travel around Africa without Malaria pills
 

after long thinking
i decided to not take Malaria pills as a prevent
and will carry it as a treatment
i have mephaquin
would like to know is it wise ?
what the best i can do to protect my self from it ?
cheers and travel safe all

I did the same just have some pills with you in case you need them. The next hospital might be a few days drive away...

Adventure Motorbike expedition through africa - Transafrika part 1

To protect your selfe just use a tent with mosquito net and long sleve clothes in the evening at the fire place...

thanks Ta rider:D

Buy the insect repellent that the locals use - in southern Africa we use Tabard and Peaceful Sleep. Those together with covering up between sunset and dawn worked for us.

I attract mozzies and react to their bites here in the UK but I can honestly say that in our travels in southern Africa I hadn't as much as 1 bite.

We didn't take the tablets because of previous reactions to them.

greater than 90% of travellers who contract malaria upon returning home did not take anti malarials. All the people we met travelling in Africa who contracted malaria were not taking anti malarials. Maleria itself is not very prevalent in South Africa but once you are in central Africa it is endemic. You should cover up and use repellent and mossie nets wether you take anti malarials or not. Anti malarials such as doxycycline are relatively safe, and very few people have negative side effects from them. Maleria is a debillitating disease, potentially fatal and mostly preventable with sensible management

My thoughts - 3 years around Africa, west coast and east coast:

- I didn't take anything and didn't get Malaria. I carried 3 packs of Coartem in case.

- I religiously covered up each night well before dark with thick socks sprayed with stuff, thick jeans and long sleeves. I would put spray on top of my hands as they often landed there otherwise. They never bit me on the neck, sometimes on the cheek.

- When getting into my tent each night I would spend a minute with a light looking for them before sleeping. If staying in a bad area I would usually spray the tent with fly spray 30 mins before bed time.

- Watch out again in the morning.

- Watch out even in daytime in shade or near water in shade - like the wash area out the back of a building for example.

- The only other long term travellers I meet who didn't get Malaria were a couple who plastered each other with creams/sprays each night the same time as me.

- Most other people got it, and once they got it once they often got in 3-4 times over a few years. My general impression was they didn't take covering up seriously enough, often too busy having a beer and waiting until they had been bitten a few times before covering up. It's hot and sticky and its a pain to cover up. I generally found that people I thought would get it did because you could see they were lazy towards not getting bitten.

- Its hard to get kids to cover up or stay covered in spray.

- Some of it is luck.

- If your a couple it seems more likely you will get it, once one has it chances are another mossie will pass it to the other one.

- I meet loads of people who were taking something and still got it. None of the drugs prevent you from getting it, they will lessen the risk, some may help slow the symptoms down hopefully enough that you can get treatment, such as Malarone I believe?. You can get self testing kist (accuracy?) and if you carry two different treatments and understand them, you might be ok if stuck in the bush days from anywhere. Know how to take your temperature for example. The best policy is not to get bitten!

- None of the drugs are suitable for taking for long periods - over 6 months - and I wouldn't want to take doxycycline (an anti-biotic) for a long period, its not healthy. It's about balancing the risk of Malaria against the longer term impact of the drugs on your body, for me at least. The drugs are all pretty harsh..

- I helped quite a few people to and in hospital with it. When it was the first time they were usually reluctant to go as getting to he hospital can be a pain in the arse etc. It's no fun for anybody.

- People often relapsed a few weeks after their first case as they start to feel 'normal' again after about 10 days so continue with hard traveling, drinking etc, but it seems the body needs longer to truly fight it off. Spending two weeks afterwards doing nothing and being healthy seems best.

Doing it again I'd do exactly the same again. Try to understand the risks, assess them to your situation, prepare for the worst case scenario and if you get a fever, stop and see what it is.

There's a lot of wisdom in #6, but some misinformation as well. For example, while the correct antimalarial drug will not prevent malaria 100% of the time, it will prevent malaria most of the time. That's very different from "all they do is slow the symptoms down hopefully enough that you can get treatment." Of course, it is still necessary to be prepared to get proper treatment in the event that you come down with acute malaria, no matter what drug you choose to take (or not).

It is also a matter of opinion whether "None of the drugs are suitable for taking for long periods - over 6 months." Compared to the effects of contracting malaria or to the possible effects of heavy use of insecticides and repellents, the effects of anti-malarial meds can seem like the best option....depending on everything under the sun, of course. For example, my first time with acute malaria I ran a 106 F (41.1 C) fever and almost died. For example, there are all sorts of studies on repellents and insecticides, including the effects of long-term use. Use your critical thinking skills and make your own informed decisions.

