Malaria is on the rise again – and children under five are particularly vulnerable. The good news is that it’s preventable and treatable, but take care. Read up on it for Malaria Week, November 5-9.

For November 2018

By Glynis Horning

Malaria season is in full swing and runs until May, with the Mopani and parts of the Vhembe district of Limpopo and the Mpumalanga lowveld, including the Kruger National Park, considered relatively high risk, says Dr Albie de Frey of Travel Doctor. ‘Parts of the Waterberg have joined northern KwaZulu-Natal as moderate risk areas, and requiring mosquito bite prevention.’

If you’re pregnant or have children and are planning to visit these areas for the December holidays, or neighbouring Angola, Botswana, Mozambique, Namibia, Swaziland, Zimbabwe and Zambia, take special care, he urges: ‘East and West Africa has seen a significant increase in malaria in the current rain season.’ Persons visiting friends and relatives (“VFR’s”) should take extra care to avoid malaria.

Although South Africa reported a substantial drop in malaria cases and deaths from 2010 to 2016, health authorities issued an alert this year of a rising risk. The Elimination 8 malaria programme to which all these countries belong has reported a 40% increase in malaria cases since 2015. The director general of the World Health Organisation issued a similar warning in the most recent WHO report on global malaria. ‘There is no room for complacency,’ says De Frey.

1 If at all possible, avoid the high-risk areas, especially if you are pregnant or have children under the age of 5. ‘Early recognition, diagnosis and treatment is very difficult in babies and toddlers,’ he says. The WHO reports that ‘new-borns and infants less than 12 months are one of the most vulnerable groups affected by malaria’, at increased risk of rapid disease progression, severe malaria and death. It adds that ‘during pregnancy, malaria infection in the mother can cause low birth weight and result in infant death’.

2 If you must go to these areas, be sure everyone wears garments that cover the body (long sleeves and especially long pants or leggings, socks and closed shoes), preferably in light colours, as mosquitoes seem attracted to dark ones, from dusk to dawn.

3 Liberally apply a repellent containing DEET (diethyltoluamide) to any skin still exposed. Ask your travel clinic or pharmacist for one suitable for children or babies, and test a little where they cannot lick it, before applying it. If also applying sunscreen, do so before applying repellent. Avoid essential oils such as lemon grass, citronella, eucalyptus or neem as they have no proven efficacy, says De Frey.

4 Get children indoors before sunset, when mosquitoes become most active, and don’t let them wander out before sunrise.

5 Choose accommodation with bed nets and fans or air conditioning, as mosquitoes avoid cooler areas and moving air.

6 Ask your travel doctor about preventative treatments such as atovaquone-proguanil, doxycycline or mefloquine. ‘Dosing depends on the specific prophylactic used, the child’s age, weight and any medical conditions he or she may have,’ says De Frey. ‘Some agents have minimum age or weight restrictions.’

7 Even after taking precautions, it is still possible to get malaria (medication is up to 90% effective), so be alert to symptoms: They typically occur 7 to 10 days after an infected mosquito bite, but may emerge only weeks and even months after returning from a malaria area. Symptoms include moderate to high fever, sweating, chills and shivering, headaches, muscle pain, drowsiness, loss of appetite, nausea, vomiting, stomach pain and a cough or breathlessness. These can easily be mistaken for flu or diarrhoea, so always tell your doctor you have been to a malaria area, so a blood test can be done to rule it out.

8 ‘The diagnosis and correct treatment of malaria is a medical emergency, and must not be delayed for any reason,’ warns De Frey. To minimise the risk of complicated (cerebral) malaria, the diagnosis must be made in the first 3 days from the onset of symptoms. The diagnosis and treatment of malaria in pregnant women and children is even more urgent and must be done by a specialist in hospital. Treatment may be with tablets but very often will require injections in these cases. ‘Home care is not an option.’