ro[ecL paper on

Malarla
ueparLmenL of ubllc PealLh
norLh SouLh unlverslLy
SubmlLLed 1o ur Arlful 8arl Chowdhury









SubmlLLed by
1awhld Sharkar 8aLul 1030603330
SM Aml lslam 1111061030
Sazzad Sharlar 1110379330
Ahmed lmran kablr 1030698330
Md 1ouhldul Paque 1111366030






age | 2


Contents


1lnLroducLlon

2Llfe cycle

3Causes lncldence and rlsk facLors

4SympLoms

3ulagnosls and LesLs

6CompllcaLlons

7Malarla SlLuaLlon ln 8angladesh

81reaLmenLs

98eferences




age | 3


Introduct|on

Ma|ar|a ls a mosqulLoborne lnfecLlous dlsease of humans and oLher anlmals caused by eukaryoLlc
proLlsLs of Lhe genus llosmoJlom 1he dlsease resulLs from Lhe mulLlpllcaLlon of lasmodlum paraslLes
wlLhln red blood cells causlng sympLoms LhaL Lyplcally lnclude fever and headache ln severe cases
progresslng Lo coma or deaLh lL ls wldespread ln Lroplcal and subLroplcal reglons lncludlng much of
SubSaharan Afrlca Asla and Lhe Amerlcas
llve specles of llosmoJlom can lnfecL and be LransmlLLed by humans Severe dlsease ls largely caused by
llosmoJlom folclpotom whlle Lhe dlsease caused by llosmoJlom vlvox llosmoJlom ovole and
llosmoJlom molotloe ls generally a mllder dlsease LhaL ls rarely faLal llosmoJlom koowlesl ls a
zoonosls LhaL causes malarla ln macaques buL can also lnfecL humans
Malarla Lransmlsslon can be reduced by prevenLlng mosqulLo blLes by dlsLrlbuLlon of mosqulLo neLs and
lnsecL repellenLs or by mosqulLoconLrol measures such as spraylng lnsecLlcldes and dralnlng sLandlng
waLer (where mosqulLoes breed) 1he challenge of produclng a wldely avallable vacclne LhaL provldes a
hlgh level of proLecLlon for a susLalned perlod ls sLlll Lo be meL alLhough several are under developmenL
A number of medlcaLlons are also avallable Lo prevenL malarla ln Lravelers Lo malarlaendemlc counLrles
(prophylaxls)
A varleLy of anLlmalarlal medlcaLlons are avallable Severe malarla ls LreaLed wlLh lnLravenous or
lnLramuscular qulnlne or slnce Lhe mld2000s Lhe arLemlslnln derlvaLlve arLesunaLe whlch ls superlor
Lo qulnlne ln boLh chlldren and adulLs 8eslsLance has developed Lo several anLlmalarlal drugs mosL
noLably chloroqulne
1here were an esLlmaLed 223 mllllon cases of malarla worldwlde ln 2009 An esLlmaLed 781000 people
dled from malarla ln 2009 accordlng Lo Lhe World PealLh CrganlzaLlons 2010 World Malarla 8eporL
accounLlng for 223 of deaLhs worldwlde
9
nlneLy percenL of malarlarelaLed deaLhs occur ln sub
Saharan Afrlca wlLh Lhe ma[orlLy of deaLhs belng young chlldren llosmoJlom folclpotom Lhe mosL
severe form of malarla ls responslble for Lhe vasL ma[orlLy of deaLhs assoclaLed wlLh Lhe dlsease
Malarla ls commonly assoclaLed wlLh poverLy and can lndeed be a cause of poverLy

