Some mistaken advice in this thread, so don't take anything literally, read up on the issue.
What "pills" are bad for your liver? Where do you find a "reputable" pharmacy in Africa?
Chloroquin, that was a long time ago (before the 1990s).
Lariam, malarone, doxycyklin, artemisia (coartem), your choice. All have side effects, read up.

Hi All,
Sorry for the long post everyone, but there was a lot of info to exchange here.

Nothing like a malaria post to get everyone excited. I've had a couple of healthy debates on the HUBB in the past on this subject and Markharf, I promise not to start anything. However, I will state my knowledge on this subject because I have gathered quite some first-hand experience with malaria over 10 years in Africa. In the interests for brevity, I have left off relevant references below. Please feel free to browse the websites of WHO, MSF or wherever you like outside of the HUBB on this subject. Here in this forum is mostly anecdotal opinion.

Firstly this: I am not advising anyone to do what I have done over the years. I have been accused of reckless endangerment simply by stating my opinion about malaria here on the HUBB. The following is my record and and a statement of what worked and did not work for me. Your Mileage May Vary.

Fact: Malaria can kill. Correct statement , it can. It is most likely to kill you if you are under 5, pregnant or have an otherwise compromised immune system. According to the World Health Organisation, 198 million cases of malaria were reported in 2013, with 584,000 people dying from the mosquito-transmitted parasite or less than 1%.

Personally I have had malaria a bunch of times. That is not a statement intended to make me sound hard. It's a fact of life of living in malaria endemic regions full time. I have had episodes that where not much more than an inconvenience (afternoon off work) the most extreme episode had me passed out on the floor in an East African hospital.

In my experience the worse case I had and worst cases I saw were in South Sudan. East Africa. By the way, I never had headaches nor vomiting so you can discount those as exclusive symptoms of malaria. I get a odd feeling inside my bones and joints, like a dull ache. I usually get very irritable immediately prior to a malaria episode.

Why did I get malaria so many times? Because most of the time I did not take malaria prophylaxis. This is the norm for the overwhelming majority of people who live in Africa. Therefore we get malaria, we get sick (sometimes really sick), we take our medication of choice and then get better. 99% of the time.

The last work contract I had was in Sierra Leone and it was compulsory to take prophylaxis as the first symptoms of malaria and Ebola are exactly the same. I took doxy for the first 6 months and then Malarone for the next 6 months. I had no noticeable side affect from either.

I still got malaria. Why? because it's blimmin' hard to take pills everyday for that length of time. I found that taking leave back to NZ really stuffed up my medicine regime and as a consequence developed a 6 out of 10 (my scale only) malaria bout after returning to country.

If you get malaria once, you have it for life. This is mostly FALSE!!! As I was working on the Ebola response, we had 1st world laboratory facilities and some very clever scientists explained to me that I had Plasmondium Vivax and Plasmondium Falciparum at the same time. Yes!! You can have 2 types of malaria concurrently..! Plasmondium Vivax can reoccur later without you being bitten.

However it can be treated with the correct regime of medicine and it has not affected me in it's dormant state.

Counterfeit drugs are a concern, but just because you bought your drugs in the EU does not mean it's 100% genuine. Chinese and Indian drugs are not always bad. IDA is a Dutch company that sources cheap medicines from emerging markets, tests them for strength and then supplies to medical NGO's. MSF Holland uses/d them for their drug supply.

Reputable pharmacies can be found in most major African cities. You find them by asking around. In my experience, very quickly you will hear the same names mentioned. In most cases they even just look more legit. Again there are no 100% guarantees in African life.

Coartem is specifically indicated for the treatment of acute, uncomplicated malaria, see attachments for the 2 types I have used in the past. Pediatric versions are sometimes flavoured, just remember to double the dosage.

Enjoy your African experience.
Cam J.

