This article is meant as an educational resource and should not replace a visit with your doctor. The information in this article has been pulled from a variety of websites and referenced throughout the article and hyperlinked eg. .
When I wrote about travel insurance at the end of January, I had no intention of doing an article series on health and travel. Well, things change, and with each of your health and travel questions, I add another article to the series. This week I’ve decided to address Malaria and anti-Malarial methods.
Malaria– a parasitic disease that involves high fevers, shaking chills, flu-like symptoms, and anemia. 
Many of us have heard of Malaria. We’ve seen the disease played out in movies [my favourite is The Sheltering Sky] and in books. The reality of the disease can play out very differently. Malaria is caused by a parasite that is passed from one human to another by the bite of infected Anopheles mosquitoes.
Key interventions to control malaria include prompt and effective treatment with artemisinin-based combination therapies; use of insecticidal nets by people at risk; and indoor residual spraying with insecticide to control the vector mosquitos. 
Knowing the symptoms for Malaria is vital, as it is important to seek medical attention as quickly as possible (chance of you knowing which parasite you have is rare).
A classic (but rarely observed) malaria attack lasts 6-10 hours. It consists of a cold stage (chills and shivers), a hot stage (fever, headaches, vomiting) and a sweating stage (sweats, return to normal temperature, tiredness).
Classically (but infrequently observed) malaria attacks occur every second day with P. falicaparum, P. vivax, and P. ovale parasites and every third day with P. malariae parasite. A combination of any of the following symptoms can occur; fever, chills, sweats, headaches, nausea and vomiting, body aches, and general malaise. In countries where malaria is not common, these symptoms are often attributed to influenza or a cold.
There are several complications involved with severe malaria. [This list is not meant to scare the hell out of you, just as an FYI]
- Brain infection [cerebritis]
- Hemolytic Anemia [destruction of blood cells]
- Kidney failure
- Liver failure
- Pulmonary edema
- Rupture of the spleen leading to massive internal bleeding
Types of Malaria
There are 4 types of malaria parasite; Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae.
P. falciparum is the most dangerous of the four. This form of malaria is transmitted by the female Anopheles mosquito [I have no clue how to tell male from female, sorry]. P. falciparum has the highest rates of complications and mortality.
P. vivax is the most frequent and widely distributed cause of recurring malaria. P. vivax and is rarely fatal. P. vivax can cause death due to a pathologically enlarge spleen. In most cases, this malaria causes debilitating, non-fatal, symptoms.
P. ovale causes tertian malaria in humans. This type of malaria is rare and less dangerous than P. falciparum. P. ovale is limited to West Africa, the Philippines, eastern Indonesia, and Papua New Guinea. It has been reported from Bangladesh, Cambodia, India, Thailand and Vietnam.
P. malariae is found worldwide, and is considered a ‘benign malaria’. P. malariae causes fevers that recur at 3-day intervals. This malaria is popular in sub-Saharan Africa, south-east Asia, Indonesia, several islands of the western Pacific, the Amazon basin of South America.
There are several drugs on the market for to help prevent malaria. There is no such thing as an anti-malarial that is 100% effective. Antimalarial medicine should be accompanied by personal protective measures like insect repellant (think DEET), long sleeves, long pants, mosquito-netting etc.
Chloroquine – Weekly doses of 500mg (300mg base). Start one week before entering a malarious area, continue weekly during your stay and for four weeks after you leave. Plaquenil is an alternative for Chloroquine.
It is imperative to use mosquito bed net to avoid being bit by the nocturnal anopheles mosquito. Use repellants and insecticides.
Lariam – Take one tablet once a week. Start one week before entering the malarious area, continue weekly during your stay and continue for four weeks after you leave. (Lariam should not be taken by persons suffering from cardiac diseases, liver or kidney disorders, epilepsy, psychiatric disorders, pregnant women and children under 30 lbs in weight).
Malarone – Take one tablet (250mg atovaquone + 100mg proguanil) daily. Start one to two days before entering the malarious area, continuing daily during your stay, and continue for 7 days after leaving. Malarone should be taken at the same time every day with food or milk. Good for last minute travellers.
Doxycycline – Take one tablet daily of 100mg Doxycycline. Start one day before entering a malarious area. Take daily while in the malarious area and for four weeks afterwards. When taking Doxycycline avoid exposure to direct sunlight and use sunscreen with protection against long-range UVA. Drink large amounts of water to avoid stomach irritation.
Fake & Crap Anti-Malarial Medicine
Yes, they exist! Fake antimalarial is made to look like the real stuff (obviously), but they have no active ingredients. The question is, how do you avoid buying fake or substandard anti-malarial? Well… 
- Buy your drugs from your home country before you travel.
- Write down the generic name for the anti-malarial, as well as the manufacturer name.
- Make sure the drug is in its original packaging.
- Look at the packaging. Poor print quality, poor drugs inside!!
- Be suspicious of tablets that have a weird odour, taste or colour, or are brittle.
Global Malaria Risk
Malaria is present in over 100 countries. It’s a good idea to be aware of the types of malarial risk in the countries you’re visiting as this will help determine the type of anti-malarial regime you need. I’ve spent hours reading and transferring data on malaria risk in countries across the globe. This information was taken from the WHO and put in a somewhat simplified format [I’m fully aware that not all of you are interested in this kind of charts].
There is no malaria risk in: Albania, American Samoa, Andorra, Anguilla, Antigua and Barbuda, Australia, Austria, Azores, Bahrain, Barbados, Belarus, Belgium, Bermuda, Bosnia and Herzegovina, Brunei Darussalam, Bulgaria, Canada, Canary Islands, Cayman Islands, Chile, Christmas Island, Cocos Islands, Cook Islands, Croatia, Cuba, Cyprus, Czech Republic, Denmark, Dominica, Estonia, Falkland Islands, Faroe Islands, Fiji, Finland, France, French Polynesia, Germany, Gibraltar, Greece, Greenland, Grenada, Guadeloupe, Guam, Hungary, Iceland, Ireland, Israel, Italy, Japan, Jordan, Kazakhstan, Kiribati, Kuwait, Latvia, Lebanon, Lesotho, Libya, Liechtenstein, Lithuania, Luxembourg, Macedonia, Madeira Islands, Maldives, Malta, Marshall Islands, Martinique, Mauritius, Micronesia, Moldova, Monaco, Mongolia, Monserrat, Montenegro, Morocco, Nauru, Netherlands, Netherlands Antilles, New Caledonia, New Zealand, Niue, Norfolk, Northern Mariana Islands, Norway, Oman, Palau, Pitcairn, Poland, Portugal, Puerto Rico, Qatar, Réunion, Romania, Russia, St. Helena, St. Kitts and Nevis, St. Lucia, Saint Pierre and Miquelon, St. Vincent and the Grenadines, Samoa, San Marino, Serbia, Seychelles, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, Tokelau, Tonga, Trinidad and Tobago, Tunisia, Turks and Caicos, Tuvalu, Ukraine, United Arab Emirates, United Kingdom, USA, Uruguay, Virgin Islands, and Wake Island.