and a ma[or
hlndrance Lo economlc developmenL



age | 4

|fe Cyc|e

A female Anopheles mosqulLo carrylng malarlacauslng paraslLes feeds on a human and ln[ecLs Lhe
paraslLes ln Lhe form of sporozolLes lnLo Lhe bloodsLream 1he sporozolLes Lravel Lo Lhe llver and lnvade
llver cells
Cver 316 days Lhe sporozolLes grow dlvlde and
produce Lens of Lhousands of haplold forms called
merozolLes per llver cell Some malarla paraslLe
specles remaln dormanL for exLended perlods ln Lhe
llver causlng relapses weeks or monLhs laLer
1he merozolLes exlL Lhe llver cells and reenLer Lhe
bloodsLream beglnnlng a cycle of lnvaslon of red
blood cells asexual repllcaLlon and release of newly
formed merozolLes from Lhe red blood cells
repeaLedly over 13 days 1hls mulLlpllcaLlon can
resulL ln Lhousands of paraslLelnfecLed cells ln Lhe
hosL bloodsLream leadlng Lo lllness and
compllcaLlons of malarla LhaL can lasL for monLhs lf
noL LreaLed
Some of Lhe merozolLelnfecLed blood cells leave Lhe
cycle of asexual mulLlpllcaLlon lnsLead of repllcaLlng
Lhe merozolLes ln Lhese cells develop lnLo sexual
forms of Lhe paraslLe called male and female
gameLocyLes LhaL clrculaLe ln Lhe bloodsLream
When a mosqulLo blLes an lnfecLed human lL lngesLs Lhe gameLocyLes ln Lhe mosqulLo guL Lhe lnfecLed
human blood cells bursL releaslng Lhe gameLocyLes whlch develop furLher lnLo maLure sex cells called
gameLes Male and female gameLes fuse Lo form dlplold zygoLes whlch develop lnLo acLlvely movlng
ooklneLes LhaL burrow lnLo Lhe mosqulLo mldguL wall and form oocysLs
CrowLh and dlvlslon of each oocysL produces Lhousands of acLlve haplold forms called sporozolLes AfLer
813 days Lhe oocysL bursLs releaslng sporozolLes lnLo Lhe body cavlLy of Lhe mosqulLo from whlch
Lhey Lravel Lo and lnvade Lhe mosqulLo sallvary glands 1he cycle of human lnfecLlon resLarLs when Lhe
mosqulLo Lakes a blood meal ln[ecLlng Lhe sporozolLes from lLs sallvary glands lnLo Lhe human
bloodsLream


I|gure 1 |fe cyc|e of the Ma|ar|a aras|te
age | 3

Causes |nc|dents and r|sk factors

Malarla ls caused by a paraslLe LhaL ls passed from one human Lo anoLher by Lhe blLe of
lnfecLed oopbeles mosqulLoes AfLer lnfecLlon Lhe paraslLes (called sporozolLes) Lravel
Lhrough Lhe bloodsLream Lo Lhe llver where Lhey maLure and release anoLher form Lhe
merozolLes 1he paraslLes enLer Lhe bloodsLream and lnfecL red blood cells
1he paraslLes mulLlply lnslde Lhe red blood cells whlch Lhen break open wlLhln 48 Lo 72 hours
lnfecLlng more red blood cells 1he flrsL sympLoms usually occur 10 days Lo 4 weeks afLer
lnfecLlon Lhough Lhey can appear as early as 8 days or as long as a year afLer lnfecLlon 1he
sympLoms occur ln cycles of 48 Lo 72 hours
MosL sympLoms are caused by
1 1he release of merozolLes lnLo Lhe bloodsLream
2 Anemla resulLlng from Lhe desLrucLlon of Lhe red blood cells
3 Large amounLs of free hemoglobln belng released lnLo clrculaLlon afLer red blood cells break
open
Malarla can also be LransmlLLed from a moLher Lo her unborn baby (congenlLally) and by blood
Lransfuslons Malarla can be carrled by mosqulLoes ln LemperaLe cllmaLes buL Lhe paraslLe
dlsappears over Lhe wlnLer
1he dlsease ls a ma[or healLh problem ln much of Lhe Lroplcs and subLroplcs 1he CuC esLlmaLes
LhaL Lhere are 300300 mllllon cases of malarla each year and more Lhan 1 mllllon people dle
from lL lL presenLs a ma[or dlsease hazard for Lravelers Lo warm cllmaLes
ln some areas of Lhe world mosqulLoes LhaL carry malarla have developed reslsLance Lo
lnsecLlcldes ln addlLlon Lhe paraslLes have developed reslsLance Lo some anLlbloLlcs 1hese
condlLlons have led Lo dlfflculLy ln conLrolllng boLh Lhe raLe of lnfecLlon and spread of Lhls
dlsease
1here are four Lypes of common malarla paraslLes 8ecenLly a flfLh Lype llosmoJlom koowlesl
has been causlng malarla ln Malaysla and areas of souLheasL Asla AnoLher Lype falclparum
malarla affecLs more red blood cells Lhan Lhe oLher Lypes and ls much more serlous lL can be
faLal wlLhln a few hours of Lhe flrsL sympLoms
age | 6


