About Malaria by Muthaiga Pediatrics

•  The best defense against malaria is

information.

•  This handy e-book will ensure your

family is equipped to both prevent

malaria infection and get the

correct treatment.

Malaria is a serious illness. It is generally most dangerous for children and pregnant women. Mosquitos are not the cause but the carrier (vector) of malaria. Certain mosquito species inject a tiny parasite into the human bloodstream when they bite. The malaria parasite attacks the liver and, in some cases, the nervous system and brain, particularly if the disease is not treated promptly.

The major symptom of malaria is a cyclical (rising and falling) fever. This is different from fever caused by flu or viruses, which tends to remain high throughout the day or perhaps rise at night. Other symptoms may include headache, back and joint pain (all often severe), and sometimes nausea or diarrhea.

•  The malaria prevalent in East Africa usually takes between 10 days to 3 weeks to incubate and c a u s e s y m p t o m s , b u t r a r e exceptions occur on either side of this window. When returning to Nairobi from a malaria risk zone, any illness experienced by a family member within two months should be reported to your doctor. This is important, even if you’ve used a prophylact ic drug to avoid contracting malaria.

DO NOT TRY TO TREAT MALARIA AT HOME WITHOUT THE ADVICE OF YOUR DOCTOR as this can mask symptoms, make detection of the parasite in blood tests difficult, and lead to sometimes life-threatening complications. Using the wrong m e d i c a t i o n o r u s i n g t h e r e c o m m e n d e d m e d i c a t i o n incorrectly also contributes to drug resistance, making malaria a much tougher disease for everyone.

Muthaiga Pediatrics recommends a two-step approach to malaria prevention for all families living in or visiting areas of East Africa that are less than 2,500 feet above sea level. Nairobi—at an elevation of about 5,889 feet and too cold for anopheles mosquitos to thrive—is considered malaria free. You still need to know about the disease and its prevention if you plan to visit the coast, Kisumu and other areas. Ask your doctor for advice before you travel.

Preventing mosquito bites is the most important way to prevent malaria and the one with by far the fewest side effects. It’s also important to understand a few things about mosquito habits in order to keep the number of bites as close as possible to the zero range.

•  Mosquitos breed in stagnant (standing) water, and they don’t travel too far once they take flight. You’ll eliminate many potential bites from all kinds of mosquitos by emptying old tins, empty flower pots and other vessels (including discarded plastic bags) around your home compound, ensuring that mosquitos have no place to lay their eggs. Make regular inspections, especially during rainy seasons, and ask your neighbours to do the same.

•  If you still have many mosquitos after getting rid of water collectors, you may want to consider having a professional exterminator apply a residual spray around your house and compound.

Tiny anopheles mosquitos (the kind that carry malaria in Kenya) feed between dusk and dawn. This means that, as night falls, you need to put all of your anti-mosquito-bite strategies into play! Ensure that mosquitos keep off your family by employing four simple keep-away strategies.

Move indoors into well-screened or air-conditioned rooms. You can spray first with Doom or another insecticide. Allow the product to settle before allowing children or those with respiratory problems to enter. Using plug-in pyrethrin-based repellent vaporizers may provide extra protection.

Change into pajamas or clothing that covers as much skin as possible (long sleeves, trousers instead of shorts or skirts, closed shoes instead of sandals). This is especially important if you must spend time outdoors in the evening.

•  Apply an effective repellent to exposed skin. •  DEET is the most effective repellent and is considered safe for

children OLDER THAN 2 MONTHS—as long as the concentration is in the 10% to 30% range.

•  In some parts of the world, Picaridin-based repellents are popular. To repel anopheles mosquitos, the Picaridin concentration must be at least 20%.

•  Picaridin will not be effective for as long as DEET and may need to be reapplied.

When it’s time for bed, sleep within an insecticide (Permethrin)-treated net in good repair. You can buy nets ready-treated with washable, long-lasting Permethrin at major retail shops. Alternatively, treat your own nets with tablets or liquid pyrethrin-based insecticide (buy from chemists supermarkets, pharmacies, or agricultural-supply shops).

•  Despite your best efforts to avoid mosquito bites, they can happen anyway. Because of this, your doctor may prescribe certain drugs that in most cases will destroy the malaria parasite before it can take hold in the body and cause the disease.

•  ALL CHILDREN TRAVELLING TO MALARIA RISK AREAS SHOULD TAKE SUCH PROPHYLACTIC (PREVENTATIVE) DRUGS.

•  Be sure to discuss with your doctor the long-term implications of prophylaxis should you reside in a malarial area rather than simply visit for a few days or weeks for work or leisure.

You may have taken prophylactic drugs for malaria if you’ve lived in or traveled to another tropical country. Now that you’re in East Africa, however, you should not continue your previous drug regimen without first consulting your local doctor. This is because the malaria parasite has developed resistance to various drugs in different parts of the world. Taking a drug that works to prevent malaria elsewhere may be ineffective in this part of Africa, giving you a false sense of security and further contributing to the problem of drug resistance.

In Kenya and nearby countries, malaria parasites have proven resistant to chloroquine-based drugs. Taking this into account, the following drugs are recommended for prophylaxis in our area: •  Malarone •  Larium •  Doxycycline

•  General: Effective and with relatively few side-effects but comparatively expensive.

•  Main side-effects: abdominal pain (17%), nausea (12%), vomiting (10-13%), changes to liver enzyme levels (normalize within a month).

