MALARIA GUIDE UK VERSION .pdf
Nom original: MALARIA GUIDE UK VERSION.pdf
Titre: Microsoft Word - GUIDE CONSEIL PALUDISME ENG.doc
Auteur: Aude GIRARD
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Guide for Residents of Tropical Areas
where Malaria is Prevalent
And more precisely, in its most
dangerous form :
« PLASMODIUM FALCIPARUM »
In Memory of Aymeric Girard
Who died on May 10th, 2010 in Dakar
From Plasmodium Falciparum Malaria.
He was only 7 years old.
Who is this guide aimed at ?
This guide is aimed at anybody who has made the choice to travel for a few months, or
years, to tropical or sub tropical areas.
It has been written with the help of Doctor Strady, a doctor in the Infectious and
Tropical Diseases Department of the Reims Hospital in France. I would like to thank him
for his availability and his humanity.
Let’s stop burying our heads in the sand ! Every year, 350 ‐ 500 million people are
infected and more than 1 million die from malaria. In France alone, there are between
6500 and 7000 cases of imported malaria. Some cases are fatal.
Malaria is an illness caught through the transmission of a parasite by a mosquito. Only
the female mosquito bites as she needs certain elements contained in blood to produce
eggs. She only bites between sunset and daybreak.
Before leaving on your trip, like many travellers, you will go and see your doctor, nurse
or pharmacist or go to a travel clinic to check if there is malaria in the country you are
travelling to. You will have the necessary vaccinations and you will be given advice
regarding any health risks.
With malaria, there is no vaccine. You may be given advice on how to prevent malaria.
You may be advised not to take anti‐malarial tablets for a long length of time due to the
side effects of these drugs. Some doctors may advise you to take the drugs for a few
months but then to stop. Others may suggest you take the drugs during and after the
rainy season. Others may even advise you take nothing. Among all this conflicting advice,
you need to make a decision for the well being of your family.
There is official advice through the National Travel Health Network
The French Health Ministry recently published the following advice for long stays in
«To prevent malaria it is necessary to arm patients with indepth information
and in written format. We must insist on protection from mosquito bites (mosquito
nets, insect repellent, etc…).From the 1st trip, a course of Chemoprophylaxis
(malaria tablets) adapted to the level of resistance, should be followed for at least
the first 6 months. Past 6 months, and knowing that taking antimalarials for
several years is unrealistic, the chemoprophylaxis course can be adapted by local
doctors. Intermittent courses of the antimalarials should be considered during the
rainy season or when visiting rural areas. It is indispensable that if a fever should
manifest itself, the patient should see a doctor straightaway. Patients should be
aware that the risks of malaria persist even on their return to an uninfected area,
particularly during the first two months. »
The prophylaxis is not a guarantee against infection, but it increases the body’s
resistance to malaria and in some ways prepares the body to fight against the disease.
If you go to risky areas with a baby or small child, closely follow the prescription for
anti‐malarial syrup that your paediatrician will prescribe.
Anybody can get infected. Nobody is safe.
After a while we start to fall into bad habits, we forget to protect ourselves and this is
when the risk is at its highest.
Contrary to other guides covering the same subject, this one is going to start the other
Most existing guides start by giving advice as to preventative measures. These measures
are necessary but you must remember that these are not 100% effective. Certain
prospectuses provide a description of the most frequent symptoms. You will sometimes
find information on « Plasmodium Falciparum » which is the most dangerous and deadly
form of malaria. Whatever the symptoms, as soon as there is even the slightest
temperature, you must consider malaria.
But before talking about preventative measures or disease symptoms, this guide will
start by providing advice to families returning to Europe on holiday, with or without
children; and to grandparents or other relatives who look after children visiting from
This guide will then provide advice for friends and relatives who may decide to come to
visit you in infected regions, before addressing preventative measures and common
symptoms of malaria.
ADVICE TO RESIDENTS
1. Returning to Europe on holiday
The year has been great. You have made the most of the wonderful country you are
currently living in. The children have settled into their new schools and are happy. The
school holidays arrive and you decide to return to Europe for a few weeks. In some cases
you may decide to return to Europe for the summer or you may decide to send the
children back to Europe to go to a summer camp or stay with their grandparents.
You no longer think of malaria as you have left the infected region. You are wrong!
The first symptoms of malaria appear between 7 days and 2 months (for the most
deadly form) after the insect bite. The people in charge of your children (or you) will call
a doctor if the children get a fever, sweat or have muscular pain. They/You may forget to
mention that your children live abroad. The doctor may diagnose flu, a stomach ache or
constipation. In the case of malaria, each day counts.
Noone is safe !
Which is why, at the SLIGHTEST FEVER (even a very light one), you (grandparents,
relatives, the childminder or even your children) MUST ABSOLUTELY CONSIDER
THAT IT COULD BE MALARIA BEFORE CONSIDERING ANY OTHER DIAGNOSIS. If
possible, go directly to the Accident and Emergency Department of the nearest
hospital and ask for a blood test, peripheral smear study and/or a Quantitative
Buffy Coat (QBC) (learn these names off by heart if necessary).
We often hear about these tests without knowing what they are. Here are some simple
‐ The Peripheral Smear Test :
Light microscopy of thick and thin stained blood smears remains the standard
method for diagnosing malaria. It involves collection of a blood smear, its staining
with Romanowsky stains and examination of the Red Blood Cells for intracellular
malarial parasites. Thick smears are 20–40 times more sensitive than thin smears
for screening of Plasmodium parasites.
