Malaria in Africa is the most important disease hazard facing hunters. Malaria is widespread throughout most of Africa and is a serious and sometimes fatal disease.
Dark Green = Malaria Transmission areas, Light Green = Areas where malaria has been largely eliminated, Yellow = Malaria free
You cannot be vaccinated against this disease in Africa or elsewhere, but you can protect yourself in three ways:
Avoiding mosquito bites
Taking Anti-Malaria drugs
Prompt treatment
Avoiding Mosquito Bites
Mosquitoes bite at any time of day but most bites occur in the evening.
If you are out in the evening or night, wear long-sleeved clothing and long trousers.
Mosquitoes may bite through thin clothing, so spray an insecticide or repellent on them. Insect repellents should also be used on exposed skin.
Spraying insecticides in the room, burning pyrethroid coils and heating insecticide impregnated tablets all help to control mosquitoes
If sleeping in an unscreened room, or out of doors, a mosquito net (which should be impregnated with insecticide) is a sensible precaution.
Garlic, Vitamin B and ultrasound devices do not prevent bites.
Taking Anti-Malaria Drugs
Start before travel as guided by your travel health advisor (with some tablets you should start three weeks before).
Take the tablets absolutely regularly, preferably with or after a meal.
It is extremely important to continue to take them for four weeks after you have returned, to cover the incubation period of the disease. Malarone requires only 7 days post-travel)
Make sure you use a drug which you can tolerate and one which is appropriate for your destination(s).
No drug is 100% effective
Common Anti-Malaria Drugs
Chloroquine
Brands: Avloclor, Nivaquine
Consider a trial course before departure, if using this regime for the first time, to detect if you are likely to get side effects (e.g. for two weeks).
Chloroquine should be started one week before exposure (to ensure adequate blood levels), throughout exposure and for 4 weeks afterwards.
Nausea and sometimes diarrhoea can occur which may be reduced by taking tablets after food.
Headache, rashes, skin itch, blurred distance vision (which may take up to 4 weeks to reverse) or hair loss may warrant changing to alternative drugs.
Use with caution with liver and renal disease.
Can aggravate psoriasis and very occasionally causes a convulsion so it should not normally be used in those with epilepsy.
Proguanil
Brand: Paludrine
One or two doses should be taken before departure. It should be continued throughout exposure and for 4 weeks afterwards.
Anorexia, nausea, diarrhoea and mouth ulcers can occur.
Can delay the metabolism of the anticoagulant, warfarin, and result in bleeding. Those planning to take warfarin must discuss this with their doctor before starting any treatment.
Use with caution with renal impairment.
Mefloquine
Brand: Lariam
One dose should be taken a week before departure and it should be continued throughout exposure and for 4 weeks afterwards.
Three doses at weekly intervals prior to departure are advised if the drug has not been used before - this can often detect, in advance, those likely to get side effects so that an alternative can be prescribed.
Nausea, diarrhoea, dizziness, abdominal pain, rashes and pruritis can occur.
Headache, dizziness, convulsions, sleep disturbances (insomnia, vivid dreams) and psychotic reactions such as depression have been reported. These reactions most commonly begin within 2-3 weeks of starting the drug and may be worse if alcohol is taken around the same time.
Avoid in epilepsy or if there is a history of psychiatric illness.
Exercise caution, and avoid if alternatives are available, in severe renal and liver failure and heart rhythm defects.
Also caution in those taking digoxin, beta or calcium channel blockers when arrhythmias and bradycardia can occur.
Doxycycline
Brand: Vibramycin, Doxymal
Can normally be used continuously for a period of at least 6 months.
Consider a trial course before departure, if you are using this regime for the first time, to detect if you are likely to get side effects (e.g. for one week).
Doxycycline need only be started just before exposure (e.g. 2 days), continued through exposure and for 4 weeks afterwards.
Sunburn due to sunlight sensitivity can occur. Use of sunscreens is especially important and if severe, alternative prophylaxis should be used.
Heartburn is common so the capsule should be taken with a full glass of water and preferably while standing upright.
It may reduce the effectiveness of the oral contraceptive pill.
Taking the capsule in the evening should reduce the sun sensitivity during the day.
It is a good idea to take daily acidophilus medication to minimise the risk of a candidal (thrush) infection which incidentally can affect men as well as women.
Occasionally anorexia, nausea, diarrhoea, candida infection and sore tongue have been reported.
Atovaquone plus Proguanil
Brand: Malarone
DO NOT confuse with Maloprim
Should be taken for 1 or 2 days before entering the malaria area, throughout exposure, and for 7 days after leaving the infected area.
Need only be commenced one or two days before exposure.
Abdominal pain, headache, anorexia, nausea, diarrhoea, coughing and mouth ulcers can occur.
Absorption may be reduced in diarrhoea and vomiting, and blood levels are significantly reduced with concomitant use of tetracyclines, metoclopramide and some other drugs.
The proguanil component can delay the metabolism of the anticoagulant, warfarin, and result in bleeding. Those planning to take warfarin must discuss this with their doctor before starting any treatment.
Use with caution with renal impairment.
Prompt Treatment
There is no guarantee of complete protection from malaria in Africa.
If you get a fever between one week after first exposure and up to one year after your return, you should seek medical attention and tell the doctor that you have been in a malaria area.
