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Wompom.ca
» Health
» Malaria - The Problem |
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Malaria - The Problem |
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Malaria is still a significant health problem in many tropical countries. After a
successful beginning, the programs instituted between 1955 and 1969 toward the goal of eradicating malaria ultimately
ended in failure. The continuation of ongoing control programs was not implemented, or only partially put into
operation in many countries for economic reasons. |
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An increase in malaria has even been observed in some countries. Besides inadequate
controls, improvements in the living conditions of the vactor mosquito due to human intrusions into the ecology are the
prime factors responsible for this. |
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In this context, the increase of food and energy production and the creation of fresh water
surfaces in conjunction with irrigation programs and energy extraction from water power have led to a considerable
expansion of mosquito breeding places. |
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Malaria - The Risk world-wide |
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The World Health Organization has estimated that 300 - 500 million persons become ill with
malaria annually. P. falciparum Malaria, caused by the parasite Plasmodium falciparum, is the most dangerous form of
malaria and almost exclusively responsible for the fatalities, with a current estimated annual rate of some 2 million.
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The most heavily afflicted persons are children. A partial immunity, brought about by a
weakened or non-apparent course of the disease, only happens after a large number of infections. |
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The geographic malaria distribution represents the extension of the malaria-vector
mosquito. Fluctuations of the malaria risk have been observed in many regions, due e.g. to seasonal changes of weather
or recently occurring parasite resistance. In higher altitudes, over 2.500 metres near the Equator and in other regions
over 1.500 metres, the malaria mosquito has not been found, which is why these regions have been classified as being
free of malaria. |
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There is a great risk of contracting malaria especially in the Sub-Saharan Africa to the
North of Namibia, Botswana and South Africa. High risk regions are also found in Central and South America, especially
in the Amazon basin, as well as in many regions of Asia, specifically Southeast Asia. |
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The World Health Organization (WHO) recommends chemoprophylaxis according to local parasite
resistance, and classifies the malaria regions in Zones A, B and C. In simple terms, Zone A represents the regions
which are sensitive to Chloroquine, Zone B the regions partially resistant to Chloroquine, and in Zone C there is
resistance to Chloroquine and other anti-malarial drugs (multi-resistance). |
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It must always be remembered that even within Zones A, B and C the risk of contracting
malaria is subject to seasonal changes, so that chemoprophylaxis must always be adjusted to the individual travel
situation. |
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Contact your physician for personal advice. A chemoprophylaxis is indispensable and useful
to avoid contracting malaria. In carefully examining benefits and risks and considering certain factors with your
physician, it is possible to decide on an individual basis whether or not a chemoprophylaxis is indicated. |
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Malaria - The Risk for Travellers |
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Over the past few years, an annual rate of approximately 1,100 cases of malaria infections
imported by Travellers were reported in the United Kingdom. The actual rate is probably much higher. In addition, it is
not known how many UK Travellers fall ill during a journey to the tropics and are then treated in the country they are
visiting. In the cases of German tourists returning home with the disease, the prevalent form by far since 1984 is P.
falciparum Malaria and is primarily accountable for the increase over the past years. |
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Over 60% of all malaria importations and some 90% of the P. falciparum Malaria cases were
acquired in tropical Africa. Fatalities occurred almost exclusively as a result of P. falciparum Malaria. While the
imported P. falciparum Malaria still ended in death in almost 10% of the cases in the seventies, the frequency of
fatality in the past few years could be reduced around 2 to 3%. |
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Fatality resulting from imported malaria is almost always preventable if the proper
therapy is administered in time. When it does occur, it is almost invariably because a diagnosis was not made or
was made too late because the possibility of malaria had not occurred to anyone. |
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Malaria - Prevention |
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Good protection against malaria is essential! |
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Simple and standard recommendations for malaria prophylaxis have become increasingly
difficult because of the continuous change of the malaria situation in the tropics and subtropics and of the increasing
resistance of the malaria parasite. |
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The accurate observance of prophylactic measures of protection against malaria offer no
absolute protection against an infection. |
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Basically, however, it can be assumed that careful and accurate prophylaxis during the
recommended period can considerably reduce the general risk of contracting malaria. |
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There are two forms of malaria prevention: |
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1 - Recommended Protection against Bites |
Mosquito Protection
Long-sleeved clothing, anti-mosquito sprays, creams,
lotions, mosquito nets, etc. |
Good Mosquito Protection
Every prophylactic measure increases the
effectiveness of protection!
