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Malaria is a disease caused by a parasite (germ) called plasmodium that lives in mosquitoes. The parasite is passed to humans from a mosquito bite. There are four types of plasmodium that cause malaria. These are called Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae. Most cases of malaria in the UK/Ireland are due to Plasmodium falciparum. This type of malaria is also the most likely to result in severe illness and/or death.

The risk of getting malaria is greatest if you do not take anti-malarial medication or do not take it properly.

The most common symptom of malaria is a high fever. Malaria can also cause muscle pains, headaches, diarrhea and a cough.

Note: if you feel unwell and have recently visited an area in which there is malaria, you should seek prompt medical advice, even if you have taken your anti-malarial medication correctly.

Preventing Malaria

There is an "ABCD" of malaria prevention. This is: Awareness of risk of malaria. Bite prevention. Chemoprophylaxis (taking anti-malarial medication exactly as prescribed). prompt Diagnosis and treatment.

Awareness of the risk of malaria The risk varies between countries and the type of trip. For example, back-packing or travelling to rural areas is generally more risky than staying in urban hotels. In some countries the risk varies between seasons - malaria is more common in the wet season. The main type of parasite, and the amount of resistance to medication, varies in different countries. Although risk varies, all travellers to malaria-risk countries should take precautions to prevent malaria.

Bite prevention

The mosquitoes which transmit malaria commonly fly from dusk to dawn and therefore evenings and nights are the most dangerous time for transmission.

You should use an effective insect repellent to clothing and any exposed skin. Diethyltoluamide (DEET) is safe and the most effective insect repellent and can be sprayed on to clothes. It lasts up to three hours for 20%, up to six hours for 30% and up to 12 hours for 50% DEET. There is no further increase in duration of protection beyond a concentration of 50%. When both sunscreen and DEET are required, DEET should be applied after the sunscreen has been applied. DEET can be used on babies and children over two months of age. In addition, DEET can be used, in a concentration of up to 50%, if you are pregnant. It is also safe to use if you are breast-feeding.

If you sleep outdoors or in an unscreened room, you should use mosquito nets impregnated with insecticides (such as pyrethroid). The net should be long enough to fall to the floor all round your bed and be tucked under the mattress. Check the net regularly for holes. Nets need to be re-impregnated with insecticide every six to twelve months (depending on how frequently the net is washed) to remain effective. Long-lasting nets, in which the pyrethroid is incorporated into the material of the net itself are now available and can last up to five years.

If practical, you should try to cover up bare areas with long-sleeved, loose-fitting clothing, long trousers and socks - if you are outside after sunset - to reduce the risk of mosquitoes biting. Clothing may be sprayed or impregnated with permethrin, which reduces the risk of being bitten through your clothes.

Sleeping in an air-conditioned room reduces the likelihood of mosquito bites, due to the room temperature being lowered. Doors, windows and other possible mosquito entry routes to sleeping accommodation should be screened with fine mesh netting. You should spray the room before dusk with an insecticide (usually a pyrethroid) to kill any mosquitoes that may have come into the room during the day. If electricity is available, you should use an electrically heated device to vaporise a tablet containing a synthetic pyrethroid in the room during the night. The burning of a mosquito coil is not as effective.

Anti-malarial medication (chemoprophylaxis)

Anti-malarial medication helps to prevent malaria. The best medication to take depends on the country you visit. This is because the type of parasite varies between different parts of the world. Also, in some areas the parasite has become resistant to certain medicines.

There is a possibility of antimalarials that you may buy in the tropics or over the Internet, being fake. It is therefore recommended that you obtain your anti-malarial treatment from your doctor's surgery, a pharmacist or a travel clinic.

The type of medication advised will depend upon the area you are travelling to. It will also depend on any health problems you have, any medication you are currently taking, the length of your stay, and also any problems you may have had with anti-malarial medication in the past.

You should seek advice for each new trip abroad. Do not assume that the medication that you took for your last trip will be advised for your next trip, even to the same country. There is a changing pattern of resistance to some medicines by the parasites. Doctors, nurses, pharmacists and travel clinics are updated regularly on the best medication to take for each country.

You must take the medication exactly as advised. This usually involves starting the medication up to a week or more before you go on your trip. This allows the level of medicine in your body to become effective. It also gives time to check for any side-effects before travelling. It is also essential that you continue taking the medication for the correct time advised after returning to the UK (often for four weeks). The most common reason for malaria to develop in travellers is because the anti-malarial medication is not taken correctly. For example, some doses may be missed or forgotten, or the tablets may be stopped too soon after returning from the journey.

Herbal remedies have not been tested for their ability to prevent or treat malaria and are therefore not recommended. Likewise, there is no scientific proof that homoeopathic remedies are effective in either preventing or treating malaria, and are also not recommended.

What are the side-effects with anti-malarial medication?

Anti-malarial medication is usually well tolerated. The most common side-effects are minor and include nausea (feeling sick) or diarrhea. However, some people develop more severe side-effects. Therefore, always read the information sheet which comes with a particular medicine for a list of possible side-effects and cautions. Usually, it is best to take the medication after meals to reduce possible side-effects.

If you are taking doxycycline then you need to use a high factor sunscreen. This is because this medication makes the skin more sensitive to the effects of the sun. Around 1 in 20 people taking mefloquine may develop headaches or have problems with sleep.

Note: medication is only a part of protection against malaria. It is not 100% effective and does not guarantee that you will not get malaria. The advice above on avoiding mosquito bites is just as important, even when you are taking anti-malarial medication. Symptoms of malaria (to help with prompt diagnosis).

Symptoms are similar to flu. They include fever, shivers, sweating, backache, joint pains, headache, vomiting, diarrhea and sometimes delirium. These symptoms may take a week or more to develop after you have been bitten by a mosquito. Occasionally, it takes a year for symptoms to develop.

This means that you should suspect malaria in anyone with a feverish illness who has travelled to a malaria area within the past year, especially in the previous three months.

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