In falciparum malaria, parasites may be hidden in tissue capillaries resulting in a
falsely low parasite count in the peripheral blood. In such instances, the
developmental stages of the parasite seen on blood smear may help to assess
disease severity better than parasite count alone. One negative blood smear
makes the diagnosis of malaria very unlikely (especially the severe form);
however, smears should be repeated every 6–12 hours for 48 hours if malaria is
The smear can be prepared from blood collected by venipuncture, finger prick
and ear lobe stab. In obstetric practice, cord blood and placental impression
smears can be used.
This is a new test that is very simple to use and can be bought in pharmacies.
The test contains all of its staining agents within a single tube. Blood is
collected by a finger prick and then centrifuged in the QBC centrifuge for 5
minutes. Since the tube has been concentrated by centrifugation, the malaria
parasites will be concentrated and it can be quite simple and fast to get a
If you are going to an isolated area, you should take a box of « COARTEM » or
« RIAMET » or « LARIAM » or « MALARONE » in your suitcase, and follow the
instructions as soon as even a small fever is detected, just in case. Go to your doctor
before you leave. He will prescribe the anti‐malarial. But don’t think you needn’t go to
your nearest emergency medical centre. You must get a test to have a quick and reliable
2. When your family come to visit
We tend to be careful to begin with and then lapse. Anti‐malarials are expensive.
Nothing has happened to you so you say to your visitors that there is no need to worry
and you will be careful when they get there.
Again, you are wrong !
Your family/friends are only coming for a few days/weeks so it is essential they take the
anti‐malarials prescribed by their doctor. The prescription must be followed to the letter
and the anti‐malarials must be taken before, during and for several weeks after the trip
(depending on the drug). There are certain exceptions for people taking other
medication or with certain medical conditions, but only doctors are in a position to make
Your friends and relatives should NOT stop the medication when they return home just
because they think they have not been bitten!
You hear sometimes that people do not want to take the anti‐malarial drugs because it
makes them feel ill. Try to take the pill at a regular time, ideally in the morning, with a
dairy product and with food. This helps a lot.
You MUST INSIST that your friends/relatives take anti malarial drugs. You will feel very
guilty for the rest of your life if anything happened. Remember that.
There is no exception for friends/relatives already living in another country where
malaria is present. The fact that they are coming to another country with malaria makes
them more vulnerable. It is best to advise them to take a course of anti‐malarials,
You have just arrived in your new home country. The removals van is in front of your
new house and you are moving in. Perhaps you are currently staying in a hotel or other
temporary accommodation while you wait for your new house to be ready/available.
One of the first things to do is to buy mosquito nets impregnated with insecticide for
each member of the family. If you are not sure you will find them in the country you are
going to, buy some on the Internet (there are several sites) or from your pharmacist
Every evening check that there are no holes in the mosquito net, particularly at the
edges and tuck it into the bed to make sure there are no possible entry points. Always
cover your baby’s cot before going to bed.
Do not think that mosquito nets are unnecessary. Sleeping in an air‐conditioned room
does not mean that you are protected. Mosquitoes don’t like air‐conditioning but it does
not kill them or prevent them coming in to the room.
You can also use anti‐mosquito plugs in bedrooms. You plug them in but if there is a
power cut and you don’t have a back‐up generator, there is a risk that you become
When you go out in the evening, make sure you wear long sleeves and long trousers.
Always keep anti‐mosquito spray on you at all times as you never know when or for how
long you will be outside. If possible re‐apply anti‐mosquito spray every 4 hours. Before
going to bed, have a shower to remove the cream. Never use an adult spray on a child
and vice‐versa. The doses are different. Protect babies and children. Some parents,
rather than put chemicals onto their babies skin, prefer to mix ordinary body lotion with
lemon eucalyptus oil (found in most pharmacies). It smells good and is less of an irritant
than most of the anti‐mosquito lotions available on the market.
If you are going to dine outside, think to light anti‐mosquito candles. You can leave them
under the table. They diffuse an odour that mosquitoes hate.
EVEN IF THEY ARE NOT 100% EFFECTIVE, IT IS ESSENTIAL TO FOLLOW
RECOMMENDATIONS TO ENSURE MAXIMAL PROTECTION.
Malaria is vicious as the symptoms are not always the same or obvious.
Certain symptoms must be taken very seriously and you should consult a doctor
‐ Muscle pains
Some of these symptoms could be mistaken for flu.
But be careful, as the most serious form of malaria, « Plasmodium Falciparum », is
difficult to detect as the symptoms are not always very noticeable, especially in
The fever can be low
There may be a stomach ache with diarrhea and/or constipation.
ONLY ONE THING TO REMEMBER : AS SOON AS A FEVER MANIFESTS ITSELF,
HOWEVER SMALL,THE RISK OF MALARIA MUST BE CONSIDERED BEFORE ANY
You must ask for a malaria diagnostic test (smear and/or QBC) even if they are
considering a different diagnosis. Listen to your instincts !
Malaria can become fatal within only a few days. In the case of « Plasmodium
Falciparum », the parasite transmitted by the mosquito into the person’s blood, travels
to the liver and then into the red blood cells where they grow and multiply and infect the
whole body. It can attack the brain (cerebral malaria), the lungs or the digestive tract.
My name is Aude Girard. My beloved son, Aymeric, died at the age of 7yrs old
on May 10th, 2010 in Dakar from Plasmodium Falciparum malaria. He had a
stomach ache and a very low fever. The doctor had diagnosed a gastric problem and
did not ask for the malaria test. He died a few days later ...
there was nothing we could do.
We never want this to happen again...to anybody