You've finally bought the 4x4. Holiday time is approaching and you really want to get away from it all. Where better than some of the more far flung parts of our own country? Somewhere along the line you've heard that malaria is a problem in these places. Is it really? Surely it can't happen to you?

It can, and it does!

The mosquito-borne disease is the number one killer across the continent, and has become the focus of a number of major projects in several countries.

The disease is infectious and consumes the red blood cells of its host, leading to fever, anemia, and in severe cases, a coma potentially leading to death.

A huge problem in Africa is that children most often succumb to the disease. Pregnant women also tend to have lower immunity and are vulnerable to severe forms of malaria to the detriment of themselves and their unborn children. Although some adults developed a semi-immunity to the disease, they were still susceptible to infection but contracted the disease in a milder form.

Cause

Malaria is caused by a parasite called Plasmodium, carried by female mosquitos. The anopheline mosquito is the usual host and most of the malaria seen in South Africa is caused by the parasite Plasmodium falciparum. The parasite lives in the blood stream of the mosquito and is passed into your blood stream as you are bitten.

How serious is malaria?

Worldwide, 10 billion people in 100 countries live with the risk of malaria infection. More than 300 million people will catch malaria this year and 2.5 million will die of it. Pregnant women and small children are particularly at risk. In South Africa malaria is becoming more common.

Where can you catch malaria?

Within South Africa, areas of the Northern Province, Mpumalanga and the north eastern part of KwaZulu-Natal below 1000 metres are know to be malarial — see maps for detailed information. The worst time of the year for malaria in South Africa is between October and May, peak holiday time.

The risk of malaria is high everywhere outside our immediate borders, except in the southern parts of Namibia and the whole of Lesotho. Within Namibia, the risk of malaria along the Kavango river and the Caprivi strip is high all year round. Other areas north of Etosha are risky from November to June.

Prevention?

If you are pregnant or have children under the age of five, reconsider your travel plans. There will be other opportunities and it's better not the take the risk of contracting malaria yourself, or exposing your young children to it.

There is drug prophylaxis (prevention), but that alone is not enough.

Preventing mosquito bites is the most important and effective way to prevent malaria:

• Mosquitos feed between dusk and dawn, so if possible, stay inside during this time.


• If you must go out wear long sleeved clothing, long trousers and socks.


• Put insect repellent on any exposed skin, taking care not to exceed the recommended dose.


• Sleep under a mosquito net or have netting across the opening of your tent or across windows wherever you are sleeping.


• Burn mosquito coils.


• If at all possible avoid camping next to marshy areas and bodies of water.


• In low risk areas or during winter these measures may be all you need to stop yourself getting malaria.

Anti-malarial drugs — prophylaxis

There are two types of anti-malarial drugs recommended for people visiting any of the high risk areas in southern Africa. These are chloroquine, (called Daramal), and proguanil, (called Paludrin), and mefloquine, (Lariam).

Chloroquine alone is not recommended because of the high incidence of resistance to this drug among southern African mosquitos. Begin your prophylaxis a week before going into the malarial area. Weekly doses should be taken on the same day each week. Carry on with the treatment for four weeks after leaving the area in case there are any parasites still lurking in your blood after you have left the area.

As with all drugs there are side effects. Both chloroquine and proguanil can cause headaches, nausea, vomiting and diarrhoea. Take the tablets with meals. Both can cause skin rashes and itching. Chloroquine can cause problems with vision, so if you use this drug regularly have your eyes checked annually.

Do not take mefloquine if:

• You are pregnant or planning pregnancy within three months.


• You are a child weighing less than 15kg.


• You have epilepsy.


• You have a history of depression or any other psychiatric disorder.


• You are on beta blockers, calcium channel blockers, digitalis or antidepressant therapy.


• You require fine co-ordination as in scuba diving, piloting a plane or mountaineering.

Side effects of mefloquine include dizziness, upset stomach, headache and general body aches and pains.

Warning!

Unfortunately there are some people who cannot take anti-malarial drugs at all, or only with difficulty. If you are epileptic, reconsider your holiday plans. If your visit is essential you can try using proguanil alone, not generally considered very effective, and take extra care not to expose yourself to bites. If you have prophyria you may use proguanil, but mefloquine should be avoided.

If you have either of these conditions, or are pregnant, consult your GP before making plans to enter malarial areas.

How do I know if I have caught malaria?

If you develop flu-like symptoms after leaving a malarial area, even if you have done all of the above, consult your GP and tell him/her that you have been in a malarial area. The latter is most important. Those of us who work outside malarial areas do not always think about malaria and if there is any suspicion of malaria it needs to be followed up urgently.