The Malaria Debate

If you pop down to your local pharmacy or travel clinic and mention that you will be travelling anywhere between north Sudan and north eastern South Africa, the doctor (or nurse as the case may be) will tell you that you are entering a high risk Malaria zone. Usually this zone is painted bright red and if you spend any prolonged period of time here you are pretty much guaranteed to get sick at some point, if not from Malaria then from a whole spectrum of other diseases and viruses all of which can leave you in a rather bad way. Luckily, a series of painful jabs will give you the upper hand in most cases but with Malaria things are a little different. Some Giardia in the system is another African experience to remember but we will leave that for another post. Usually on short trips you would take a course of malaria prophylaxis and you would be fine but taking these drugs for a longer trips is not always ideal.

The typical long term prophylaxis is Larium. You take it once a week and you can take it for ages (up to 12 months or something) but the problem is it does not agree with everyone and tends to induce vivid dreams and mood swings. I have taken Larium before and while I did not suffer any serious side effects I did feel somewhat depressed and irritable for at least 24 hours after taking it. I recently read that the veterans of French Foreign Legion are suing the French Government due to long term effects of being forced to take Larium when on operations.

An alternative to Larium is a popular prophylaxis called Malarone, a proprietary drug from GlaxoSmithKline, which is taken daily. It has very little side effects in most people but it costs a bomb and is more suited to short trips. It has an added benefit of being and effective treatment for malaria.

Other prophylaxis include doxycycline and the combination of Paludrine and Chloroquine. Doxycycline is essentially an antibiotic. It works well but it makes your skin very sensitive to sun light, which does not help when you are very close to the equator and don't have the luxury of being indoors. The Paludrine/Chloroquine combination used to be really effective until P.falciparum, the malaria prevalent in West, East and Southern Africa, built up a resistance to it and it has become effectively useless. Strangely enough the NHS and Boots still prescribe it.

So what do you take? Well you can take your chances with Larium or take out a loan and have a large(!) box of malarone or go colonial and drink tankards of gin and tonic and hope there is a enough quinine in the local tipple. Or you can not take prophylaxis and rather try and avoid getting malaria in the first place, and if this fails, have the necessary drugs to treat malaria. We have decided to go with this latter option.

Our preventive strategy is simple and involves wearing long sleeve shirts and trousers at night, sleeping under mosquito nets as well as the liberal use of DEET based mosquito spray. Should this fail, and there is not a clinic or hospital in sight (Plan A), we have a whole bunch of malaria test kits, a stash of plan B malarone for treatment purposes (4 tables daily) as well as a malaria treatment drug called Halfan, which is effective against P.falciparum and was develop by the US military following lessons learnt in Vietnam. There are mixed reports on the potential side effects of Halfan so this is our Plan C.