Malaria
in South Africa
About Malaria
Malaria is a mosquito-borne disease caused
by a parasite. People with malaria often experience
fever, chills, and flu-like illness. Left untreated,
they may develop severe complications and die.
Each year 350-500 million cases of malaria occur
worldwide, and over one million people die,
most of them young children in sub-Saharan Africa.
This sometimes fatal disease can be prevented
and cured. Bednets, insecticides, and antimalarial
drugs are effective tools to fight malaria in
areas where it is transmitted. Travelers to
a malaria-risk area should avoid mosquito bites
and take a preventive antimalarial drug.
Usually, people get malaria by being bitten
by an infected female Anopheles mosquito. Only
Anopheles mosquitoes can transmit malaria and
they must have been infected through a previous
blood meal taken on an infected person.
When a mosquito bites, a small amount of blood
is taken in which contains the microscopic malaria
parasites. The parasite grows and matures in
the mosquito’s gut for a week or more,
then travels to the mosquito’s salivary
glands. When the mosquito next takes a blood
meal, these parasites mix with the saliva and
are injected into the bite.
Once in the blood, the parasites travel to
the liver and enter liver cells to grow and
multiply. During this "incubation period",
the infected person has no symptoms. After as
few as 8 days or as long as several months,
the parasites leave the liver cells and enter
red blood cells. Once in the cells, they continue
to grow and multiply. After they mature, the
infected red blood cells rupture, freeing the
parasites to attack and enter other red blood
cells. Toxins released when the red cells burst
are what cause the typical fever, chills, and
flu-like malaria symptoms.
If a mosquito bites this infected person and
ingests certain types of malaria parasites ("gametocytes"),
the cycle of transmission continues.
Malaria in South Africa
Malaria is endemic in the Lowveld of Mpumalanga
and in Limpopo and in KwaZulu Natal, malaria
is endemic on the Maputaland coast. So if you
are travelling to the far north of South Africa,
please consult a heath-care professional for
the latest advice on malaria prophylaxis as
it changes regularly. In intermediate risk areas
(Kosi Bay, Sodwana Bay, Mkuze Game Reserve and
St Lucia Lake (not the town of St Lucia and
the river mouth), the use of anti-malarial drugs
is advisable only for high risk people from
October to May.

Anti Malaria Dugs
Drugs
and dosage for chemoprophylaxis |
Drugs |
Dosage |
Pros
and Cons |
Adverse
Effects |
Adults |
Children |
| Atovaquone
(250 mg) plus Proguanil (100 mg)
(Malarone®) |
1
tab. daily
|
11-20kg:
¼ tab. daily
21-30kg: ½ tab. daily
31-40kg: ¾ tab. daily
>40kg: 1 tablet daily |
Daily
dosing; only have to continue for 7 days
after exposure; not in pregnancy and lactation |
Nausea,
vomiting, abdominal pain, diarrhea, increased
liver enzyme levels;
rarely seizures, rash, mouth
ulcers |
|
Chloroquine
(Tablet with 150mg base) |
300
mg base once weekly |
5mg/kg
base weekly;
maximum 300 mg |
Long-term
safety known; chloroquine resistance reported
from most parts of the world; not for
persons with epilepsy, psoriasis |
Pruritis,
nausea, headache, skin eruptions, nail
and mucous membrane discoloration, partial
hair loss, photophobia, nerve deafness,
myopathy, blood dyscrasias, psychosis
and seizures |
|
|
|
Proguanil |
200
mg daily |
<
2 yrs: 50
mg/day;
2-6 yrs:100 mg/d
7-9 yrs: 150 mg/day;
>9 yrs: 200 mg/d |
Used in combination |
|
|
| Doxycycline
(100mg) |
100mg
once daily |
1.5mg
base/kg once daily
(max. 100 mg)
<25kg or <8 yr: Not given
25-35kg or 8-10 yr: 50mg
36-50kg or 11-13 yr: 75mg
>50kg or >14 yr: 100mg |
Daily
dosing required; not in pregnancy and
lactation |
Abdominal
discomfort, vaginal candidiasis, photosensitivity,
worsening of renal function tests in renal
diseases, allergic reactions, blood dyscrasias,
esophageal ulceration |
|
| Mefloquine
(Tablet with 250mg base, 274mg salt) |
250
mg base once weekly |
<15
kgs: 5mg of salt/kg;
15-19 kg: ¼ tab/wk;
20-30 kg: ½ tab/wk;
31-45 kg: ¾ tab/wk;
>45 kg: 1 tab/wk |
Weekly
dosing; occasional reports of
severe intolerance; not in first trimester
of pregnancy, breast feeding, high altitudes
or deep sea diving, patients with
epilepsy, psychosis, heart blocks, receiving
ß blockers |
Dizziness,
headache, sleep disorders, nightmares,
nausea, vomiting, diarrhea, seizures,
abnormal coordination, confusion, hallucinations,
forgetfulness, emotional problems including
anxiety, aggression, agitation, depression,
mood changes, panic attacks, psychotic
or paranoid
reactions, restlessness, ?suicidal ideation
and suicide |
Prevention
And while they describe the side effects,
warnings and contra-indications of the malaria
prophalaxis, they don’t mention that these
drugs will, in a lot of cases, make you feel
horrible. A better approach is don’t get
bitten. That’s not so difficult. There
are plenty of people who live in malaria areas,
and since you can’t take these drugs for
a sustained period of time, not getting bitten
is their only defense. And they manage. To protect
yourself, always use mosquito repellent (even
during the day) wear light, long sleeved shirts,
long pants and shoes and socks at night, and
sleep under a net or in a mosquito-proof room.
Even if you are taking oral malaria prophylactic,
you can still get malaria if you are bitten
by an infected anopheles mosquito, so a good
repellent is your easiest and most effective
precaution.
Malaria Symtoms
* fever
* chills
* headache
* flu-like symptoms
* muscle aches
* fatigue
* low blood cell counts (anemia)
* yellowing of the skin and whites of the eye
(jaundice)
When Symptoms Appear, Seek Immediate Medical
Attention. Malaria is always a serious disease
and may be a deadly illness. Travelers who become
ill with a fever or flu-like illness either
while traveling in a malaria-risk area or after
returning home (for up to 1 year) should seek
immediate medical attention and should tell
the physician their travel history. The sooner
malaria is treated the easier it is to treat.
|