One likely reason for repeated bouts of malaria is that two of the five forms of the disease are recurrent. When taking the cure, it's important to know that if you have one of these two varieties you may need to take a second drug as part of your cure. This second drug is Primaquine.

Finally, the test kits available in my country are not reliable--they test for some varieties of the parasite but not others. I don't know about other kinds of test kits, but I'd suggest a dubious attitude. Even blood tests are only as good as the people who read the slides, and they won't show a dormant infection (during which the parasites are not found in the blood). Caveat emptor.

Best source of balanced information on malaria is a poster named "nutraxfornerves" on the Lonely Planet Thorntree forum Health Branch.

Hope that's helpful.

Mark

Thanks for your thoughts mate - I speak only from my own experience, I'm not a doctor, but I looked at the risks in detail for myself...

Malarone is supposed to be the great new drug, but I meet 4 people on it who came down with Malaria. They had all purchased it in their home countries. (fake drugs are huge problem in Africa, so its important to ask where somebody bought each box from etc)

Will 'they' actually prevent Malaria? Or just prevent the onset of fever/symptoms for a while? We probably need to break it down for each drug, sorry for the generalisation, but it is my overall impression - nothing will stop you from having Malaria anywhere near to 100%. Drug companies may claim otherwise!

Certainly my impression of hanging out with peace corp people on a previous trip was that Doxy just slowed down the onset of the symptoms. They were all required to take it for their 2 year stay and that was the experiences they told me. Hard to know how many cases it 'stopped'....

In the UK the advise is not to take any of the meds for more than 6 months.

Look at the huge list of side effects of each drug as well. For me it was a case of Larium is just plain awful (previous trip, bad dreams, hair loss), Malorone too expensive and not recommended for more than 3 or 6 months(??), Doxy an antibiotic would make my fair skin even more sensitive to the skin and I don't like the idea of pumping myself full of antibiotics for years.... and so on....

I used clothing because I didn't want deet on my skin, but Citronella based creams seemed to work well and were natural enough.

Its a difficult area - doctors will always say to take something to cover themselves and because they work to some degree.

Worth reading up on the cures as well as the prevention. Most are based on a plant with a cocktail of drugs added to try and prevent resistance buildup.

Artemisinin - Wikipedia, the free encyclopedia

Thanks for the shared thoughts, all interesting....

"Will 'they' actually prevent Malaria? Or just prevent the onset of fever/symptoms for a while? We probably need to break it down for each drug, sorry for the generalisation, but it is my overall impression - nothing will stop you from having Malaria anywhere near to 100%. Drug companies may claim otherwise!"

Sorry, but in this case your overall impression is not correct. Anti-malarial medications do not mask symptoms. Ever.

Malaria doesn't come directly from the parasite received from an infected mosquito. That parasite is the wrong life-stage. Anti-malarials kill the parasite as it enters your bloodstream, before it can cause any symptoms whatsoever. In order to make you sick, the parasite must lodge in your body for a while, growing into another life stage. If the anti-malarial in your blood kills all parasites before it can do so, you won't get malaria. See how that works? No survival at the earlier stage, no malaria and therefore no symptoms.

If some or all parasites survive--either because some are resistant to the antimalarial drug in your bloodstream, because concentrations aren't high enough, or because you're not taking antimalarials at all--they spend some time multiplying and evolving into their next life stage, at which they re-enter your blood and attack your red blood cells, causing acute malaria and potentially threatening your life. It's at this point you get symptoms, but by the time you've got symptoms you've got malaria by definition.

Antimalarial medications don't mask symptoms (fever, chills, aches, gut upset, weakness, strange visions, etc. etc. etc.). They may ensure that you get a far less serious case of acute malaria than you would have gotten otherwise, by killing most (but not all) of the parasites. This is a good thing. Maybe you won't die, or maybe you won't get as high a fever, or maybe your anemia won't be as severe.

Maybe you call this "masking symptoms." I call it "keeping you more healthy than would otherwise have been the case." You could say that taking penicillin for a bacterial infection will just "mask the symptoms," but you'd be incorrect.