ymptoms


O Anemla

O 8loody sLools
O Chllls
O Coma

O Convulslon
O lever
O Peadache
O aundlce
O Muscle paln
O nausea
O SweaLlng
O IomlLlng







I|gure 3 1ransfus|ng a ch||d w|th severe anaem|a
due to Ma|ar|a
I|gure 4 A pat|ent suffer|ng from [aund|ce due to
severe ma|ar|a
I|gure 2 ymptoms of Ma|ar|a
age | 7

|agnos|s and tests

ln order Lo make a malarla dlagnosls Lhe healLhcare provlder may ask a number of quesLlons
concernlng

O CurrenL sympLoms
O Medlcal condlLlons
O lamlly medlcal hlsLory
O CurrenL medlcaLlons
O 8ecenL Lravel hlsLory

1he healLhcare provlder wlll also llkely perform a physlcal exam looklng for slgns or sympLoms
of malarla Pe or she may also order cerLaln LesLs Lo help ln dlagnoslng malarla or anoLher
condlLlon

The doctor may suspect malaria based on the patient's symptoms, and the physical findings
at examination; however, to make a definitive diagnosis of malaria, laboratory tests must
demonstrate the malaria parasites, or their components.


The best test available to diagnose malaria is called a blood
smear. In this test, malaria parasites can be identified by
examining a drop of the patient's blood under the microscope,
spread out as a "blood smear" on a microscope slide. Prior to
examination, the specimen (blood) is stained to give to the
parasites a distinctive appearance.

There are other blood tests available that may be used along
with a blood smear to confirm a malaria diagnosis.

A malarla dlagnosls can be dlfflculL Lo make especlally ln areas where malarla ls noL very
common A number of oLher condlLlons share slmllar sympLoms wlLh malarla Some of Lhese
condlLlons Lhe healLhcare provlder wlll conslder before dlagnoslng malarla lnclude



I|gure S 8|ood smear test
age | 8

O 1he flu (lnfluenza)
O Common cold
O MenlnglLls
O 1yphold fever
O uengue fever
O AcuLe schlsLosomlasls (dlsease caused by worms)
O 8acLeremla/sepLlcemla (lnfecLlon ln blood)
O PepaLlLls
O Ilral gasLroenLerlLls (sLomach flu)
O ellow fever (dlsease Lyplcally LransmlLLed by mosqulLoes)