•  Other side-effects: headache, dizziness, itching, diarrhea, lack of appetite, muscular weakness (1-10%).

•  Regimen: Daily, beginning 2 days before arrival in the malaria risk area, continuing throughout the trip and for 7 days after leaving the area.

•  Notes: Must be taken with food or a milk-based drink. Repeat dosage if vomiting occurs within one hour of taking. It is not recommended for use in pregnant women due to insufficient safety data

•  General: Usually well tolerated, is less expensive than malarone, has a similar efficacy to malarone (about 90%,) and is a once a week medicine..

•  Main side-effects: chills, dizziness, fatigue, fever, headache, rash, vomiting, abdominal pain, diarrhea, nausea (1-10%).

•  Other side-effects: neuropsychiatric effects including hallucination, disturbed dreams and depression (1%), also cardiac effects (chest pain and cardiac arrest if used with propranolol).

•  Regimen: Weekly, beginning 1 week before arrival in the malaria risk area and continuing for the duration of trip and for 3 weeks after leaving the area

•  Notes: Take with food and with at least 250 mls of water. For pregnant patients who cannot avoid travel to areas with chloroquine-resistant P. falciparum, mefloquine may be safely administered during all trimesters

•  General: Should not be given to pregnant women and children under 8 years due to permanent tooth staining. This medicine is less expensive than malarone. It has a similar efficacy to malarone and mefloquine

•  Main side-effects: diarrhea, dyspepsia (indigestion), nausea, back pain, sinus headache.

•  Regimen: Daily, beginning 2 days before arrival in the malaria risk area, continuing throughout the trip and for 4 weeks after leaving the area.

•  Notes: Must be taken with at least 250 ml water. Sitting upright for 30 minutes after taking the medication will reduce digestive side-effects. Sunscreen should be applied liberally for the duration of prophylaxis as it can cause sun sensitization.

Consulting your doctor beforehand about anti-malarial drug prophylaxis is always the best choice. If this is not possible—or if you misplace your prescription or instructions—on the next pages you’ll find a basic guide to malaria prophylaxis in East Africa. Remember, for prophylactics to be effective, you must take the prescribed drugs as directed and for the entire recommended period following your travel exposure.

Drug   Tablet Size   Dose   Frequency   Start Treatment   End Treatment  

Atovaquone-Proguanil (Maralone or Malanil)  

Pediatric  62.5mg atovaquone& 25mg proguanil  Adult  250mg atovaquone&  100mg proguanil  

Body weight  5-8kg  give ½ pediatric tablet  Body weight  9-10kg give ¾ pediatric tablet  Body weight  11-20kg give 1 pediatric tablet  Body weight  

21-30kg give 2 pediatric tablets  

Body weight  31-40kg give 3 pediatric tablets  Body weight  ≥41kg give 1 adult tablet  

Once daily   1-2 days  before exposure  

7 days  after last exposure  

Drug   Tablet Size   Dose   Frequency   Start Treatment   End Treatment  

Mefloquine hydrochloride (Lariam and its generic versions)  

Pediatric & Adult  250mg  

Body weight  ≤9kg give 1/8 tablet  or 5mg salt per kg  Body weight  10-19kg give ¼ tablet  Body weight  20-30kg give ½ tablet  Body weight  31-45kg give ¾ tablet  Body weight ≥46kg  Give 1 tablet  

Once weekly   >1  week  before  entering  malaria  area    3 weeks  before exposure preferable.    1-2 weeks  before exposure acceptable  

4 weeks  after last exposure  

Drug   Tablet Size   Dose   Frequency   Start Treatment   End Treatment  

Doxycycline hyclate (Vibramycin, Vibra-Tabs and other brands, plus generics: doxycycline monohydrate sold as Monodox, Adoxa and others)  

Pediatric & Adult  100mg  

≥8 years old only  give 2mg per kg  of body weight orally  (maximum dosage  100mg per day)  

Once daily   1-2 days  before exposure  

4 weeks  after last exposure  

There’s a slight chance that you could contract malaria despite following all of the recommended precautions. If you or your child have a fever that you feel could be caused by malaria, see your doctor IMMEDIATELY for a test and DO NOT ATTEMPT TO TREAT ON YOUR OWN. Remember, it is possible to have malaria and a cold or flu at the same time.

•  Expatriate residents of East Africa or residents who travel or move to another part of the world may want to consider carrying enough malaria treatment medication for the entire family if they have resided in or recently visited a malarial area.

•  Because doctors in other countries may have minimal experience in treating malaria, they may not have the most recent knowledge about drug resistance.

•  In addition, if you should come down with malaria, obtaining the correct medications may be difficult, so treatment could be delayed and make your case more complicated.

•  Discuss this with your doctor and, if appropriate, he or she will write the necessary prescription and give you instructions for administering the medication if any of your family members should need it.

For further information we r e c o m m e n d y o u g o t o www.cdc .gov /mala r i a . Th i s authoritative site includes a global malaria map, animated videos, podcasts and frequently asked questions.

Muthaiga Pediatrics offers medical services to well and sick children, immunizations, antenatal and newborn services and telephone advice, along with after-hours support to patients and their families from our offices at Gertrude’s Children’s Hospital Doctor’s Plaza in the Muthaiga area of Nairobi. To book an appointment, telephone +254 0722 519 863 / 254 0733688517 or visit us online at www.muthaigapediatrics.co.ke or on Facebook.