How to manage Malaria

Cause

Malaria is carried by thee female Anopheles mosquito and infection occurs following a mosquito bite and the injection of the insect’s saliva containing the malaria parasite into the wound. The disease occurs in many parts of the world and is caused by a parasite called Plasmodium. There are four species of Plasmodium, the most dangerous of these being Plasmodium falciparum.

Presentation

Malaria usually presents initially with flu-like symptoms: headaches, muscle and joint aches, and fever. Severe shivering attacks (rigors) and high fever then occur and recur in a cyclical pattern every third or fourth day. In severe cases of Plasmodium falciparum malaria, the urine may become bloody (blackwater fever) or the brain may be affected with unconsciousness and convulsions (cerebral malaria).

Prevention

No drug provides 100% cover against malarial infection. Prophylaxis must involve both mosquito avoidance and antimalarial drugs. Mosquito avoidance involves:

•  meticulous application of insect repellent to exposed skin and clothing. The repellent of choice is N,N-diethyltoluamide (e.g. Peaceful Sleep, Mylol and Tabard lotions and sticks)
•  wearing long-sleeved shirts or blouses, slacks and socks between sunset and sunrise (the feeding time of the Anopheles mosquito)
•  moving continuously when outdoors at night (mosquitoes prefer a static meal)
•  mosquito screening on all doors and windows
•  spraying insecticide inside living quarters every day at dusk
•  burning insecticide coils in the sleeping quarters at night
•  sleeping under insecticide-impregnated mosquito nets tucked under the mattress.

Antimalarial drugs

The drug of choice depends on the area visited, the presence or absence of drug-resistant P. falciparum malaria, personal allergies and idiosyncrasies to antimalarial medication, drug interaction with any maintenance medication a diver may be using, pregnancy, age, health and the availability of the drug. Consult your doctor to determine the best choice of medication and to ensure that no untoward side effects or contraindications are present.

Chloroquine 150 mg tablet: In South Africa, with the exception of the Ingwavuma and Ubombo districts, all species of malaria are, to date, chloroquine sensitive. Preventative treatment should begin 24 hours before entering an endemic area. In adults and children over 12 years, two tablets are taken initially, repeated weekly on the same day while in the area, and then weekly for four weeks after leaving the area. Children aged six to 12 years take one tablet; aged one to five years take half a tablet (or 10 m syrup); aged six weeks to 12 months take 5 m syrup.

In areas where drug-resistant P. falciparum prevails (South-East Asia including Philippines, Thailand, Burma and China; Gabon and most of sub-Saharan Africa including the Comores and Madagascar; Sodwana; and the Ingwavuma and Ubombo districts of South Africa),
other antimalarial drugs are required.

Treatment

•  A doctor must always be consulted, if at all possible.
•  Self-treatment of malaria: Divers in remote malarial areas and without access to immediate medical treatment may be faced with the problem of an unexplained fever, headache, body aching and rigors. Self-treatment is potentially very dangerous.

 If malaria is suspected and there is absolutely no professional help available use:

• Coartem (artemether 20 mg, lumefantrine 120 mg) tablets. Take with food/fluids. Repeat dose if vomiting occurs within one hour of administration. An intensive three-day course is recommended. The dose depends on body mass. 

Children of 10-15 kg: one tablet initially, repeat after eight hours; thereafter one tablet twice a day for the following two days (total: six tablets). Children of 15-25 kg: initially two tablets as a single dose; repeat two tablets after eight hours and thereafter two tablets twice a day for the following two days (total: 12 tablets).
Children of 25-35 kg: initially three tablets as a single dose, repeated after eight hours; thereafter three tablets twice a day for the following two days (total: 18 tablets).
Persons of 35-65 kg: initially four tablets as a single dose, repeated after eight hours; thereafter four tablets twice a day for the following two days (total: 24 tablets).
For persons over 65 kg, the same dose (total: 24 tablets) is recommended.
With new or recrudescent infections, a second course is recommended.

• Fansidar (pyrimethamine/sulphadoxine) as a single dose (three tablets for adults, two tablets for ages nine to 14, one tablet for ages four to eight; half a tablet for ages under four).

NOTE: 

• Coartem and Fansidar are temporary measures only and a doctor must then be found and consulted urgently.
•  Safety in pregnancy and lactation has not been  established. Side effects have been reported and special precautions do exist. If at all possible, contact a doctor before using the treatment.