Everything You Need to Know About Malaria

The Background of Malaria

Malaria is a life threatening disease caused by a single cell parasite and transmitted from person to person by the bite of a female mosquito. Between 300 and 500 million people become acutely ill and more than one million people die each year from malaria. Some 90 percent of deaths occur in sub Saharan Africa, especially in children under five, where it kills more than any other single infection. This equates to one child dying every 30 seconds. Children who survive severe malaria may suffer from brain damage, learning difficulties or paralysis. Pregnant women and their unborn offspring are also particularly at risk from malaria which is a major cause of infant death, low birth weight and maternal anaemia.

The disease was eradicated in developed countries many years ago but it continues to pose one of the biggest threats to health in the developing world, threatening some 40 percent of the global population who are living in the world's poorest countries. Nicknamed 'the disease that keeps poor people poor', It has also been identified as one of the top four causes of poverty. In areas where malaria is a constant threat, mosquito nets and medical interventions take money away from reinvestment in agriculture, absences from work as a direct or indirect result of malaria further reduce income and children miss out on opportunities to learn. It is estimated that some sub Saharan African countries spend nearly half their health budgets on malaria treatment and prevention, leading to a total economic burden of malaria in Africa alone which is estimated at some US$12 billion per year.

Why Malaria Is Harmful

Malaria can cause high fever, chills, and flu-like symptoms that can be life-threatening when not treated quickly. The disease is caused by Plasmodiumparasites, which are carried by Anophelesmosquitoes

Only female mosquitoes spread the malaria parasites. When a mosquito bites a person who already has malaria, it sucks up the person’s blood, which contain the parasites. When the mosquito bites its next victim, it injects the parasites into that person. That’s how the disease is spread.

Once the parasites enter your body, they travel to your liver, where they multiply. They invade your red blood cells, which are important cells in your blood that carry oxygen. The parasites get inside them, lay their eggs, and multiply until the red blood cell bursts.

This releases more parasites into your bloodstream. As they attack more of your healthy red blood cells, this infection can make you feel very sick.

Types of Malaria

There are five species of Plasmodium parasites that affect humans. Two of them are considered the most dangerous:

1. P. falciparum. This is the most common malaria parasite in Africa, and it causes the most malaria-related deaths in the world. P. falciparummultiplies very quickly, causing severe blood loss and clogged blood vessels.

2. P. vivax . This is the malaria parasite most commonly found outside of sub-Saharan Africa, especially in Asia and Latin America. This species can lie dormant, then rise up to infect your blood months or years after the mosquito bite.

Symptoms

Symptoms for malaria usually start about 10 to 15 days after the infected mosquito bite. Here are some things to keep in mind, though:

1. Because the signs are so similar to cold or flu symptoms, it might be hard to tell what you have at first.

2. Malaria symptoms don’t always show up within 2 weeks, especially if it’s a P. vivax infection.

3. People who live in areas with lots of malaria cases may become partially immune after being exposed to it throughout their lives.

A blood test can confirm whether you have malaria. Along with high fever, shaking chills and sweating, symptoms can include:

Throwing up or feeling like you're going to

Headache

Diarrhea

Being very tired (fatigue)

Body aches

Yellow skin (jaundice) from losing red blood cells

Kidney failure

Seizure

Confusion

Malaria can cause you to go into a coma.

Children with severe malaria may get anemia, a condition that happens when you lose too many red blood cells. They may also have trouble breathing. In rare cases they can get cerebral malaria, which causes brain damage from swelling.

When to Call a Doctor

Given how quickly malaria can become life-threatening, it’s important to get medical care as quickly as possible. Young children, infants, and pregnantwomen have an especially high chance for severe cases of malaria.

Seek care if you’re getting high fever while living in or traveling to an area that has high chance for malaria. You should still get medical help even if you see the symptoms many weeks, months or a year after your travel.

8 Fables About Malaria

1) “I always use mosquito repellent, so I won’t get malaria,” or “I’m taking malaria pills, so I won’t get infected.”

Malaria pills alone are not enough. You should also take other measures. And only applying mosquito repellent certainly isn’t enough. It takes just one malaria mosquito to infect you, and you will find those in the jungle as well as a four-star hotel. It is therefore a good idea to take malaria pills as well as applying repellent.

2) “I don’t take malaria pills, because of all the side-effects.”

The side-effects of malaria pills can be reduced by obtaining good instructions and adhering to them. Fables about side-effects are often based on experiences involving medication that were frequently prescribed in the past, but not anymore. There are various types of preventative medication for malaria, so if there are side-effects, you can always try an alternative.

