Malaria

How is malaria caused? :: Where am I likely to catch malaria?
How can malaria be prevented? :: Common myths

British backpackers are increasingly travelling to malarial areas of the world and each year around 2000 Brits come home having contracted malaria, one of the world's biggest killers. On average, nine of these people die whilst others end up seriously ill from a disease which is preventable.

We take a look at how the disease is caused, the malarial hotspots located around the world, ways to protect yourself (both in terms of not being bitten and in deciding which drug is best for your trip), how to recognise the symptoms of malaria, what to do if you think you may have contracted the disease, and we also dispel the many myths surrounding the disease.

How is malaria caused?

Malaria is an infectious disease caused by a bite from an infected mosquito. It is carried by the female Anopheles mosquito which tends to bite between late evening and early morning, with a peak around midnight. This mosquito needs human blood to nourish her eggs and once a person is bitten by an infected mosquito, the plasmodium parasite enters the blood stream and moves to the liver. Once there, it reproduces quickly before re-entering the bloodstream where it attacks the red blood cells. It can take from about one week to a year after being bitten for malaria to appear.

Where am I likely to catch malaria?

Malaria is endemic in over a hundred countries and travellers should always research the risk well in advance before travelling. As a general rule, the areas worst affected are those near the equator which are warm and wet but anyone travelling to Asia, Africa, South and Central America would be advised to seek medical advice. Generally speaking, rural areas are more at risk than urban areas although mosquitoes can fly several miles and also hitch a lift in a car, ship or plane! A high percentage of fatal malaria cases occur in sub-Saharan Africa.

For an interactive map showing which countries are malarial, click here.

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How can malaria be prevented?

Travellers should take a double-pronged approach to avoiding malaria. Firstly, they should do all they can to prevent themselves being bitten in the first place and, secondly, they should take anti-malarial medication so that if they are bitten by an infected mosquito they will not contract the disease.

How can I avoid being bitten?

Mosquito nets

Mosquito nets are a highly effective method of keeping mosquitoes away from people and are made even more effective if they are first sprayed with an insecticide. For maximum effect the net should be sprayed every six months so long-term travellers in malarial areas should bear this in mind. If for any reason you have washed your mosquito net on your travels it will need to be re-treated. Kits for treating mosquito nets are widely available and it is a relatively simple operation to carry out, even whilst abroad.

A search on the internet will reveal just how many different types of mosquito net there are on the market. Some require hanging hooks to be screwed into the ceiling (not always easy if you are staying in hostels or hotels) whilst others are free standing. Some are bell shape, others box shape, some are pop-up whilst others use lightweight poles like a tent. Some are lighter and less bulky than others and they vary in price too. Any good camping shop or travel shop will advise you on the best buy for your trip.

It is important to remember that it only takes one tiny tear to allow a mosquito through the net, rendering it useless, so be careful when packing and re-packing the net and, if a hole appears, repair it straight away with heavy duty tape or buy a new one.

Mosquitoes love dark places so when using your net make sure that you tuck it into your mattress, day and night, to prevent mosquitoes hiding under the bed and climbing inside the net. If you get up during the night, try to do so with as little disturbance of the net as possible.

Vaporizers

Insecticide vaporizers in the form of coils and sticks which are burnt are becoming increasingly popular, especially in parts of Asia such as India and China. They are, however, not particularly effective and there are a number of question marks over their long term use because of health concerns. Studies have shown that they can cause breathing problems, eye irritation, coughing, headaches, and even asthma attacks in people who had not previously suffered from asthma. Because of this, individual travellers need to weigh up the benefits against the risks before deciding whether or not to use these devices.

Slightly more sophisticated plug-in vaporizers use liquids and are advertised as being a very cost-effective measure. They are also less likely to cause the problems mentioned above.

Insect repellent

Chemical repellents come in a range of liquids, lotions, sprays, roll-ons, and impregnated wrist bands. The most effective contain at least 50% DEET.

Always follow the manufacturer's instructions about the best way to apply the repellent but the following tips are generally applicable:

  • If using a spray, do not spray directly on to the face. Instead, spray on to the hands and rub on to your face.
  • Use as soon as dusk falls and remember to re-apply as necessary (3 to 4 hourly in hot humid areas)
  • Avoid using near eyes, nostrils, lips, and mouth
  • Do not exceed the recommended dose
  • Wash hands thoroughly after use
  • Do not use on damaged skin or sunburned areas
  • If an adverse skin reaction occurs stop using and consider using a natural repellent instead (e.g. citronella, lemongrass or neem oils)
Protective clothing

Covering up in the evening when the mosquito is at its most active is a sensible precaution. Wear long sleeved tops and long trousers with socks, preferably in a thick enough material to prevent the mosquito being able to bite through the fabric.

Spraying clothing with an insecticide adds an extra layer of protection and repellent is in any case longer lasting when sprayed on to clothes rather than skin. Light colours seem to deter mosquitoes better than dark colours. It is possible to buy hats with netting which covers the face if you want to make sure that as little flesh as possible is exposed.

Air conditioning

Backpackers are generally on a tight budget but if you are flush enough to stay in accommodation with air-conditioning you will find that it is an effective way of keeping mosquitoes at bay.

Keeping them outside

Keep all windows and doors closed between dusk and dawn to ensure that the mosquitoes do not enter the room in the first place.

