This Q & A interview is an abridged transcription of a video interview conducted with Dr Peter Vincent, head of the Tokai Medicross Hospital, in Tokai, Cape Town. Malaria remains a killer disease and any traveler to a malarial zone needs to understand the disease and how to combat it.

Uyaphi: What is malaria and how do you catch it?

Dr Peter Vincent: Malaria is a protozone parasite that’s transmitted by female mosquitoes. The important thing to know is that they are dusk to dawn feeders and that’s the time you have to protect yourself. If you don’t get bitten, you wont get malaria. During the day are more denge biting mosquitoes and quite often the areas of denge fever and malaria overlap. As I said, malaria biting mosquitoes bite from dusk to dawn and preventative measures you should take include wearing light weight long pants, preferably light coloured and long sleeve shirts.

Uyaphi: Are there different types of malaria?

Dr PV: There are four different types. Malaria falciparum which is endemic throughout Africa and that is the serious form which you can get cerebral malaria if it is not diagnosed early. It is mainly for this type of malaria you should be taking prophylactics and other preventative measures. Also in Africa there are plasmodium malariae and ovale (rare, mostly west Africa) and a rare type in south east Asia.

Uyaphi: Does every malaria develop into cerebral malaria which is the mostly deadly kind?

Dr PV: No. Cerebral is a complication of malaria if it is not diagnosed and treated quickly and early enough.

Uyaphi: If you are unlucky enough to come back from holiday and you do not feel well, what are the symptoms from which you can detect malaria?

Dr PV: Any fever, flu like symptoms. You can have vomiting. Coughs. With little children, changes in feeding. In general, any fever coming back from a malaria endemic region ought to be tested with blood samples to exclude malaria. It can be a life saving blood test.Any time from 10 days to 3 to 9 months after leaving a malarial area, you ought to demand a blood test if you are feeling unwell.

Uyaphi: How can you distinguish it from a common cold or a flu?

Dr PV: It can be difficult. Generally the fevers are higher and there is more sweating. But it is important that you tell your doctor that you have been to a malarial area. That is probably the most important lesson to be learnt from this interview. Have a blood test and follow it up so you can firmly exclude malaria.

Uyaphi: What are the best precautions and preventative measures you can take?

Dr PV: As we touched on earlier, light weight pants and long shirts. Put on a Deet containing lubricant which will disorientate mosquitoes and you can put on fabric sprays containing primetherine on your cuffs, collars and leggings.It is also useful to put around your bed and curtains in your room. Make sure you sleep under a mosquito net which is properly tucked in under your bed, make sure that there are no holes. Sometimes the nets themselves are treated. Also, if you sleep under a fan, it reduces the risk of being bitten by a mosquito.

Uyaphi: What drugs and anti prophylactics are recommended in modern medicine?

Dr PV: In Africa since we are chloroquine resistant there are only three alternatives. Malinol, known as Malarone overseas. It is an expensive drug but can be taken less of a time than the other two. You take one a day before you enter the area, then daily, then for a few days after you leave the area. Malinol can sometimes cause an upset tummy. Doxycycline, can make you a bit sun sensitive, it is taken with a full glass of water. It can be taken the day before you enter the area, daily in the area but for four weeks after you leave the area. Then lastly, Larium which is very effective and is a once a week tablet. Take two doses before you enter the area, weekly while you are there and then once a week for four weeks afterwards. However, Larium does have a bad reputation because if you have any psychological problems it does bring them to the fore.

Uyaphi: Apart from the side effects mentioned, are there any other problems?

Dr PV: People can react to all three drugs in different ways. Sometimes it is best having a test dose of each to see how you react especially with the Larium. Generally speaking, we would prefer to give the other two drugs to people with history of psychiatric problems.

Uyaphi: And for children?

Dr PV: There is a paediatric form of Malinol which works very well according to weight.It is bitter and best given with condensed milk or jam. It is taken on a daily basis like the adults. Larium for children from 5kg in weight also works very well.

Uyaphi: Is there anything else you would like to add about malaria?

Dr PV: Yes, there is a story which does the rounds that people should stay away from prophylactic drugs because you can mask the symptoms of malaria which is absolute nonsense. It is extremely important that you take the appropriate drugs. It can be a death sentence if you do not take the proper precautions. Things have to be weighed up. Obviously if you are staying in a 5 star hotel , you will be less likely to catch malaria than if you were staying in a tent by the river but in the end; if you are staying in a malarial area take the prophylactic drugs.

Uyaphi: Dr Vincent, thank you so much for speaking with us.

This interview is in no way comprehensive and we recommend that if you are travelling to a malarial area, you seek your doctors advice beforehand. Prevention is always better than cure. Malaria is a deadly disease and kills over 3000 children a day in sub- Saharan Africa.

Nicolas Edwards

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