Scenario 

Janet Clarkson tells pharmacy technician Vicky that her daughter Katie has booked her first holiday away with friends, rather than parents. “She’s going to Kenya, and has a safari trip planned as well as a few days on the coast, but she tells me that she doesn’t need any jabs or malaria tablets. I’m not so worried about the injections because we all had to have typhoid and hepatitis A when we went to Burma last year, and I know that things like her tetanus and polio are all up to date, but I am worried about malaria. What do you think?”

Answer

Janet is right to be concerned. Malaria is present year-round in all of Kenya, though the risk is considered very low in Nairobi and its environs, and low in places at 2,500m above sea level or higher. Given that Katie has plans to go on safari and to the coast, she should take antimalarials in the form of atovaquone/proguanil, doxycycline or mefloquine, starting the course of medication before she travels so the drugs have time to get into her system before she gets there.

Taking tablets is not the end of the story, however. Bite prevention is essential. Measures that can help include: reducing the amount of exposed flesh by wearing long-sleeved tops and trousers (particularly after sunset); impregnating clothing with a DEET-containing insect repellent, and using a lower concentration DEET-based repellent on any areas of skin that are not covered.

At night, the best protection is to sleep in an air-conditioned room that has screens on all of the windows and doors, or under a DEET-treated mosquito net. Despite media reports to the contrary, there is little or no evidence supporting the use of alternative measures such as homeopathic medicines, electronic repellents, vitamin B or garlic supplements, yeast extracts and tea tree oil products as protection against malaria or mosquito bites.

The bigger picture

The risk of getting malaria when abroad may seem remote compared to the likes of a stomach upset or sunburn, but around 1,500 travellers a year are diagnosed with the mosquito-borne disease in the UK, and up to 10 people die as a result of it on an annual basis. Anyone travelling to a place where malaria is present is at risk – even people who were born in a country with malaria and have moved to the UK. In fact, this group is at particularly high risk of contracting malaria, as they can be oblivious to the need to take precautions and may be more likely to travel off the tourist trail to areas where the risk of malaria is very high because they are visiting friends and family.

Children of immigrants are also at high risk, not only because their parents may have a misguided belief that they will have an inherited immunity to malaria, but also because babies and infants are more likely to suffer complications if they do develop the disease. The symptoms of malaria include a high fever that sometimes occurs in cycles with episodes of chills and sweats, vomiting, headache, muscle pain and diarrhoea, usually occurring a week or two after becoming infected, but sometimes not manifesting for up to a year. Prompt diagnosis and treatment are the key to making a full recovery, with any delay putting the individual at risk of complications such as dehydration, anaemia, fits, organ failure, brain damage and even death.

Extend your learning

• Fit For Travel is a very easy to understand and navigate site that allows people to search by country to check the health risks, including malaria maps for the destination they are travelling to. 
• Find out about the different types of antimalarials, in particular how long they need to be taken for and at what dose, who can and can’t take them, and likely side effects here
• As described in this article, bite avoidance is as important as taking prophylactic medication when travelling to malaria-endemic areas of the world. Read up on this topic here.