIDS).
• Not wearing clothing and shoes that cover skin.
• Not using insect repellent.

What are the Symptoms of Malaria?: The symptoms of malaria are:

• Chill
• Followed by a high fever
• And sweating.

These symptoms can present themselves at any time of the day.

Note: These symptoms may be accompanied by headache, vomiting, and watery diarrhea. Bloody urine may also be present. Jaundice and anemia can also be signs of malaria.

How is Malaria Prevented?: Prevent malaria by:

• Sleeping with a mosquito net treated with insect repellent. The best nets are made with fibers impregnated before fabrication of the net.
• Wearing clothes that cover skin, including feet.
• Using insect repellent that contains a minimum of 15-20 per cent DEET. Follow precautions present on insect repellent containers regarding the use of DEET on small children. DEET can be absorbed through the skin!
• Taking anti-malaria drugs. Malaria prophylaxis can be taken according to your doctor's prescription. Lariam, Malarone and Doxicycline are the three most effective anti-malarial drugs.

Who Should Take Malaria Prophylaxis?: Travelers and people who work in an area temporarily, usually not more than 9 months, although many people who work with international organizations have taken prophylaxis for up to two years or more. Long term use of malaria prophylaxis requires regular medical follow up.

Children weighing more than 25 pounds can take malaria prophylaxis adapting the dosis to their weight. Children can take Lariam or Malarone, but doxicycline should not be taken by children under 12 years-old.

Who Should NOT take Malaria Prophylaxis?: Pregnant women in their first trimester should not take malaria prophylaxis, but can take anti-malarial drugs in the second and third trimesters. Lariam is the most recommended malaria prophylaxis for pregnant women.

Children weighing less than 25 pounds should not take malaria prophylaxis. Children under 12 should not take doxicycline.

How is Malaria Diagnosed?: Malaria is diagnosed looking at blood from a finger prick under a microscope at 100 X magnification. Malaria is diagnosed when plasmodium are present in the blood film.

There are also rapid diagnostic tests (RDTs). In general RDTs are reliable and results appear in 10-15 minutes. The downfall to RDT's is that most RDTs only can detect P. falciparum malaria, although a few can also detect all four types of malaria.

How is Malaria Treated?: Very carefully. The treatment regime for malaria depends on the type of malaria present and any complications that may arise. The plasmodium must be eliminated from the body. In most endemic countries, malaria is highly resistant to chloroquine and Fansidar, the most common treatments.

New treatment protocols are based on ACT, Artemisinin Combination Therapy. These drugs are not approved in Europe or the US, but are used extensively in Africa by Doctors Without Borders and are highly effective.

One example is Coartem 20/120 produced by Novartis. Coartem contains 20mg Artemether and 120 mg Lumefantrine.

What to Carry for Malaria When There is No Doctor: Recommendations for those who cannot get to a doctor and suspect malaria should first try to get to a doctor. However, if it is absolutely impossible to arrive to a doctor or a hospital, one should take a three day treatment of Artemisinin Combination Therapy, ACT.

Note: ACT is not always the same combination of drugs. Find information from the World Health Organization (WHO), by country, regarding the best ACT for the place you are traveling. Fansidar and chloroquine are no longer recommended to treat falciparum malaria in most countries.

Treatment must be followed up with a visit to a doctor in order to treat possible complications like anemia, kidney, liver or brain diseases.

Source: Thank you to Oscar Bernal, M.D, MPH, Ph.D. for this updated information concerning malaria. Dr. Bernal is an infectious diseases advisor for Doctors Without Borders, a non-profit medical humanitarian organization he has worked with for over 10 years.

Dr. Bernal is a medical doctor from the University of Antioquia, Colombia with an MPH in international public health from Tulane University School of Public Health and Tropical Medicine and a Ph.D. in public health from the Autonomous University of Barcelona, Spain. Dr. Bernal's Ph.D. dissertation was to determine when a malaria outbreak becomes an epidemic. He has treated patients with malaria all over the world and has himself been infected with the disease on more than one occasion.

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