Note that I agree that people sometimes get malaria while taking malarone, mefloquine, choroquine, artemisinin and doxycyline. There are a lot of reasons for this, including failures of absorption, dosing, medication suitability, natural resistance, and anti-mosquito measures taken. However, most people taking front line anti-malarials suited to the area in which they'll be traveling do not get malaria--most of the time. The longer you stay in a malarial area and the more you are exposed to the disease vectors (i.e., female anopheles mosquitoes who are carrying the parasite) in those areas, the more likely that sooner or later you'll get the disease itself.

Not all doctors recommend taking antimalarials all of the time. To say that they do is kind've silly. Nor will any pharmaceutical company claim that their antimalarial formulation will prevent malaria 100% of the time. Really. I'm always in favor of everyone making informed decisions for themselves, but spreading misinformation doesn't help anyone accomplish this.

Note that this post consists almost in its entirety of gross oversimplifications of the disease process....and that's without even giving any details at all about the ways people get ill while properly taking anti-malarial medications. Do your own research, but for godsakes don't stop at the point where you heard something from a bunch of Peace Corps workers and drew ill-informed conclusions based on what they told you.

I'll add only that what works in Southern Africa, where malaria is rare, won't necessarily work elsewhere, where it is not. And those mosquitoes biting your hands and neck were probably not anopheles, which tend to hang out at floor level and bit ankles. There are dozens such variables applicable to any discussion like this one, which makes all generalizations (including mine!) highly suspect.

As always, take what's helpful and discard the rest at will.

Mark

Thanks Mark, but I do resent your tone a little. I'm sharing what I discovered for discussion, not 'spreading disinformation' and the other numerous slurs implied......

"Nor will any pharmaceutical company claim that their antimalarial formulation will prevent malaria 100% of the time."

- I didn't say that did I. Please read more carefully.

"Not all doctors recommend taking antimalarials all of the time. To say that they do is kind've silly"

- No its not. Every doctor I have discussed it with recommended taking something, and this is 'normal' as it covers them in case you get Malaria and die etc - it is the sensible precaution given the risks for most cases. It was my decision not to, against the advice I received. Pick up any travel medicine book and try not to get the impression that you should take something. There will be cases where the person shouldn't take something for medical reasons of course, but standard advice is to take something.

"in this case your overall impression is not correct.Anti-malarial medications do not mask symptoms."

- I never used the word 'mask' but you keep referring to it like I did. I used question marks when I was asking a question rather than making a statement of fact.

"Certainly my impression of hanging out with peace corp people on a previous trip was that Doxy just slowed down the onset of the symptoms." and "but for godsakes don't stop at the point where you heard something from a bunch of Peace Corps workers and drew ill-informed conclusions based on what they told you."

- That was based on driving a sick person to their doctor and discussing it with their own in country doctor about their strategy.

And so forth....

I understand how Malaria works well thanks and when the drugs kick in etc.

You seem to be trying to give an opinion from a medical point of view, I am trying to give an opinion on my experience of trying to calculate the risks for my own trip. Which is what the original poster is asking for.

I'll try once more, then quit. Sorry you find my tone unappealing. I'm telling you you're spreading misinformation because that seems clear to me. I'm not saying you're doing it deliberately, and I'm not ascribing motivation, whether positive or negative. Perhaps you're unaware of the meaning of some of what you've been saying, or perhaps I'm out in left field somewhere, extracting meanings which no one else sees. Either way, I'm fine with it.

You said "None of the drugs prevent you from getting it, all they do is slow the symptoms down hopefully enough that you can get treatment. " This is not framed as a question--it's an assertion of fact, and it is not true. You may not like my calling this "masking symptoms," but that doesn't make your statement true.

You said, "nothing will stop you from having Malaria anywhere near to 100%. Drug companies may claim otherwise!" You may consider this to mean something other than "Drug companies claim that their antimalarial formulation will prevent malaria 100% of the time...." but I don't.

You said, "doctors will always say to take something...." I said, ""Not all doctors recommend taking antimalarials all of the time..." I said that because I've consulted doctors on more than one occasion who recommended not taking anti-malarials. The fact that you haven't had this experience does not mean that "doctors will always say to take something." Your statement is untrue.

The portion of your posts where you suggest research and careful consideration before making informed decisions based on the best available information are the portions which I agree with wholeheartedly. The portions of your posts in which you make blanket assertions ("doctors will always...") or unfounded claims ("None of the drugs prevent you from getting it, all they do is slow the symptoms down...") do not uphold this standard. Nor, for that matter, do they offer evidence that you "understand how Malaria works well....and when the drugs kick in," although that may be true.

I welcome any further posts, but I think I've probably said what I have to say and won't offer responses unless I really think I've got something crucial to contribute.