Comp||cat|ons

Malarla can be faLal parLlcularly Lhe varleLy LhaLs common ln Lroplcal parLs of Afrlca 1he
CenLers for ulsease ConLrol and revenLlon esLlmaLe LhaL 90 percenL of all malarla deaLhs occur
ln Afrlca mosL commonly ln chlldren under Lhe age of 3
ln mosL cases malarla deaLhs are relaLed Lo one or more of Lhese serlous compllcaLlons
O Cerebra| ma|ar|a lf paraslLefllled blood cells block small blood vessels Lo your braln (cerebral
malarla) swelllng of your braln or braln damage may occur
O 8reath|ng prob|ems AccumulaLed fluld ln your lungs (pulmonary edema) can make lL dlfflculL
Lo breaLhe
O rgan fa||ure Malarla can cause your kldneys or llver Lo fall or your spleen Lo rupLure Any of
Lhese condlLlons can be llfeLhreaLenlng
O evere anem|a Malarla damages red blood cells whlch can resulL ln severe anemla
O ow b|ood sugar Severe forms of malarla lLself can cause low blood sugar as can qulnlne
one of Lhe mosL common medlcaLlons used Lo combaL malarla Iery low blood sugar can resulL
ln coma or deaLh
kecurrence may occur
Some varleLles of Lhe malarla paraslLe whlch Lyplcally cause mllder forms of Lhe dlsease can
perslsL for years and cause relapses
age | 9



Ma|ar|a s|tuat|on |n 8ang|adesh
Malarla has been a ma[or publlc healLh problem ln 8angladesh ApproxlmaLely 336 of Lhe
LoLal populaLlon are aL rlsk of malarla Ma[orlLy of malarla cases are reporLed from 13 ouL of
Lhe LoLal 64 dlsLrlcLs ln Lhe counLry AbouL 4 mllllon populaLlons llvlng ln 34 upazlllas of elghL
of Lhe LhlrLeen dlsLrlcLs llve ln Lhe epldemlcprone border areas local ouLbreaks occur every
year and Lhe response Lo conLrol Lhe epldemlc ls lnadequaLe Malarla cases are grossly
underreporLed due Lo shorLcomlngs ln survelllance and lnformaLlon
CounLry ls reporLlng on average 30000 conflrmed malarla cases wlLh around 70 of f cases
(klller malarla) and 430 malarla deaLhs annually 1he case flndlng ls very poor and 2
populaLlon aL rlsk of malarla screened every year ln 200809 wlLh Lhe help of Clobal funds
enhanced survelllance and case flndlng acLlvlLles lncludlng vecLor conLrol Lhrough bedneLs and
LreaLmenL Lhrough AC1s
resulLed ln a lncrease ln lab
conflrmed cases and slgnlflcanL
decrease ln malarla deaLhs
CounLry dld noL reaporL any
probable malarla case ln 2009
rogramme ls promoLlng LLlns
l1ns amongsL Lhe communlLy
as a vecLor conLrol measure ln
Lhese areas whlch has lncreased
Lremendously ln lasL few years
1oLal 237 mllllon bedneLs (LLlnS
+ l1ns) were dlsLrlbuLed and 642 mllllon people are covered by lL Powever lL's coverage ln
hlgh endemlc dlsLrlcLs ranges beLween 40 Lo 63


I|gure 6 1rends of conf|rmed ma|ar|a cases |n 8ang|adesh 19702009
age | 10



I|gure 7 |str|but|on of AC1 and Number of ma|ar|a deaths |n 8ang|adesh 200S2009
I|gure 8 2Cumu|at|ve ava||ab|||ty of effect|ve INs I1Ns |n 8ang|adesh 200S2009

1oLal flnanclng for malarla ln 2009 was approxlmaLely uS$ 93 mllllon Lhe maln sources
belng Lhe CovernmenL (uS$ 333 000) Lhe Clobal lund (uS$ 77 mllllon) Lhe World 8ank
(uS$ 890 000) and WPC (uS$ 230 000)


I|gure 9 Ava||ab|||ty of funds by ource |n 8ang|adesh 20062009





age | 11



ogramme Goa|s and 1argets
1o reduce malarla morbldlLy and morLallLy unLll Lhe dlsease ls no longer a publlc healLh
problem ln Lhe counLry
1argets 8ase||ne data
|n 200S
2010
1o provlde early dlagnosls and prompL LreaLmenL (Lu1)
wlLh effecLlve drugs Lo 80 of malarla paLlenLs
40 80
1o provlde effecLlve malarla prevenLlon Lo 80 of
populaLlon aL rlsk
24 80
1o sLrengLhen malarla epldemlologlcal survelllance
sysLem
60 100
1o esLabllsh 8apld 8esponse 1eam (881) aL naLlonal and
dlsLrlcL levels and lncrease preparedness and response
capaclLy for conLalnmenL of ouLbreaks
80 100
1o promoLe communlLy parLlclpaLlon and sLrengLhen
parLnershlp wlLh prlvaLe secLor and nCCs for malarla
conLrol
23 80

