Malaria
Malaria is a disease caused by a parasite, a protozoan of the genus plasmodium. In Madagascar, malaria is caused by the ubiquitous species Plasmodium falciparum which is transmitted to humans by the bite of an infected female anopheles mosquito. Malaria is characterised by fever, chills, and influenza-like illness, headache, myalgia, and malaise. These symptoms are usually occurring at intervals. Uncomplicated disease may be associated with anaemia and jaundice. If left untreated, malaria may develop severe complications like seizures, mental confusion, kidney failure, acute respiratory syndromes, and coma and can lead to death. Malaria symptoms can develop as early as 7 days, usually at least 14 days, after exposure yet symptoms in certain cases of infection can develop as late as several months after departure from a malaria-endemic area. Travellers in Madagascar or who return from Madagascar and who have symptoms of malaria are advised to seek medical evaluation as soon as possible. Anyone who develops influenza-like illness even months after return from Madagascar shall always bear in mind a possibility of development of malaria and shall seek medical assistance and inform one’s own physician of the late travel in Madagascar, a malaria endemic island.
Preventive measures for travellers
Although sometimes lethal, malaria can be efficiently prevented and cured. Malaria prevention consists of a combination of mosquito avoidance measures and chemoprophylaxis.
1.- Mosquito avoidance measures
Anopheles mosquitoes have nocturnal feeding habits and can transmit malaria between dusk and dawn. While in the open during that period, travellers are advised to use an effective mosquito repellent, wear trousers and long leaves clothes. Hotel rooms either provide with mosquito bed nets or a pyrethroid-containing flying insect spray. Running air conditioning to cool down room temperature is known to be efficient.
2.- Chemoprophylaxis
Among the most known and recommended primary chemoprophylaxis regimens can be named atovaquone/proguanil (malarone), doxycycline (many brand names and generic), primaquine. Please note that the above list is released for informational purpose only and that travellers shall take advise from their physician or health-care provider as those drugs can show known side effects variable to each traveler. In any case, as many travellers had very bad experience with mefloquine (lariam), that drug shall be kept away from the above list.
Madagascar is malaria endemic country resistant to chloroquine. Please bear in mind though that in remote areas choloquine might be the sole drug available. As use of the same drug for prophylaxis and therapeutic is not recommended, travellers to very remote areas in Madagascar are advised to check with their physician for a prophylactic and self-treatment drug for emergency, many of the above listed drugs are unknown in Madagascar. Travellers should be advised though that self-treatment of a possible malarial infection is only temporary measure and medical evaluation is imperative be it in Madagascar or after return home.
Please note that none of the recommended malaria prevention measure is 100% effective. It is paramount that travellers inform their physician of the trip in Madagascar in case of any symptom to malaria disease or to influenza-like illness even months after return home.