Malaria week - Protect yourself from one of the biggest killers in Africa

Summer is here and we are - once again - at risk of contracting malaria. This is particularly true in sub-Saharan Africa where, according to the World Bank, 90% of acute malaria infections occur costing the continent more than US $12 billion per annum in healthcare expenditure and lost productivity. This figure is roughly the equivalent of all the aid provided to the continent each year.

14 November marks SADC Malaria Day and although malaria is not quite as prevalent in South Africa as in our neighbouring countries, travellers and holidaymakers in malarial areas need to take extra precautionary measures in order to protect themselves against this potentially lethal illness.

As part of the Government Employees Medical Scheme's (GEMS) ongoing effort to educate our members - and future members - on a range of healthcare topics, we would like to inform you about how malaria can affect your family and yourself and what to do about it.

The number of malaria infections and deaths is indeed staggering. According to UNICEF, (the United Nations Children's Fund), between 300 and 500 million people are infected with malaria while more than one million people die as a result thereof each year.  In Africa, where the disease is at its most prevalent, a child - most are under the age of five - dies of malaria every 30 seconds.  

Malaria is transmitted to humans by the female Anopheles mosquito. Business or leisure travellers are always at risk when entering a malarial area, especially within Mozambique, Swaziland and Zimbabwe. Although no preventative strategy is foolproof, there are certain critical lines of defence, which can be followed when it comes to malaria prevention. Even in our country, statistics from the Department of Health show that the low-lying areas of Limpopo, Mpumalanga and the north-east KwaZulu-Natal are still malaria hotspots.

Travelers should call on the help of a travel clinic or their local doctor. Recommendations of malaria preventative strategies should be tailor-made to suit the individual traveller as far as possible. The time of year, their travel itinerary, accommodation, expected activities, medical conditions and personal preferences should all be taken into account. Taking anti-malarial medication may be appropriate for some but not for others.
The following persons should think twice about entering a malarial area as they risk contracting severe malaria, which could be life threatening:

• non-immune persons
• children younger than five years
• pregnant women
• HIV-positive persons
• splenectomised patients

Despite all the information available in the public domain there is no substitute for a one-to-one consultation with a medical professional who can make an individual risk assessment. 
Even if you do take anti-malarial medication, you should adhere to the following preventative measures:

• Do not get bitten!

Personal protective measures against mosquito bites are the cornerstone of malaria prevention, whether in a high- or a low-risk area. It is therefore critical that you are aware of the risks of the area that you are travelling to or are deployed in. Also ensure that you:
o wear long-sleeved clothing and lightweight pants with thick socks from dusk until dawn when you are outside;
o sleep under mosquito nets;
o use lotions, sprays and coils to kill or repel mosquitoes;
o stay in rooms with screening in front of the doors and windows;
o use fans or air conditioners where possible.

• Be sure to take malaria chemoprophylactic measures as advised by your doctor or travel clinic

This is a critical line of defence. It is also important to remember that there are only three types of medication, namely Mefloquine, Doxycycline and Atovaquone plus Proguanil, that are effective in Africa. These medications, which are only 95 percent safe, are also suitable for long-term use.
Your medication requirements will be prescribed to you according to your age, whether you are pregnant, whether you have any other disease like epilepsy, the duration of your trip and the time of year you are travelling. Your allergies and activities such as diving or flying will also be taken into account.

• Be alert to any signs of illness after visiting a malarial area, no matter what time of year it is!

Please bear the following points in mind if you fall ill after returning from a visit to a malarial area, whether it's ‘low risk' geographically, or if your visit took place during a ‘low-risk' period:

Malaria can develop as early as seven days after entering a malarial area and for up to six months after leaving a malarial area;
Early symptoms include fever, flu-like symptoms (chills, headache, body aches, joint pain and coughing) as well as gastro-intestinal symptoms (nausea, diarrhoea, vomiting and abdominal pains).  If you have any of these symptoms, have yourself tested for malaria immediately;
Malaria can lead to serious complications, including cerebral malaria, severe anaemia and kidney failure, which can develop within hours, so immediate action is needed;
Please note that a negative test does not necessarily exclude malaria.
Strict adherence and compliance to ALL of the above lines of defence are needed to ensure maximum protection against malaria. By doing all of these you can ensure you or a family member do not become another malaria death statistic.

• Is there a vaccination against malaria available?

Unfortunately not yet, but research and studies to find a malaria vaccination are underway. The PATH Malaria Vaccination Initiative (MVI) consists of a team who are backed by the Bill & Melinda Gates Foundation as well as GSK Biologicals - the vaccines division of GSK. The MVI is currently carrying out clinical trials on a malaria candidate vaccine with the hope that it will protect children against malaria caused by Plasmodium falciparum - the most prevalent species in Africa.

The candidate vaccine has already shown promising results in a study which involved 2 000 children and infants in Mozambique over an 18-month follow-up period.

This represents a breakthrough in this field and demonstrates that a malaria vaccine is absolutely feasible. Conducted in partnership with a number of leading African research institutions, new studies are currently being undertaken in Gabon, Ghana, Kenya, Mozambique and Tanzania. This will determine the best formulation for the vaccine. If these third-phase trials are successful, we may just have a candidate vaccine submitted for regulatory approval as soon as 2011.  However, this vaccine must be seen as an additional weapon in the armoury against malaria and not as a replacement.