Anti-malarial medication

If you are unlucky enough to be bitten despite taking all possible precautions, your anti-malarial medication should hopefully prevent you becoming infected.
Of course no anti-malarial medication is one hundred percent effective so even if you have taken your tablets regularly you should still be alert to the possibility of having contracted the disease should you become unwell.

There are various anti-malarials on the market and you should seek medical advice from your GP or travel clinic on which is best well before your trip departure date (ideally at least eight weeks before). Much will depend not only on how much you can afford (none are available on the NHS and there are huge variations in price between the drugs), where you are travelling (different drugs are recommended for different parts of the world), and what sort of medical history you have (not all are suitable for everyone).

Make sure you take the tablets according to the manufacturer's instructions. You will need to start the course before you enter the malarial region, take them regularly when in the region, and continue taking them after you have left to take account of the incubation period of the disease.

All medicines have possible side effects and anti-malarials are no different, although many travellers take the drugs with no problems at all. By starting your regime in plenty of time, any side-effects can be addressed before you leave the UK.

Common side effects include the following:

  • Nausea - proguanil and chloroquine
  • Mouth ulcers - proguanil
  • Rashes - chloroquine
  • Temporary blurred vision - chloroquine
  • Photosensitivity (i.e. you are more likely to burn in the sun) - doxycycline
  • Thrush - doxycycline
  • Anxiety, depression, mood changes, and other psychiatric disturbances (especially in those who have suffered symptoms of this kind before) - mefloquine
  • Sleep disturbances - malarone

Probably the best tolerated option is Malarone. Although this is only licensed for one month's use, travellers have been using it for some time for stays of up to three months with no apparent ill-effects. Unfortunately it is the most expensive drug on the market.

There is no effective homoeopathic or herbal remedy against malaria and many travellers have discovered this to their cost.

Do NOT be tempted to save money by buying your medication abroad - you have no way of knowing whether the drugs are counterfeit or substandard and your life is worth a lot more than the savings you will make.

For country by country information on suitable drugs, click on this map.

How do I know I have malaria and what should I do?

Although symptoms can appear as early as a week after being infected and as late as a year, the most common time frame is ten days to a month.

Early symptoms include the following:

  • Fever
  • Shaking
  • Chills
  • Joint aches
  • Muscle pain
  • Headaches
  • Fatigue
  • Nausea
  • Vomiting
  • Diarrhoea

Later, more severe symptoms include:

  • Severe anaemia
  • Confusion
  • Coma
  • Breathing difficulties
  • Convulsions
  • Neurological damage
  • Kidney damage

Anyone travelling (or who has travelled in the last year) in a malarial region who experiences flu-like symptoms should seek medical advice. Malaria is a medical emergency and needs prompt diagnosis and treatment.

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Common myths

Some policies will provide you with a level of cover if you need to cancel any of or your entire trip. You should arrange for this part of the cover to start on the date that you book your holiday.

I'm hardly ever bitten - bugs don't seem to like me - so I don't think I'll bother taking anti-malarial pills.

It only takes one bite from an infected mosquito to contract a potentially fatal disease so be sensible and take the appropriate medication.

We're only staying in five star hotels so we should be OK.

Mosquitoes are unimpressed by the size of someone's monthly pay cheque - their blood will provide as good a feast as the blood of anyone else. Although a five star hotel is likely to have air-conditioning this is by no means a guarantee that you will not be bitten.

I always smother myself in DEET. That should keep the mossies away.

Whilst avoiding being bitten in the first place is an excellent idea, there can be no guarantee that repellent alone will mean you escape, so anti-malarial medication is an absolute must.

I've been bitten before and never had a bad reaction, unlike my partner who comes up in huge lumps and bumps. I reckon they're much more likely to catch malaria.

Everyone reacts differently to being bitten but this is no indicator of whether or not the mosquito was carrying the disease.

The list of side-effects scared me so much I have decided not to take any drugs - the side effects sound worse than the disease.

All drugs have side effects but by discussing your medication with a professional you can minimise the likelihood of suffering anything too unpleasant. At the end of the day malaria can kill or put you out of action for a long time so why take the risk?

My friend took a brilliant herbal remedy and didn't catch malaria - it's cheap, effective and has no side effects.

It may well be cheap and free of side effects but there is absolutely no scientific evidence that herbal or homoeopathic remedies are effective so don't take the risk and stick to the tried and tested methods of prevention.

I consume so much garlic/Marmite/tonic water that no mosquito will come near me.

Apocryphal stories abound on the efficacy of various foodstuffs but there is no hard scientific evidence to support them. The only way to prevent malaria is to avoid being bitten and take medication.

We're going to be travelling in the dry season so we'll be OK.

Although mosquitoes are more active in the wet season this is no guarantee that you will not be bitten in the dry season so you should still take the necessary anti-malarial medication.

I'm only having a two day stopover in a malarial area so it's not worth forking out for medication.

Again it only takes one bite to become infected. Seek advice from your doctor on what medication is needed and what length of course is advised.

You don't hear of many people dying of malaria - it sounds like a risk that I'm prepared to take.

With our appetite for travel to adventurous destinations growing by the year, the malaria risk has grown too. Every year 2000 Brits bring the disease home as an unwanted souvenir. Although only nine of these two thousand people die, it is simply not worth taking the risk.

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