Contro| strategy
Malarla conLrol acLlvlLles are lnLegraLed wlLh Lhe general healLh servlces
AcLlve Case ueLecLlon (ACu) and asslve Case ueLecLlon (Cu) wlLh laboraLory dlagnosls
rompL LreaLmenL
Case managemenL of severe malarla and compllcaLed cases ln hosplLal
IecLor conLrol mlnlmal no l8S wlLh uu1 slnce 1993
SLA8 worklng group recommendaLlon on revlsed conLrol sLraLegy has been adopLed
uue Lo spread of chloroqulne reslsLance drug reglmen has been revlsed and CCA81LM has
been lnLroduced by programme
SLrengLhenlng programme managemenL ls of hlgh prlorlLy

8est pract|ces and success stor|es
LsLabllshmenL of parLnershlp wlLh nCC consorLlum
romoLlon and use of l1ns/LLlns
CuallLy dlagnosls uslng 8u1 and effecLlve LreaLmenL uslng AC1s
age | 12





Issues and Cha||enges
lnadequaLe access Lo LreaLmenL and
dlagnosLlc faclllLles especlally ln Lhe
remoLe areas
lnadequaLe programme managemenL
capaclLy aL varlous level and managemenL
of severe malarla ln hosplLals
oor coverage of prevenLlon and conLrol
meLhods (l8S l1n/LLln coverage sLlll low)
ln Lhe communlLy
8eferral sysLem ls weak and prereferral
LreaLmenL provlslons are llmlLed
CpLlmum LreaLmenL of cases of severe
malarla ln dlfferenL caLegorles of hosplLals
are lnadequaLe
Crossborder malarla aL Lhe 8angladesh
lndla and 8an Myanmar border




artners and donors
WPC
World 8ank
Clobal fund
88AC and 14 member nCC ConsorLlum
4 Local nCCs ln ChlLLagong Plll 1racL (CP1)





age | 13

1reatments
revenLlng malarla four sLeps
1here ls an A8Cu for prevenLlon of malarla 1hls ls
O Awareness of rlsk of malarla
O 8lLe prevenLlon
O Chemoprophylaxls (Laklng anLlmalarlal medlcaLlon exacLly as prescrlbed)
O rompL ulagnosls and LreaLmenL
Awareness of the r|sk of ma|ar|a
1he rlsk varles beLween counLrles and Lhe Lype of Lrlp lor example backpacklng or Lravelllng
Lo rural areas ls generally more rlsky Lhan sLaylng ln urban hoLels ln some counLrles Lhe rlsk
varles beLween seasons malarla ls more common ln Lhe weL season 1he maln Lype of paraslLe
and Lhe amounL of reslsLance Lo medlcaLlon varles ln dlfferenL counLrles AlLhough rlsk varles
all Lravellers Lo malarlarlsk counLrles should Lake precauLlons Lo prevenL malarla

1he mosqulLoes whlch LransmlL malarla commonly fly from dusk Lo dawn and Lherefore
evenlngs and nlghLs are Lhe mosL dangerous Llme for Lransmlsslon
8|te prevent|on
We can an effecLlve lnsecL repellenL Lo cloLhlng and any exposed skln uleLhylLoluamlde (uLL1)
ls safe and Lhe mosL effecLlve lnsecL repellenL and can be sprayed on Lo cloLhes lL lasLs up Lo
Lhree hours for 20 up Lo slx hours for 30 and up Lo 12 hours for 30 uLL1 1here ls no
furLher lncrease ln duraLlon of proLecLlon beyond a concenLraLlon of 30 When boLh
sunscreen and uLL1 are requlred uLL1 should be applled afLer Lhe sunscreen has been applled
uLL1 can be used on bables and chlldren over Lwo monLhs of age ln addlLlon uLL1 can be
used ln a concenLraLlon of up Lo 30 lf anyone ls pregnanL lL ls also safe Lo use lf you are
breasLfeedlng