Attached Images

  

Thanks for the message, I have heard of Coartem multiple times through-out my research. Maybe I will get a couple of different typres. I don't think I will be taking any pills daily, only treatment pills for if I am stuck far out from a medical centre. I have read quite a few reports now where people have come down with Malaria, some who have been taking pills, some who haven't, but it seems like they got it either way. They check themselves into a clinic and are better in a couple of days. This will be my plan, but take a few treatment pills for an emergency. Maybe this is considered idiotic to some, but I guess it is down to a personal decision. At least there has been some good information given, maybe some bad, but at least it is worth being aware at the minimum. I will report back in a few months when I make it to South Africa to give my experience.

Pretty good information, Cam. Nothing to provoke arguing from my corner, and nothing incendiary. I do favor full and free discussion of experience and knowledge, absent rancor and promotion of personal agendas.

To me, the issue of individual research, responsibility and accountability is key. My approach is somewhat different from Cam's, based in part on the fact that I often travel in malarial areas (never for longer than 6 or 8 months) rather than living there long term, and in part on my direct experience.

I have nearly died from acute malaria, and I'm glad to be here today. That informs my decision to always take antimalarials. I've also been merely very, very sick--not ideal when on a time-limited holiday--and I've had adult friends nearly die. This has included local friends in Africa who are presumed to have some degree of immunity, plus ex-pat friends who generally don't take prophylactic meds but are confident they can recognize and treat acute episodes as they occur. Confidence in this regard is sometimes not justified by the evidence. As well, I've had the experience of descending from full functionality to total helplessness within a few hours--none of this "I'll just find a clinic when I first notice the symptoms."

I've gotten malaria while taking antimalarial meds. One of the main variables in their effectiveness seems to be dosing--as Cam said, messing up dosing when forgetful or when transiting in and out of malarial areas is a big risk factor. Another variable has to do with your body's ability to fully absorb the medication itself. It's not uncommon to get the runs from time to time while traveling, and when your food is shooting right through your g.i. tract at a high rate of speed, you're probably not getting the full benefit of medications or nutrients during that period. As far as I can tell, this is what almost killed me the first time.

The side effects of chloroquine (still effective in a few areas), mefloquine, and Malarone have never bothered me. I've found Malarone quite satisfactory, so have never tried the far cheaper doxycycline. Side effects are, however, another important variable in dosing--people bothered by side effects tend to stop taking their meds. I always suggest that people try out their medications at home, before traveling, in order to make adjustments when there's nothing at stake.

As Cam stated, the recurring forms of malaria, which involve a persistent liver phase, are easily cured by a second round of meds. Personally, I don't trust anyone to accurately read a blood smear and tell me which variety of parasite is making me ill--they can only see what's currently in my blood, and cannot tell whether I've also got one of the persistent forms which is not currently active. I make a point of taking a curative dose of primaquine (as it's known in the US) after each acute malarial episode. This is not standard procedure, so take it for what it's worth. It's also worth knowing that some people cannot safely take primaquine, and this needs to be determined by a separate blood test.

One last comment: the reason that Artemisinin preparations like Coartem are not recommended as prophylactics is that using them this way will rapidly create resistant strains of malaria parasites, rendering this medication as useless as chloroquine (and, increasingly, mefloquine). That's why it's generally reserved for curing acute malaria, which it does fairly reliably in most areas.

Hope this information is helpful. As stated by others, everyone really needs to do their own research and take responsibility for making their own decisions. Best, in any case, not to rely too heavily on wishful thinking (e.g., "I'll recognize it when it comes and will surely be within easy reach of a treatment facility'), or for that matter whatever persuasive argument you last read on the internet.

Hope this information is helpful.

Mark

I concur with Markhaf. If you don't want to get malaria the recommended course is to take some kind of anti-malarial drug. Make sure you take it regularly and continue to protect yourself against being bitten. That sundowner session is a dangerous time because mossies tend to buzz around under the table and you'll probably be bitten a few times before you are aware they are about. Use a repellent and cover yourself.

