The end of Malaria Week in South Africa coincides with World Malaria Day today (November 9) as part of a campaign to draw awareness to the disease that affects between 200 and 300 million people each year and causes 1,5 million deaths, most of which occur in sub-Saharan Africa.

For travellers to malaria areas, the key concern is what precautions are most effective? In an age where increasingly mosquitoes have developed resistance to traditional anti-malaria drugs, should one rely on new stronger medication, or rely on wearing protective clothing and good insect repellent?

Mefloquine (otherwise known as Lariam) is one of the most popular and widely used anti-malarial drugs. Developed by Swiss pharmaceutical company Hoffman LaRoche, it came onto the market in the mid-1980s and has a proven success rate of 90%. It was developed as an alternative to chloroquine, a drug to which most mosquitoes have developed a resistance.

A spokesman for Hoffman LaRoche, Charles Alfaro says “Lariam has been used since 1985 by more than 12 million people worldwide for prevention of malaria.”

Despite its high success rate and popularity, mefloquine has been known to cause side effects that make some users feel as though they would have been better off contracting malaria.

According to the makers of mefloquine, severe side effects occur in 1 in 10 000 individuals. However, a study published in the British Medical Journal in 1996 argued that “0,7% or 1 in 146 travellers taking mefloquine can expect to have a neuropsychiatric adverse event unpleasant enough to temporarily prevent them from carrying out their day to day activities.”

Side effects reported by Hoffman LaRoche include ailments such as headaches, dizziness and stomach pains as well as more serious psychological changes such as depressive mood, confusion, anxiety, hallucinations, and paranoid reactions. While it is recommended that people with existing psychological disorders should not use mefloquine, two thirds of the people who experience neuropsychiatric and other severe reactions to mefloquine have solid mental and physical health histories.

Kristi Anderson is an American citizen who first took mefloquine on a visit to the Kruger National Park in 1991. Within the first few months she took mefloquine, she began to have panic attacks a few times a week, had difficulty sleeping, had horrible nightmares, and developed a fear of flying. “Prior to taking Lariam,” said Kristi “I had a responsible job for the federal government. Two years after taking Lariam, I could not understand why I had become a different person: a scared individual who had trouble taking care of herself.”

Given these side effects, it is no wonder that pharmaceutical companies have been working to create alternative anti-malarial drugs.

One drug to come on the market in the past two years is Malarone, which is a combination of the drug atovaquone with proguanil and has been proven to be 98% successful. Clinical trials have shown mild side effects that include upset stomachs and headaches, yet so far it has not been shown to have any neuro-psychiatric side effects like mefloquine.

In South Africa, malaria is found in parts of KwaZulu-Natal, Mpumalanga and the Northern Province. Last year, some 62 000 South Africans contracted malaria and 423 died from the disease.

According to Dr. Steve Toovey of the British Airways Travel Clinic in Johannesburg, “if you grow up and survive past age five in a malaria area, you will develop a degree of immunity.”

Government efforts to protect those citizens who live in malaria areas include the re-introduction of DDT spraying programmes and initiatives to distribute bed nets more widely.

According to the health minister, Dr Manto Tshabalala-Msimang, the use of DDT and the investment of an additional R39-million into the Lubombo Spatial Development Initiative, have reduced the number of malaria cases in the northern parts of KwaZulu-Natal by 70 percent
– Health-e News Service