Lize Cornelius, a pharmacist from Somerset West, dispels some of the myths around malaria infection and educates us on ease of access to preventative medication.
With 18 638 confirmed cases in 2018 and 120 confirmed deaths, malaria is still a great concern in South Africa. Most malaria infections are caused by the parasite, Plasmodium falciparum, and are transmitted via the infected female Anopheles mosquito. Prevention is, therefore, still of utmost importance. Avoiding mosquito bites should still be the first line of prevention.
As a pharmacist, I would always recommend taking chemoprophylaxis (malaria tablets) if travelling to a malaria risk area – even if the risk is low. Although no anti-malarial medication is 100% effective, it will at the very least reduce the severity and progression of the disease (if not stop it completely). When weighing up risks vs. benefits, the benefit of taking chemoprophylaxis greatly outweighs any possible side-effects.
There are currently two options for chemoprophylaxis available in South Africa without prescription. Both options have very few side-effects, especially Atovaquone-Proguanil.
The following considerations can help one decide between the two options:
Compliance (duration of regimen)
The first option, Doxycycline, can be started one day before entering the malaria area. Take one tablet daily while in the area and daily for four weeks after leaving the area. Take at the same time each day. Take with a meal with a full glass of water. It is recommended not to consume Doxycycline at the exact same time as dairy products nor to lie down for at least one hour after dosing.
Atovaquone-Proguanil can also be started one day before entering the malaria area. Take one tablet daily while in the area and daily for seven days after leaving the area. Take at the same time each day. Take with a meal or milk.
From a cost perspective, Doxycycline is considerably cheaper than Atovaquone-Proguanil.
Doxycycline is contraindicated in children under 8 years of age whilst Atovaquone-Proguanil has a paediatric formulation for children weighing more than 11kg. That said, it is not recommended to take children under the age of 5 years into high-risk malaria areas.
The side effects of Doxycycline include skin photosensitivity, oesophageal ulceration, gastrointestinal symptoms, candida infection of the gut and vagina. Atovaquone-Proguanil, by contrast, is generally well tolerated although side effects may include headaches, mouth ulcers and abdominal pain.
Avoid travelling to high-risk malaria areas if you:
- Are pregnant and/or breastfeeding. The safety of Doxycycline and Atovaquone-Proguanil in pregnant patients has not been established.
- Are under 5 years of age.
- Are taking oral anti-coagulants (especially Warfarin).
- Are diabetic as you will especially need to monitor blood glucose levels.
- Are on epilepsy medication as some epilepsy medications could have can have interactions.
- Have severe renal or hepatic impairment.
- Are on ARV’s or anti-TB medication as some medications can have interactions.
- Have cancer or are taking anti-cancer medication.
Some facts about malaria worth knowing:
- Symptoms of malaria infections commonly develop 10 – 14 days after an infective mosquito bite, but this period may be prolonged (especially if prophylactic drugs have been taken). There have been some instances where symptoms have occurred months after being bitten.
- The symptoms of Malaria are very similar to flu-like symptoms.
- Female Anopheles mosquitoes buzz very softly, so one does not necessarily hear them and often their bites do not always leave marks either.
- Malaria is not contagious. It can only be transferred via the bite of an infected mosquito.
- Malaria chemoprophylaxis will not mask the symptoms if one gets malaria. This is a myth.
- Taking natural medicines to prevent malaria can be dangerous from both safety and effectiveness perspectives.
- It is vital to complete the full course of malaria prophylactic medication – even if you think you have not been bitten. This is to ensure that any parasites that may be in your blood or liver following a bite from an infected mosquito are killed.
- One does not develop immunity to malaria. People growing up in highly endemic areas who may have survived numerous malaria infections, may develop ‘semi-immunity,’ but the lose this very quickly after leaving these areas.