What is malaria?

Malaria is by far the world's most important tropical parasitic disease, and kills more people than any other communicable disease except tuberculosis. There are four different forms, three of these (vivax, ovale and malariae) are often referred to as "benign" malaria: they will not kill you, though they may make you very ill. The fourth form, falciparum, is sometimes known as "malignant" or "cerebral" malaria; you can die within 48 hours of developing symptoms.

How is malaria transmitted?

Malaria is caused by a single-cell parasite transmitted by the bite of an infected anopheline mosquito, the number and type of which determine the extent of transmission in a given area. Once inside the body the parasite makes its way to the liver, where it incubates. Transmission of malaria is affected by climate and geography, and often coincides with the rainy season.

Where are the high risk destinations for infection?

More than 90% of all malaria cases are in sub-Saharan Africa. Malaria is endemic in a total of 101 countries and territories: 45 countries in Africa, 21 in the Americas, four in Europe, 14 in the Eastern Mediterranean Region, eight in South East Asia and nine in the Western Pacific Region. Malaria is re-emerging in areas where it was previously under control or eradicated such as in the central Asian republics of Tajikistan and Azerbaijan, and in Korea. The emergence of multi-drug resistant strains of the parasite is also exacerbating the situation.

What are the symptoms of malaria?

Symptoms of malaria include fever, shivering, pain in the joints, headache, muscle aches, tiredness, repeated vomiting, generalised convulsions and coma. Nausea, vomiting, and diarrhoea may also occur. If you or your child becomes ill with a fever or flu-like illness while travelling in a malaria-risk area and up to one year after returning home, seek immediate medical care.

How is malaria diagnosed?

It could be months or years before you experience the classic symptoms of malaria: a flu-like illness and a high fever. So, if you have been in a malaria-infected country and you develop a high fever it is important to see your doctor. A blood test is usually all that is needed to make a firm diagnosis. Treatment is usually straightforward if the disease is caught early.

How can malaria infection be prevented?

The only sure way is to avoid mosquito bites. Mosquitoes that transmit malaria, bite between dusk and dawn. Measures to prevent them getting through can be personal (individual or household), such as protective clothing, repellents, bed nets, or community/population protection measures such as use of insecticides or environmental management to control transmission.

Avoid mosquito bites by wearing long-sleeved shirts and long pants. Spray living areas and sleeping areas with an insecticide to kill mosquitoes. Use a mosquito bed net if you or your child is not sleeping in well-screened or air-conditioned housing. For greater protection, spray clothing with the insecticide permethrin and soak bed nets in it. Permethrin will repel insects for several months.

Portable mosquito bed nets, repellents containing DEET, and permethrin should be purchased before travelling and can be found in hardware, camping, and military surplus shops. Apply insect repellent to exposed skin. Other measures that protect against disease, but not against infection include medication (chemoprophylaxis).

Should I travel to a malaria-risk area during pregnancy?

No. It is best if you can postpone travel to a malaria risk-area during your pregnancy.

Do I need to take anti-malarials before I travel?

Yes, usually seven days before departure. In the early stages of malaria, anti-malarial drugs are useless because the parasite is "hidden" from their effects. This is why you must always take the pills for at least 28 days after your return.

Anti-malarials are only available by prescription through a healthcare provider. The kind of anti-malarial you are prescribed will be based on the area of the world in which you are travelling and any other medical conditions you may have.

Antimalarials include chloroquine or the more recently developed mefloquine. Doxycycline may also be prescribed. Drug resistance is an increasing problem.

What are the risks from taking anti-malarials?

Overdosage of anti-malarials can be fatal. Keep drugs in childproof containers out of the reach of children. Plan ahead; it will likely take three to four days for the prescription to be filled. Mefloquine and chloroquine taste very bitter. Anti-malarials should be taken exactly on schedule without missing doses. Mefloquine, which came into common usage in the mid 1990s, can cause dizziness, anxiety, depression and hallucinations in isolated cases. Buy anti-malarials in Ireland before travel overseas. The quality of anti-malarials sold outside the EU may not be reliable.

Do they offer total protection?

No. You can still get malaria despite taking anti-malarials. Seek medical advice if you are unwell following travel to a malaria infected area.

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