Minggu, 29 September 2013

Malaria Prevention

Malaria is a preventable and curable disease. Awareness and precautions, especially before travelling to an area endemic for malaria, is important for prevention of malaria. Travellers are most susceptible to bringing back infections. For example in 2010, over 1,700 travellers were diagnosed with malaria after returning to the UK. Most of these cases were acquired in Africa.

Four step approach to prevention

There is a four step approach to prevention of malaria:
1. Awareness of the risk of malaria and the risk of complications associated with it is the first step in prevention. Travellers to areas with a high incidence of malaria need to be aware of their risk and take adequate precautions.
2. Prevention of mosquito bites. A single bite is enough to transmit malaria infection. Adequate protection against mosquito bites is important. Simple measures like wearing covered clothes, using a mosquito net and using an insect repellent helps in preventing bites. Complete avoidance of bites is not possible however the number of bites may be reduced as much as possible.
All travellers and residents of high malaria risk areas are advised to stay indoors especially after dusk and keep doors and windows screened or closed to mosquitoes. A mosquito net especially ones treated with insecticide help prevent bites during sleep.
An insect repellent should be used on the skin and around the sleeping area. Those applied over the skin need to be re-applied frequently. The most effective repellents contain diethyltoluamide (DEET) and are available in sprays, roll-ons, sticks and creams.
Covered clothes also help prevent bites. Light colored, loose fitting, trousers, rather than shorts, and shirts with long sleeves are preferable particularly during early evening and at night when mosquitoes prefer to feed.
3. Antimalaria tablets for prevention of infection. A complete course of prescribed medication before, during and after travel is important in prevention of acquiring infections. This is called chemoprophylaxis and is useful for travellers.
Antimalarials are not 100% effective so taking steps to avoid bites is also important. Commonly prescribed drugs include Chloroquine, doxycycline, mefloquine, primaquin and atovaquone plus proguanil (Malarone) etc. Choloroquine needs to be taken for four weeks after return from travel. Malarone may be taken for one week after return.

Drug	Adult dose
Atovaquone (250mg) plus proguanil (100mg)	1 tablet daily
Choloroquine	300mg base tablets once weekly
Doxycycline	100mg orally daily
Hydroxycholoroquine sulfate	310mg base once weekly
Mefloquine	228mg base once weekly
Primaquine	30mg base orally daily

4. Immediate diagnosis after onset of symptoms helps prevent complications of malaria. Symptoms could appear after a year after travelling and this needs to be considered while diagnosing and treating malaria.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)

Sources

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