Having malaria is a total bore, there is no positive to it. It's much better to maximise your travel time by avoiding the subject all together, however I do recognise that there maybe times you would like to conserve your supply of anti-malarials. Do so at your own risk and remember that you should continue to take them after you leave the risk area for up to 2+ weeks.

Just to confirm, the pictures of the drug I posted of were for the treatment of malaria. Additionally I discovered I had the persistent strain of malaria because I had malaria at a time when I worked alongside the best field laboratory and staff on the face of the planet.

Out of interest, if you just start "popping pills" as it were, as soon as you start feeling strange or different, then at least that will cover you until you get confirmation of whether you do or don't have it right? I mean I know people who take anti-biotics when they have the flu, even after being told anti-biotics don't help with a virus. They generally don't care, but its not doing them any harm. Other than making anti-biotics become obsolete faster lol

I am really hesitant to say what you want me to say here. What you describe was roughly my strategy towards dealing with malaria. However, usually I had a circle of colleagues and/or friends who could take care of me if things got bad. You on a bike may not have that luxury.

I can recognize the symptoms in myself very early. You will not be able to do that. Lecture over.

I have taken some measured risks whilst solo traveling on a bike through remote Africa. One such occasion, my calculations regarding water were thrown completely out of whack because I developed sudden and violent diarrhea.

If you want to operate in the same manner, bear in mind you might find yourself sick and in no shape to ride a motorcycle. Your outlook on life changes during these times and you'll promise to be a better son to your mum.

I have never had malaria whilst on a bike trip, probably I think because I am covered up much of the time and I camp a lot. Because of my past fun times with malaria, I have developed a genocidal manic attitude towards mosquitoes and I take pleasure in killing as many as I can, whenever I can, regardless if they carry malaria or not. They are the devils spawn. Consequently I spray my own tent religiously.

Good luck mate.

Really interesting stuff, will report from the guyanas soon, for the South American angle soonish

If going to the Guianas, best be aware that while malaria is present, it's the dengue which will more likely fell you. No preventative, and no cure. I was spared, but some people I hung with for a while got it on the same beach during the same evening (as far as could be determined). Nasty stuff. DEET is your friend, as is pyrethrum.

Real aficionados of malaria can recognize the specific species of mosquitoes which carry it. They're small and fast, and they hang around at floor level biting your ankles at sunset--see Cam's description above. People wonder why I wear long pants, socks, and shoes in the heat.....

Mark

Good discussion, thanks!

Hi

We've travelled from Zürich - Cape Town many years ago, stayed for about 1 year in West Africa as well once.

Those days we used Paludrine and Nivaquine as daily prophylaxe until after a few months we got a side effect with the eyes. Stopped right away at all with prophylaxe. All our friends still used it, but all got Malaria except for us. :-D

As someone said already, use always mosquito nets, repellents, clothes for protection. We found that the African countries know much more about Malaria than the tropical institutes in Europe...

Get yourself malaria cure medicaments ( 20 years ago it was Halfan in West Africa for malaria tropica ) Later we had Fansimef. Plus some medis to fight high fever seperately.

Better to treat malaria when you have it, instead of using prophylaxe which might lower the symptoms, but you still get it.

If any doubt, rather take a malaria cure than waiting too long...

Don't be too worried. With some logic sense and care your fine.

Have fun
Silvi

While everyone has to decide for themselves (riding a motorcycles is dangerous, yet we do)... .

It's important to distinguish between people who know malaria and are surrounded by people who know malaria, and people who don't.

If you know malaria, you can make on informed decision.

If you don't know malaria you can't. Especially when traveling on your own, you should take prophylaxis. There's a fairly high probability of getting malaria if you don't, and it doesn't take many other factors for that to make an end to your life as you know it.

