For those who are curious, here is a brief introduction to
malariaJ
Prevalence: Unfortunately, malaria is very prevalent here in
Tanzania, which is why the Lutheran Malaria Initiative is very active here. Malaria
is most dangerous for pregnant women, children under the age of 5, elderly and
those with compromised immune systems, such as those with HIV. Malaria causes about
60,000 deaths in Tanzania each year. About 80 percent of these deaths are
children under five years old. When I got malaria, I joined the 14-18 million
clinical malaria cases reported by Tanzanian public health services each year.[1]
Prevention: We sleep under a bed net every night and try to
avoid mosquitoes by using bug spray and spraying our room periodically. Yet, despite
our best efforts, sometimes they still get us. The malaria parasite is carried
by the female anopheles mosquito, which is not longer found in the U.S. This
type of mosquito was eradicated in the U.S. in 1949-1951, mainly through the
use of DDT. It was only later that people began to realize the negative effect
that DDT has on the environment, and its use is no longer recommended.
Prophylaxis: Many people have asked “How did you get malaria if
you were on prophylaxis?”
1) Prophylaxis is not the same thing as a vaccine.
Prophylaxis is basically putting a little bit of the treatment medicine in your
system over time so that if you do get the parasite, your body is better able
to fight it. It is not a guarantee that you will not get malaria. Prophylaxis can help a person avoid the most
dangerous form of malaria called cerebral malaria, and it greatly reduces the
chance of getting malaria. For example, the prophylaxis I was on, Malarone
(atovaquone-proguanil hydrochloride), is typically 95-100% successful at
keeping the malaria parasite from running rampant. In spite of my getting
malaria while on prophylaxis, I would still highly recommend prophylaxis for
those taking short-term trips. It’s not a guarantee, but it does help. Just
remember to also take steps to avoid being bitten in the first place.
2) There is a possibility that the prophylaxis I
bought here in Tanzania might have been a different concentration than what I
purchased in the U.S. There are three standard options for prophylaxis: atovaquone-proguanil
hydrochloride (a.k.a. Malarone), doxycycline, and mefloquine (a.k.a. Larium).
Eric is currently taking the Doxy, but it isn’t an option for me because it
interferes with my other medications. I tried mefloquine when we went to
Nigeria, but I had too many negative side effects. That left me with Malarone. Unfortunately Malarone
is terribly expensive in the United States. Because of the expense of Malarone,
we only bought 3 months worth of it in the U.S., and then bought another month
here in Tanzania. It is impossible for us to tell whether what we bought here was
the same as what we bought in the U.S.
Regardless, prophylaxis is not a
long-term solution. We won't be able to stay on it forever, because it isn't
good for the body in the long term. Our initial thought was to stay on it for
our first 6 months, so that it could help our bodies start fighting the malaria
as we are building up antibodies. Then we will determine how best to proceed.
Types of Malaria: There are five different kinds of malaria
parasites-- P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi. Of
those, the most common in Africa and unfortunately the most dangerous is the P.
falciparum. Of all the African malaria, about 80% are P. falciparum, 10% are P.
vivax, 8% are P. ovale, and 2% are P. malariase.
We aren't sure what type of
malaria parasite I got. The good news is that if it was P. faciparum, then it
probably isn't still living in my liver. However, if it was the P. vivax or P.
ovale, it can live in the liver and pop out again at any time (i.e. I could
have a malaria relapse). If it does seem that I have recurrent malaria, there
is a medicine called primaquine that can be used to clear the malaria out of
the liver. It's not something one wants to do unless necessary, because it is
hard on the liver and has unpleasant side effects. However, it is effective at eliminating the malaria
parasite from the liver.
Treatment: The symptoms of malaria are very similar to the
flu—fever, headache, vomiting, diarrhea, aches, etc. The fever was our first
sign that this was, in fact, malaria and not just some stomach bug. A classic
feature of malaria is that the fevers and symptoms will often cycle. Therefore,
someone with malaria may feel significantly better one day and then feel wretched
again 24-48 hours later.
After I was diagnosed through a
blood test, I began a three-day combination treatment of artemesinin and mefloquine.
Unfortunately, I had some of the same negative side effects to the mefloquine
treatment that I had when I was using mefloquine as a prophylaxis in
Nigeria—anxiety, insomnia, depression, heart palpitations, etc. Next time (if
there is a next time), we will try to get a combination treatment that does not
use mefloquine.
After the three-day treatment, I
was still becoming severely dehydrated, so we made a trip to the hospital for
IV fluids and an antibiotic called ciprofloxicin (often used to treat
traveler’s diarrhea). Since this was my first time to have malaria and I had no
natural immunity, I required a second treatment course. Therefore, I followed
up my first round with another five-day artemesinin treatment. It seems to have
finally kicked the malariaJ
For
more information about malaria, Wikipedia has a pretty
extensive page on the subject (http://en.wikipedia.org/wiki/Malaria
)
If you want to help keep the malaria death-toll down, especially among
children, please go to the Lutheran Malaria Initiative
website (www.lutheranmalaria.org). LMI is doing great work here in Tanzania and
in other parts of Africa! For just $10, you can buy a bed net that will protect
a family and reduce their chances for getting this terrible disease.
[1] http://pmi.gov/countries/profiles/tanzania.html
[1] http://pmi.gov/countries/profiles/tanzania.html
