So for thousands of years, it was thought that the cause of malaria was in fact “something in the air” – bad swamp vapours in fact. Hence the name. It was only in 1880 that the vector borne parasite was even identified. So now we know – it is a parasitic disease caused by various types of Plasmodium – and it has a life cycle that requires humans (as the main host) and a specific species of mosquito (Anopheles) (so not the usual whiny Culex ones that you chase around your room). It is thought that Alexander the Great, Genghis Khan, Dante, Caravaggio, Lord Byron and at least six popes have succumbed to malaria; while notable celebrity malaria survivors include Mother Theresa and Ernest Hemingway.

So – how does malaria kill people? The parasite travels around the human body (after transmission from the bite of the female mosquito) inside the red blood cells. These are the cells in your bloodstream designed to carry oxygen. The parasite causes the red cells to become fragile, less flexible and essentially dysfunctional – and they break down or clump together in small vessels in important organs in the body. Severe disease occurs when this takes place in the brain or the kidneys, resulting in complications like cerebral malaria or blackwater fever, in which the haemoglobin within red cells is released as they rupture and travels to the body’s filtration plant in the kidney where it causes significant damage. Just the breakdown of the red cells reduces the oxygen carrying capacity of the blood and so the patient suffers from anaemia.

We can treat malaria – with relatively simple compounds like quinine, or the artemesinin based combination therapies which are the best we have. Artemesinin is in fact a plant extract from a Chinese herbal remedy. The sad situation is that despite the available treatments and knowing that we simply have to control the specific mosquito vector  – malaria still kills millions of people (mostly children) per year. In another blog post I will discuss the social ills of unavailable medical therapies.

So how do you avoid catching malaria, perhaps as a traveller to a malarious area?

Firstly – know where you are going. Is there a malaria risk ? (not a low or high risk – JUST A RISK). If so – you need to adopt an ABCD protection strategy. Awareness is the first key element. Secondly Bite prevention – which means long sleeves at mozzie feeding times (especially dusk and dawn) and use of proper skin spray or roll on deterrents at all times and sleeping under an effective mosquito net. Chemoprophylaxis is next – take the pill ! There are various safe options available on the market – consult your healthcare practitioner or pharmacist regarding which is best for you. There are weekly regimens like mefliam and daily regimens like malanil/malarone or doxycycline. They all work extremely well. Be sure to understand the dosing intervals and how long to take them for. Diagnosis is the last consideration – if you present with any symptoms of a ‘flu like illness or even just a fever within a month of travelling to a malaria area – consult your healthcare professional for a malaria test.

There is so much to share regarding malaria……perhaps for another blog post:

• can you go scuba diving while on malaria chemoprophylaxis?
• can children take anti-malarial medication?
• can you take these medicines if you are pregnant?
• can you become immune to malaria?
• is there a vaccine available (and how do vaccines work by the way – see later….)