Preventing mosquito bites not only reduces the risk of malaria infection by a factor of 10-20, it also prevents
other diseases transmitted by insects!
Helpful suggestions for good mosquito protection include:
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Wear clothes which cover as much of your body as possible
i.e. long-sleeved shirts,
long pants, socks covering the ankles. |
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Use insect repellents in cream, lotion or spray form on uncovered body parts.
The composition of the medium determines how long it is effective:
For
example, creams have a longer-lasting effect than sprays.
Common active substances: ethereal oils,
N,N‑Diethyl‑m‑Toluamide (DEET) or Dimethylophthalate |
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Use insecticides in form of aerosols, vaporisers, candles, smoke spirals or others in
living and, most of all, in sleeping areas. |
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Remain in mosquito-protected rooms after twilight and at night
e.g. in rooms with
air-conditioning or mosquito nets attached to windows and doors. |
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Hang a mosquito net over beds, if the room cannot be kept free of mosquitoes e.g. in cabins
or huts, tents, etc. |
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For country tours: select sites for sleep and rest at a distance from stale waters, ditches
and water barrels. |
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Avoid travelling in high-risk areas during the rain season. |
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In view of the fact that these measures of protection against mosquito bites are
practically free of risks, they should be carried out meticulously by all people travelling in areas of endemic
malaria. |
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2 - Protection against the parasite (use of medication) |
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The proper Anti-malaria medication must be selected by a physician for each individual
traveler through careful consideration of the benefits and risks. |
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The specific destination, travelling season and duration, style of travel and personal
circumstances (i.e. former diseases, intolerance, present medication, etc.) play an important part in this selection.
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Note: No effective vaccination against malaria will be available in the near future. |
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Malaria - Prevention through medication |
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The chemoprophylaxis is based on medical protective measures to destroy the parasite. Due
to increasing parasite resistance, there is presently no medication which offers 100% protection against malaria.
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After carefully weighing up the benefits and risks with a physician, the advisability of
malaria prophylaxis through medication must be decided individually and under consideration of certain factors.
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Decisive factors: |
Travel destination:
Is the travel destination an area of endemic malaria, if so,
to what extent? Is the risk of malaria infection all year or seasonal, does it involve the whole country or is it
limited to certain regions? The occurring malaria parasite variety is another important factor. |
Time of travel
Time is a significant factor: not only the travel duration but
also the season for which the trip has been planned. |
Style of travel:
Accommodations are also of great importance in considering the
malaria risk, i.e. whether the traveler will spend most of his/her time in air-conditioned hotels or tourist centers,
or whether he/she has planned a backpack trip through the country. |
Individual factors:
A number of factors are decisive in selecting the adequate
anti-malaria medication, as e.g. the health conditions of the traveler: medication intolerance, allergies,
immunodeficencies, regular medication, pregnancy, age, etc. |
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Malaria - How to recognize malaria |
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The typical symptoms of malaria are fever, malaise, headache, pain in the limbs, shaking
chills, and others. Basically, there are practically no complaints which cannot be connected with a malaria. |
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Therefore, every sign of illness during or after staying in a malaria region can be a first
indication of an infection. The variety of symptoms which might appear during a malaria aggravate a clear and simple
diagnosis. |
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A clear diagnosis is only possible by identifying the parasite in blood tests. The period
between arriving in the endemic region and possibly showing malaria symptoms ¨C incubation period - is of at least 7
days. |
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Every patient presenting unclear fever while staying in tropical regions, or after
returning home from the tropics, even after the lapse of several weeks and months, must be suspected of malaria until
the opposite has been proven. |
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Remember: a malaria chemoprophylaxis does not offer 100% safety against an infection, and
it might initially suppress the fever, so that only a slight temperature is noticed. Be watchful and remember that
every malaria is curable if diagnosed and treated on time! |
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