I took Lariam for 8 months (one tablet a week, not daily). I've had one bad-dream-night probably caused by the lariam during these eight months. I guess that adds to the statistics of side effects.
I also saw a fellow travel waking up with a light flew, getting a bad fever and loosing consciousness in less then the time it took from the place where we spend the night (bush camping) to the nearest hospital (all in the a.m. don't remember actual time). It's a vicious thing, and it can go really fast. I don't want to be in such a condition when on my own.

Take care! And enjoy!

*Opinion Alert*

I would just like to put forward my opinion on couple of points that have been made in this thread. I don't think that taking malaria prophylaxis masks the symptoms of malaria. In my experience you can have different 'strengths' of malaria. This may have to do with which type of malaria you have. This is my opinion only, not a medical fact.

I'm glad to see that this thread is largely absent of the dire word of God type posts that proclaim; 'If you get malaria you will die'. Statistics and my own experience indicate otherwise. However, if you're going to bareback through a malaria zone, my advice is have a riding buddy. Not a bad option for motorcycling in Africa in general actually.

My recommendation is that you should take anti-malarial drugs during your trip, because having malaria is a real drag. Health and hygiene should be paramount on a bike trip because you can avoid so many nasties by basic precautions. Even Ebola can be avoided.

Just to clarify something else, I think that people who caught malaria while on prophylaxis probably messed up their dosage somewhere along the line. It is highly unlikely that someone one that sticks to their dosage regime (remembering markharfs wise words regarding diarrhea) will develop the condition.

In regards to local medics, it can be pot luck. I was misdiagnosed in the Ahga Khan clinic in Nairobi (this is a high end hospital clinic). They gave me a negative result for a malaria quick test despite me telling them of my previous history with malaria. Next time I'll insist that they do a proper blood check. That event made me delay taking medication and I was back in their emergency room 24 hours later.

*Opinion Over*.

Thepinproject more or less has hit the nail on the head.

I could write a book on the topic, but in brief, two things worth pointing out

A) the the chances of getting malaria are radically lower than the 10% a month chance that the grossly corrupt and 74% corporate funded WHO claims. This, I can only assume, conveniently logs every report of malaria as actually being malaria. I've met countless Africans who have quite obviously had a common cold but thought they had malaria (sore throat and runny nose are not symptoms of malaria). Hypochondria is rife in Africa, and most Africans love popping pills if they can afford them/get them free.

B) nobody who takes the correct medication within 20 hours of contracting malaria ever dies. It's no joke to get it, but if you're responsible there should be no risk of death. It is worth noting that cerebral malaria can be fatal within 24 hours if it's untreated, but if you've got cerebral malaria, you'll know it. Or at least you'll suspect it, and as already noted, if you have good reason to think you have it (you'll have a horribly painful headache amongst other things like fever), take no chances and pop the pills.

No expats (or locals) I know of ever take "preventative" pills. Most of them have never had malaria. Most educated Africans (that is to say people who won't confuse a common cold with malaria) I know have had malaria once at most in their lives. Whatever the chances in rainy season, the chances of contracting malaria in dry season are extremely low.

The pills are way cheaper in Senegal than Europe and if malaria does exist in southern Mauritania, it's really rare. Though you can get them in Nouakchott too.

Probably best are artemesia based tablets. This is banned in Europe in order to protect the existing monopoly, but has been used in China for milennia. The herbal version of this is what is generally used in Casamance where herbalists who were outlawed in Europe grow it in abundance. I've lived here and everybody I've ever spoken to says nobody ever dies of malaria in Casamance.

Experience of taking pills for six month before I knew what was what as well as many first hand stories would make me strongly urge anybody to avoid the side effects of taking these very heavy "preventative" drugs for no good reason. They WILL wreak havoc with your liver, possibly your skin and probably your mind.

In response to which I can only suggest (again) that people do their own research, while not relying too heavily on unsubstantiated claims made by anyone on internet forums, no matter how sure of themselves they seem.

Mark
(who has personally disproven some of the categorical statements in the post above, in addition to accumulating my own small collection of datapoints to contradict some of his more general claims)