Malaria is caused by a microscopic sized parasite called Plasmodium.
This process involves a very complex mosquito - human being life cycle:
A female Anopheles mosquito itself infested with a Plasmodium parasite bites a human being. This parasite which has multiplied in the mosquito salivary glands is then injected into that person's bloodstream.
The Plasmodium parasite then moves to the human liver where it multiplies again. It is later released into the human blood stream which causes the symptoms of Malaria. The infected human being is subsequently bitten by another mosquito which in turn bites and transmits Malaria to another human being.
The commonest forms of Malaria are Plasmodium vivax which is rarely fatal and Plasmodium falciparum which can be fatal. The other forms, P.ovale and P malariae are not so important.
Incidence:
• Malaria is one of the 10 most prevalent and fatal diseases worldwide. Approximately 1.5 -2.7 million people die from Malaria each year with 300-500 million people infected at any given time.
• About 90% of cases are in sub Sahara Africa with most fatalities in young children in remote rural areas.
• About another 6-7% of Malaria cases are from India, Brazil, Sri Lanka, Vietnam, Colombia and the Solomon Islands.
• Indonesia has a relatively low incidence of Malaria especially large cities and major tourist areas e.g. Jakarta and Bali. Risks are greater in remote areas.
Prevention of Malaria
1. Be aware of the local incidence of Malaria:
• Not always easy to get this information.
• Overall risk in Indonesia is about 1:50,000 but varies greatly with location eg risk much higher in Irian Jaya than Bali.
• Likelihood of contracting Malaria increases with time spent in the area.
2. Reduce exposure to Mosquitoes:
• Obsessive prevention of mosquito bites reduces the risk of contracting Malaria about ten -fold.
• Use mosquito nets preferably treated with permethrin unless in reasonable standard accommodation in a low risk area.
• Spray an aerosol insecticide in your room before retiring.
• Use mosquito coils or vapourising mats containing pyrethoid.
• Cover arms and legs from dusk to dawn – the time when the female Malaria mosquito bites.
• Avoid dark areas or garden areas from dusk to dawn.
• Use mosquito repellents preferably those containing DEET eg “RID”, “Tropical Strength AeroGard”, “Autan” (a local brand).
• Wear light coloured clothing.
• Scent attracts mosquitoes –avoid perfumes and after shaves.
3.Preventive Medication:
• The objective of preventive medication is to prevent death caused by Plasmodium falciparum Malaria.
• No drug is 100% effective in preventing Malaria.
• Drugs do not prevent initial infection. Mosquitoes still bite and parasites will be transferred to your blood stream.
• It is reasonable not to take Malaria preventive drugs if you are only visiting a Malaria area for up to 3 days: Obsessive mosquito protection should be sufficient.
• The choice whether or not to take preventive medication is yours.
• Malaria may be up to 10 times more common in those who do not take any drug prevention in known Malaria areas.
• About 50% of people do not take the preventive medication as directed.
• All preventive drugs have side effects, usually but not always mild.
• Resistance to preventive drugs is a major problem. Assume all of Indonesia has Chloroquin resistance.
• Which preventive drugs to take depends on many factors. This should be discussed with your doctor.
Early Diagnosis and Treatment:
• Malaria has no specific symptoms eg it can mimic Flu, Pneumonia, Gastroenteritis etc. Shivering, headache & high fevers are common.
• Malaria symptoms usually occur more than 7 days after infection but symptoms may occur weeks or months later.
• ANY fever on return from or while travelling in Indonesia may be Malaria and MUST be investigated within 48 hours of onset. Young children and pregnant women are particularly at risk from Malaria. See a doctor and insist on a Malaria screen.
• If appropriate treatment is started by the fourth day of illness(not infection) then the adult Malaria patient is not likely to die.
• If you are travelling in an area more than 24 hours from medical help consider taking an Emergency Self Treatment Pack for Malaria. Further treatment on return home will still be necessary. Discuss with your doctor.
• Pregnant women and young children should think seriously about travel in known Malaria areas. Our advice is not to travel unless necessary.
Preventive Malaria Drugs:
Discuss preventive treatment with your doctor well before you leave. Your past medical history, any drug allergies, other medication you are taking, whether you are pregnant and the age of children traveling will influence drug choice.
The most commonly used Malaria preventive drugs are:
1. Doxycycline
• Dose is 100mg per day starting 2 days before travel and continuing for 4 weeks on return.
• Not suitable for pregnant women and children under 8 years.
• Common side effects: Nausea, indigestion, increased sensitivity to sunburn, thrush in females.
2.Malarone
• Dose is 1 tablet per day starting 1-2 days before travel, continuing 1 tablet a day and 7 days on return.
• Suitable for children(Malarone Junior)
3.Mefloquine ("Lariam"):
• Dose is one tablet per week taken on the same day each week starting one week before travel and continuing for 4 weeks after return.
• Suitable for pregnant women in the second and third trimesters and can be given to children over 3 months of age but discuss first.
• Common side effects: Nausea, vomiting, dizziness, headaches -usually transient. Occasionally confusion, anxiety, agitation, depression, sleep disorders. Incidence of all side effects is low but discuss with your doctor.
4.Other Drugs:
Fansidar, Chloroquin, Proguanil plus Chloroquin combination are also used but not usually recommended by your doctor.
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