Safe travels!

Mark

PS: I am not medically trained. I'm an ex-carpenter who, like you, believes in paying close attention and making my own decisions, then sharing the results with others who might want to do the same. Hope this discussion is helpful for someone out there.

Mark Harf has this right.

I am medically trained and I agree with everything he has said.

Malaria kills people, esp the sort in sub-saharan Africa. Reduction of risk of getting malaria is about 70-90% if you take anti-malarials AND practice bite avoidance - long sleeves and copious repellant, mosquito nets.

I've largely given up contributing to malaria posts on this and other sites but the misinformation in your posts (roaming yak) is too dangerous to other travelers to ignore.

I would suggest taking the drugs recommended for your area of travel together with bite avoidance practices. One can take the drugs for longer than you will likely be in any one area as a traveler with no problems.

Carrying a treatment dose in case you develop symptoms is a risky strategy, not least because you might take it when you have, for example, dengue and then not have it when you get malaria.

And one last thing - a study with n=1 is pointless. It is called anecdote and any medical professional basing their practice on this won't be practicing very long.

Helpful thread, thanks for your comments markharf.

Advised by a doctor in Spain, I got Chloroquine (Resochin) to go to Bolivia. Some weeks later, I started an amazingly unbearable pain in my belly (if this is 10 on my scale, no other injury has reached 5 yet). Two hours later, already able to stand, walk and chat, an ultrasonography showed the gallbladder measured 16cms long, while they said in normal conditions it should be 5-6 cms (imagine the volume). Since I was feeling better and it had certainly reduced its size, the initial idea of surgery was (thank God!) discarded. But I should avoid any heavy/fatty meals to cope with the congenital problem I was diagnosed (and the awful pain I “mildly” kept suffering for some time). After hearing later about the side-effects of anti-malarials (not taken into account by the doctor), I assessed the risk and stopped Chloroquine. I completely recovered and blamed the doctor and Chloroquine for being unnecessary in that region during winter time.

After that, I’ve check very well if there’s actually risk in a region during the season I’m going and, of course, taken all measures and more to avoid been bitten by mosquitoes. If the risk’s being relevant, I’ve avoided the area/time of the year as I still feared any pills. There are side-effects (Lariam-Mefloquine earned its bad reputation for a reason) and some of us are more sensitive to them.

HOWEVER, I would never plainly recommend not having antimalarials, but more the opposite (if required in the region/season), although I’d warn about the side-effects. It's just a too big risk. If I were going to Central Africa, where malaria is endemic all year round, I would definitely go to a tropical diseases department in a hospital to have tests done to prevent/forecast possible reactions/side-effects and would try the antimallarial in advance at home to see how I could cope with those side effects (if any). Add to these considerations that in Colombia you may still find a good hospital if you get malaria, but in Central Africa you may not, what makes it more fatal too.

I´m as far from an expert as possible. But I think it´s one of those subjects, where you really need to consult one.

The net is full of all sorts of information, good and bad (and everything in between), but fact is that malaria is a potentially a lethal disease, and not to be played around with, even though us Westerners may have access to better care than the locals in many areas.

Using light-colour, covering clothing in the evenings is one thing that probably makes sense in any case, because that could not possibly harm you, and mosquitoes could transmit some other nasty diseases, not just malaria.

(No offence to anyone, emphasizing the 1st and 2nd sentence, and just my 0.02)

Deep breaths and gritted teeth all round ;-p

@Docsherlock

"misinformation in your posts (roaming yak) is too dangerous to other travelers to ignore."

- Please make it clear what you consider misinformation.

"Carrying a treatment dose in case you develop symptoms is a risky strategy, not least because you might take it when you have, for example, dengue and then not have it when you get malaria."

- You mean we shouldn't travel with any sort of cure like Coartem?! Many places in Africa won't have it, or it will be fake, so having your own supply is vital I would suggest. The NHS suggests the same: Emergency Treatment of Malaria - Fit For Travel
Or we shouldn't rely solely on this strategy? I travelled with 3 boxes of Coartem assuming I would give at least one away along the way. Agreed, its hard to judge when camping in the bush what a fever actually is, and local labs can be rudimentary at best. But I would say definitely travel with some of your own.

"One can take the drugs for longer than you will likely be in any one area as a traveler with no problems."

- That seems to be a blanket assertion that "the drugs" will never cause any medical problems no matter how long you take them? This is certainly not the advice I got from the NHS before leaving. Malorone was considered a bit 'untested' in this area I seem to remember.

