MALARIA – Do you really “KNOW IT ALL”?

An open letter by Dr Rick

I always enjoy fielding questions from concerned company representatives regarding malaria. You might be aware that there are both acute AND chronic complications associated with malaria.

Firstly, malaria is a lethal disease surrounded by a tremendous amount of myths and misconceptions. The latter flourish when you are trying to provide sound travel advice to seasoned expatriates that have already been working in tropical climates for longer than they care to remember. A lot of expatriates adopt the attitude that they “know it all” since they have been “working in Africa their whole adult life”.

As a clinician involved in travel medicine, I find it challenging to change this mindset. It is however, a challenge that I relish!

My discussion regarding malaria with a traveller usually starts off with the following statement:

Although you have been working in a malaria area for a long time, you are STILL at risk of developing SEVERE and COMPLICATED malaria. The idea that expatriates are “immune” to malaria is a misconception. “Semi-immunity” only develops in people that are born and reside in a malaria endemic area, suffering recurrent bouts of malaria. Semi-immunity in a population comes at a huge cost in terms of lives lost in the community in the process. Individual immunity is quickly lost if the person leaves the malaria area (typically within 3 years).

In Africa, malaria is the most important cause of death in travellers and expatriates, due to an infectious disease.

For this reason, expatriates are urged to consider malaria chemoprophylaxis.

 Other topics that are discussed during the pre-travel consultation include the “ABC of malaria” as per the World Health Organisation:

  • awareness
  • bite prevention
  • chemoprophylaxis (taking the drug)
  • diagnosis must be early
  • effective treatment

Complications of malaria can be acute and/or chronic.

As a clinician, my main concern when treating a patient with malaria is the acute complications. Without rattling off a whole list from a textbook, big concerns include

  • Acute kidney damage and failure.
  • Haemolysis (breakdown of red blood cells) and subsequent anaemia (low red cell count). In most cases this requires cautious transfusion of safe blood products (a luxury not commonly available in most third world countries).
  • Cerebral complications (neurological) including stroke, seizures and permanent brain damage. Often referred to as “Cerebral malaria”
  • Respiratory failure (in the form of ARDS – acute respiratory distress syndrome), which requires ventilation and carries a high risk of mortality despite offering ventilatory support.
  • Sepsis and septicaemia (generalised infection with OTHER bacteria as result of malaria) which also carries a high risk of death.

As you should see, there are other significant factors to keep in mind apart from malaria as disease in itself.

Malaria complications can result in numerous chronic issues, especially in the inhabitants of endemic areas. Examples include chronic anaemia, low birth weight, stunted growth and impaired neurological development.

Most importantly, the expatriate and frequent traveller NEVER develop any form of malaria immunity and are at risk of death every time they contract malaria, no matter how many times they “…have had malaria…”

Contracting malaria is an issue that employees should not take lightly because “They have been working in Africa their whole adult life and think they know it all”!

Malaria is a serious and often fatal disease. While myths, legends and folklore about its prevention and treatment abound, its risks are very real.

Contact the Travel Doctor for the unadulterated facts and suitable precautions.


Dr Rick