Alcohol Abuse Advice

Malaria Preventin and Travel

Malaria and travel

Malaria is a major international public health problem. There are enough statistics to prove the same and in order to protect ourselves against it , all it requires is common sense and an understanding of how the disease is spread.

To summarize, malaria is caused by a parasitic micro-organism called Plasmodium. Since there are four different types of Plasmodium that infect humans it stands to reason that there are four different types of malaria. There are a few other less common species but of limited health significance to us.

These parasites are transmitted by the female Anopheles mosquito. It is important to understand that only Anopheles can transmit malaria. If visiting an area endemic for or rampant with dengue , it would be useless and not to mention toxic , to binge on anti malarials since dengue is transmitted by a totally different mosquito – the Aedes species. Of course , standard mosquito repelling measures must be taken as usual since other mosquitoes transmit a fair number of other diseases as well.

The standard approach to dealing with this is traditionally described as ABCD

A – awareness

B – bite protection

C – chemoprophylaxis

D – diagnosis and treatment in case of infection

Awareness

This means to familiarize ourself with the area about to be visited … whether mosquitoes are present, what type of mosquitoes, what diseases are endemic , drug resistance patterns. Such information is constantly updated and hence it needs to be reviewed often.

Unnecessary panic is also unwarranted – in many cases mosquitoes are present but there might not be active malaria. Its good to follow local news and health reports to ascertain this.

Though many might be of the opinion that its safer to take the medicines before hand , sometimes it could be overkill.

Medicines – and in many cases high end ones, have to be started a week before and have to be continued for 2 weeks after returning from the area. It is an individual decision and there will always be arguments for and against it.

Bite protection

Anopheles mosquitoes generally have nocturnal feeding habits. Hence it is prudent to take maximum precautions during the evening and night. However , it must be kept in mind that other mosquitoes which are involved in spread of diseases like Dengue are daytime biters as well

Wearing clothes that cover arms and legs adequately as well as applying repellent on exposed areas usually works well – and in many cases obviates the need for taking medication. While sleeping its wise to use mosquito nets – those impregnated with repellents work even better.

A variety of insect repellents work , but the most effective one is DEET. Various formulations of varying concentrations are available and how often reapplication is required depends on the manufacturer.

Using electronic repellents which vaporize liquid formulations of insecticide is reliable .

They might be fancy pieces of equipment but most ultrasonic frequency emitters have been shown to be ineffective in repelling mosquitoes.

Often, the local practices for keeping the marauding insects at bay are most effective.

 

 

Chemoprophylaxis

This refers to the widespread practice of taking antimalarial drugs before , during and after the expected period of exposure to the mosquitoes. The idea being that it takes care of any parasites that might be in the blood as a result of a bite.

For the most part , all the routinely prescribed drugs are well tolerated , but side effects can occur. Mostly they are more inconvenient rather than outright debilitating , however in case of serious reactions , it goes without saying that medical attention is needed.

Drug regimes broadly fall into 2 types :-

Chloroquine resistant areas – where the parasite is no longer susceptible to chloroquine. This is the case with most areas. If not full blown – there is at least a moderate level of resistance. In such cases drugs such as Mefloquine, Doxycycline and Malarone ( Atovaquone + Proguanil) are the standard choices.

Chloroquine responsive areas – these are fairly rare in number . Chloroquine is rarely prescribed alone , its mostly given along with Proguanil.

A detailed review of dosages and side effects of anti malarial drugs, as well as special circumstances like pregnancy, is beyond the scope of this article.

Diagnosis and Treatment

In spite of all precautions , sometimes mosquitoes could find a chink in the repellent armor. If nothing else, they have sheer numbers on their side.

The good news is , malaria is very much treatable. In case there are no healthcare facilities nearby, it is wise to keep emergency medication ready. Consulting a doctor beforehand to understand symptoms of malaria and what to do in case you end up having it is a good idea.

 

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