Malaria, A complete guide

“What about malaria?”

It’s one of the most frequently thing people ask when they hear about our stints into the bush.

What you need to know about malaria

The disease is endemic to the area between the two tropics, including countries in sub-Saharan Africa, Central America and the backpackers’ darling, South-East Asia. But in al truth there is almost ZERO chance to get malaria in countries like Thailand, Laos, Vietnam, Cambodia, Philippines, Myanmar and Malaysia. We have been traveling for a decade to the region and heard of no confirmed case so far. On the other hand, you should be warned about Dengue fever. In Africa the malaria transmission zone begins with Mali/Senegal on the west coast, and with Ethiopia to the east. It ends with Angola, Zambia and Mozambique. In Kruger Park (South Africa), in Delta Okavango (Botswana) and in the Zambezi Region of Namibia(formerly known as the Caprivi Strip) there is limited risk of infection during rainy season. Check the appropriate maps for seasons and patterns of transmission of malaria or contact us.

Malaria is not a transmittable disease. You can only become infected with malaria if bitten by a female mosquito from the Anopheles species, that is carrying Plasmodium protozoa: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale or Plasmodium malariae. Remember, not all Plasmodium are made equal.

Anopheles mosquitoes are easily recognizable: they keep their body at a 45 degrees angle from the surface that they rest on.The most risky interval is at sunset during the rainy season, especially in an area with luck vegetation, marshes and water pools.

But let’s not get driven by paranoia. We should discuss the two main

Malaria myths:

1. Is there a Malaria vaccine?

No. There is no such thing, yet. The only effective way to not get malaria is prevention.

2. Will I die or carry lifetime after-effects if I become ill with malaria?

Malaria is indeed a tremendous killer. Every year up to 3 million people die from it, mostly children in Africa. The reason is utter lack of access to medicine and lack of adequate prevention education. If a person infected with malaria is treated in a timely manner with the correct medicine, after-effects are improbable.

When to worry

If you notice the following symptoms for at least 7 days and maximum 3 months since visiting a malaria zone during the transmission season: cyclic fever (body temperature rises in the second half of the day and subsides by dawn), shaking chills, body aches (in joints), feeling weak and powerless, vomiting, loss of appetite, cramps.

What to do if you believe you have malaria

First of all, don’t panic. The thermometer is your friend. I do hope you’re carrying one in your luggage, so start monitoring yourself right away. If it feels like a cold when it shouldn’t, if it feels like a ‘weird’ cold, you probably have malaria. The key to getting better is to get treatment as soon as possible. Confirm diagnostic with a doctor or pharmacist if possible, if not, try to validate your suspicions with local folk. Remember you have a short window of safety – between 48 to 96 hours, then unfortunately there is risk for potential complications. One of the most dangerous is a kidney failure and the first symptom you want to look for is urinary continence. If you cannot get treated right away, double your liquid intake and supplement with lukewarm tea, vegetable soup and coconut water.

If you are smart enough to carry the medicine with you, start using it immediately. Again, it’s best to talk to a local doctor or pharmacist. Do not be surprised if the locals suggest traditional medicine. Some of them do work. The very popular prophylactic Malarone can also be effectively used as support treatment in case of emergency. For proper malaria treatment in Africa, these are the most common formulas:

1. artesunate 200mg + sulfamethoxypyrazine 500mg + pyrimethamine 25mg. A deadly cocktail for all Plasmodium protozoa. Sold under 3 widely available brands:

FALCIDOX PLUS, Made by: Alisons, Belgium

Treatment scheme: 1 tablet/8 hrs or 1 table/day x 3 days. Total 3 tablets. Ana got cured with Falcidox in DR Congo. Our take on it: this medicine is a bit stronger, but fast and effective. Prepare for 24 hrs of hell. Try to eat and rest, even if you might not be able to do either. The perk: in maximum 2 days you’ll be back in the game.

LONART, Made by: Bliss GVS Pharma, India

Treatment scheme: 4 tablets/8 hrs x 3 days, total 24 tablets. John got rid of malaria with Lonart in Namibia. Our take on it: Lonart is gentler, but the treatment takes longer. If you can afford to linger, Lonart is a solid option.

ARTESUNATEDENK 200 PLUS, Made by: Denk Pharma, Germania

Treatment scheme: 2 tablets/zi x 3 days, total 6 tablets.

2. Artemether 20mg + lumefantrin 120mg. Sold under the common name COARTEM 20/120. The most popular with doctors and tourists alike. Made by drug giant Novartis. Treatment scheme: 4 tablet + 4 tablet 8 hrs after first dose + 4 tablet twice/day for the next 2 days. Total 24 tablets. Our take on it: Coartem works 100% and has no known side effects. I’d rather not say why I am so sure.:)

You’ll be surprised to learn that all these drugs cost between 3 and 10 euro/complete treatment. If you buy them in Africa. Sadly, for people forced to survive on less than a dollar a day, even this price is one they cannot afford.

What about malaria prophylactics?

Think 100 times before taking any. But if you insist to:

– poison your liver
– stress your immune system
– waste your money

you are looking at these prophylactic drugs:

Lariam

Pro: cheap, you only need to take one/week. Cons: strong side effects, from gastric acid reflex and vomiting, to hallucinations and psycho-somatic after-effects. Ok, you may be into recreational drugs, DMT or amanita muscaria. Then stick to the natural thing, man, and DON’T take Lariam.

Mefloquine

Con: obsolete formula, known to be effective on limited types of protozoa. Took it in vain in Sri Lanka in 2007.

Doxycycline

Pros: cheap as cheaps. Prescribed by all western doctors who are ashamed to admit they just don’t know. They say to take one tablet every day, with meals. Like most prophylactics, can be taken for 3 months while in transmission zone (plus 2 weeks before exposure and 2 weeks after). Cons: Doxy is in effect a large spectrum antibiotic. It will support in case of disease, so you will feel better, while masking the disease symptoms. Under Doxy you risk to underestimate your situation and to delay proper malaria treatment. Side-effects: nausea, extreme skin sensitivity to UVA/UVB (avoid sun exposure), weaken immune system (watch for skin ulcers, fatigue), interference with menstrual cycle (delays up to a couple of months), renders certain contraceptives ineffective.

Malarone

The most famous prophylactic, with little to no side effects, solid results in testing and great marketing. It’s expensive (12 tablets for 50 euro). Recently a cheaper Indian-made version has been released, with positive feedback from travellers. Must take 1 tablet/day, for the same maximum amount of time as Doxy. Like any other prophylactic, it cannot guarantee you will not get malaria.

How not to get malaria?

The safest thing you can do is to stay at home and not travel atl all. Now, we hope you won’t do that. Risk is part of adventure. You may get malaria in Africa, break your leg in Siberia or suffer with altitude sickness in Bolivia, or could catch a cold at home and regret your life in front of a TV. Best don’t get paranoid and take all things for what they are. Also you could:

Sleep under an impregnated mosquito net – or just spray some Dietiltoluamid (DEET) on your regular net.

Don’t wander around naked all day – starting with 4 p.m. you want to wear long pants and long-sleeved shirt in a thick loose fabric. Switch from flip-flops or sandals to socks and shoes.

Spray on your exposed skin and clothing proper anti-mosquito products. Forget supermarket brands. Those don’t work at tropics. Your product must contain DEET, we recommend INSECT ECRAN, CINQ SUR CINQ and BEN’S. They have milder formulas for sensitive skin and for children. Another solid option is organic Citronella oil.

Our favorite anti-mosquito products

Finally, do not forget that if you stay long enough in a malaria zone, in time you will build immunity. Enjoy your trip!