3) ‘I take the malaria pills along with me and only start taking them if I start feeling ill.”

This is very unwise. Without proper blood analysis, you can never be sure that you have malaria. And if you do have malaria, you require a different dosage with a different type of pills. What’s also risky is that the initial symptoms are very similar to flu and may only present themselves one or two weeks after infection. The disease may develop very quickly after that and, if you don’t recognise the symptoms, it may be too late to get proper treatment and you may end up in coma.

Never underestimate malaria. It should always be treated under a doctor’s supervision.

4) “It’s annoying to keep taking pills so long after you have left the malaria zone.”

This is an exaggeration. The most commonly prescribed malaria pill, atovaquon/ proguanil, has to be taken for a week after leaving the malaria zone. Most other pills have to be taken for four weeks. This is because the pills work in different ways.

5) “Malaria tablets don’t prevent malaria, but ensure that the symptoms are less severe, which may cause the disease to go undiagnosed.”

This is not true. If you take the pills as instructed, they do not prevent malaria parasites from entering your body if you are bitten by an infected mosquito, but they do ensure that the parasites are killed very quickly, before they can cause the disease.

It also bears mentioning that, even if the disease is less severe, malaria parasites can be detected in a blood sample.

6)“I fly to malaria zones so often, it can’t be a good thing to keep taking those pills.”

I hear a lot of cabin and cockpit crew saying this. Over the years, experience has been gained with the use of atovaquon/proguanil over longer periods of time. Although the instructions sometimes say otherwise, medical experts agree that this medication can be used for longer periods of time without additional side-effects, health risks or reduction in the effectiveness of the medication.

7) “I’ll be staying in the hotel, so there’s no risk of me getting malaria.”

Although hotels make every effort to ward off mosquitos, there is a very real risk of catching malaria if you stay at a hotel. Every year, numerous airlines report cases of flight crew who have contracted malaria after spending just one night in a crew hotel.

8) “I’m pregnant and cannot therefore use DEET”

This is incorrect. According to guidelines from the Netherlands national coordination centre for travel advice (LCR), a mosquito repellent milk containing up to 30% DEET can be used safely throughout the entire pregnancy. Pregnant women are advised to avoid travelling to high-risk malaria areas entirely, due to the serious consequences for mother and child of a malaria infection. If the journey is unavoidable, malaria pills can be obtained which are safe to use during pregnancy alongside mosquito repellent.

Types of Malaria Tests

1. Thick and thin blood smears. These are the most common and accurate malaria tests. A lab technician, doctor, or nurse will take some of your blood and send it to a lab to be stained to make any parasites show clearly. The technician spreads it on a glass slide and looks at it with a microscope. A thin blood smear, also called a blood film, is one drop of blood spread across most of the slide. A thick smear drops the blood on a small area. A normal test does two of each.

The number of malaria parasites in your blood can change each day. So your test might say you don’t have malaria even if you do. For that reason, you may need your blood drawn several times over 2-3 days for the best results.

2. Rapid diagnostic test. Also called RDT or antigen testing, this is a quick option when blood draws and smears aren't available. Blood taken from a prick on your finger is put on a test strip that changes color to show whether you have malaria or not.

This test usually can't tell which of the four common species of malaria parasites caused your infection. Nor can it tell whether the infection is minor or major. Your doctor should follow up all results with blood smears.

3. Molecular test. Also known as polymerase chain reaction test, it can identify the type of parasite, which helps your doctor decide which drugs to prescribe. This test is a good choice if your blood has low number of parasites or if the results of your blood smear are vague.

4. Antibody test. Doctors use this to find out if you've had malaria in the past. It looks for antibodies that show up in the blood after an infection.

5. Drug resistance test. Some malaria parasites are resistant to drugs. But doctors can test your blood to see if certain drugs will work.

6. Blood test. In addition to other tests, you may also have your blood drawn for a blood count and chemistry panel. This can tell your doctor how serious your infection is and if it's causing other problems, like anemia or kidney failure.

Malaria Vaccine and Prevention

In recent years, there has been a lot of research into the development of a malaria vaccine, partly financed by the Bill & Melinda Gates Foundation. Because malaria is a parasite and not a virus, the development is a bigger challenge than it is when developing vaccines for viruses. Unfortunately, the results have been rather disappointing, which means a malaria vaccine for travellers is probably still a long way off.

Malaria can be prevented and cured! You can prevent malaria by taking malaria pills as instructed, in combination with a mosquito repellent containing DEET, wearing clothing that effectively covers your skin, and sleeping under mosquito nets (impregnated with insecticide).