@Mark

"You said "None of the drugs prevent you from getting it, all they do is slow the symptoms down hopefully enough that you can get treatment. " This is not framed as a question--it's an assertion of fact, and it is not true. You may not like my calling this "masking symptoms," but that doesn't make your statement true."

Question: As Malorone is used as a treatment as well as the prevention, if a person was taking it for prevention, surely it would also help control/slow down the onset of fever/symptoms/Malaria in general? It provides some resistance?
The NHS says "The same antimalarial medicines used to prevent malaria can also be used to treat malaria" for example.
Malaria - Antimalarials - NHS Choices

If that is true, then to my untrained eye with my strange Kiwi logic, my statement seems to be true, but it was lazy to say "none of the drugs" as I don't know if this is true of them all.

"You said, "nothing will stop you from having Malaria anywhere near to 100%. Drug companies may claim otherwise!" You may consider this to mean something other than "Drug companies claim that their antimalarial formulation will prevent malaria 100% of the time...." but I don't."

- "anywhere near to" being the key phrase. Must be a cultural mismatch of language ;-)

"You said, "doctors will always say to take something...." I said, ""Not all doctors recommend taking antimalarials all of the time..." I said that because I've consulted doctors on more than one occasion who recommended not taking anti-malarials. The fact that you haven't had this experience does not mean that "doctors will always say to take something." Your statement is untrue."

- Agreed, it was a slightly lazy blanket statement. I was trying to convey that the default western medical opinion is that you should take drugs to prevent Malaria. This seems also to be the general consensus of posters here?

I offered my own opinion, which is to prevent bites, carry a cure and not take any drugs, which I stand behind as a valid option, especially for a long trip.

There may be cases where the likely risks and the side effects don't balance, but from my experience the discussions start off with 'what drug would be most suitable' rather than 'shall we discuss malaria' which to me is strongly implying you should take something, its just a question of what, hence my statement.

Anyway, lets hope we all end up in a hospital ward in Congo one day in a fever to discuss it further ;-p

@roaming.yak
 

Mate, I have simply offered some opinions, based on my education and professional experience. Please feel free to ignore or consider, as is your personal preference.

I can't really be bothered to get into an extensive discussion with you; if you search the forum you will find all my previous posts on malaria and I don't feel like re-typing any of them.

Good luck, ride safe.

DS

No worries, but perhaps best to avoid saying somebody is spreading dangerous misinformation if your not willing to discuss it with them ;-p

I think Mark Harf covered this pretty well in his previous extensive posts. Largely to do with not taking anti-malarials and the drugs masking the symptoms of malaria.

I would not travel through Africa without taking anti malarials. :thumbdown:

It' would be pretty hard to wake up somewhere with malaria and know that you have 500 kms with hard offroad driving before you get to a place with a bed and clean water.

I have more or less carried a fellow biker to hospital, he was not able to walk when he wake up. Luckily this happened in a town. It took him almost a week before he was able to drive a bike at all. He would probably have been dead if he had traveled alone on a remote place.

On the other hand, if you follow the tarmac and stay in cities it might be an option to decide otherwise.

Was the fellow biker taking anything when he got Malaria? That would seem to be an important point in your posting ;-)

He was not taking anything.
In my (limited) experience the few who gets sick when eating pills get don't get sick that suddenly.

That was my impression as well - but I got jumped on when I said it on here, so watch out ;-p

At the end of they day this comes down to a personal assessment of risk to your health. By all means take a sounding here but you really should take professional medical advice.

For what worth my personal experience of living in Africa (much of the time in very remote locations) is as follows

1) I started on Lariam and had a very bad experience after scuba diving (I had no idea there was a specific risk)
2) Switched to Doxy which I took for 3 years with no side/ill effects
3) Met and worked with many ex pats/long term expats who took no meds but "took the muti". Malaria amongst them was an accepted consequence which made them (sometimes very) ill on a regular basis.
4) Worked with a group of locals several of whom lost children to malaria whilst I was there. Again an accepted consequence.

For me living in an area where malaria had an obvious impact and being 4-6 hours away from even basic medical care the downside of long term use of an antibiotic v. the consequences of getting malaria made it an easy decision.

However, I'm sure others would have taken a different view - as is their right.

In summary - it's your life, your decision but I'd encourage you to take some professional advice.

Malaria
 

Look after your body....as you have NO WHERE ELSE TO LIVE !!!!!

:-)
 

When you get sick, you get sick.
Life decides. :-)