lf we sleep ouLdoors or ln an unscreened room we should use mosqulLo neLs lmpregnaLed wlLh
an lnsecLlclde (such as pyreLhrold) 1he neL should be long enough Lo fall Lo Lhe floor all round
your bed and be Lucked under Lhe maLLress We should check Lhe neL regularly for holes neLs
need Lo be relmpregnaLed wlLh lnsecLlclde every slx Lo Lwelve monLhs (dependlng on how
frequenLly Lhe neL ls washed) Lo remaln effecLlve LonglasLlng neLs ln whlch Lhe pyreLhrold ls
lncorporaLed lnLo Lhe maLerlal of Lhe neL lLself are now avallable and can lasL up Lo flve years

lf pracLlcal we should Lry Lo cover up bare areas wlLh longsleeved looseflLLlng cloLhlng long
Lrousers and socks lf we are ouLslde afLer sunseL Lo reduce Lhe rlsk of mosqulLoes blLlng
CloLhlng may be sprayed or lmpregnaLed wlLh permeLhrln whlch reduces Lhe rlsk of belng
blLLen Lhrough our cloLhes
age | 14


Sleeplng ln an alrcondlLloned room reduces Lhe llkellhood of mosqulLo blLes due Lo Lhe room
LemperaLure belng lowered uoors wlndows and oLher posslble mosqulLo enLry rouLes Lo
sleeplng accommodaLlon should be screened wlLh flne mesh neLLlng we should spray Lhe room
before dusk wlLh an lnsecLlclde (usually a pyreLhrold) Lo klll any mosqulLoes LhaL may have
come lnLo Lhe room durlng Lhe day lf elecLrlclLy ls avallable we should use an elecLrlcally
heaLed devlce Lo vaporlze a LableL conLalnlng a synLheLlc pyreLhrold ln Lhe room durlng Lhe
nlghL 1he burnlng of a mosqulLo coll ls noL as effecLlve

Perbal remedles have noL been LesLed for Lhelr ablllLy Lo prevenL or LreaL malarla and are
Lherefore noL recommended Llkewlse Lhere ls no sclenLlflc proof LhaL homoeopaLhlc remedles
are effecLlve ln elLher prevenLlng or LreaLlng malarla and Lhey are also noL recommended
Ant|ma|ar|a| med|cat|on (chemoprophy|ax|s)
AnLlmalarlal medlcaLlon helps Lo prevenL malarla 1he besL medlcaLlon Lo Lake depends on Lhe
counLry you vlslL 1hls ls because Lhe Lype of paraslLe varles beLween dlfferenL parLs of Lhe
world Also ln some areas Lhe paraslLe has become reslsLanL Lo cerLaln medlclnes

1here ls a posslblllLy of anLlmalarlals LhaL we may buy ln Lhe Lroplcs or over Lhe lnLerneL belng
fake lL ls Lherefore recommended LhaL we obLaln our anLlmalarlal LreaLmenL from our docLors
surgery a pharmaclsL or a Lravel cllnlc MedlcaLlons Lo proLecL agalnsL malarla are noL funded
by Lhe nPS We wlll need Lo buy Lhem regardless of where we obLaln Lhem

1he Lype of medlcaLlon advlsed wlll depend upon Lhe area you are Lravelllng Lo lL wlll also
depend on any healLh problems we have any medlcaLlon you are currenLly Laklng Lhe lengLh of
our sLay and also any problems we may have had wlLh anLlmalarlal medlcaLlon ln Lhe pasL

We should seek advlce for each new Lrlp abroad uo noL assume LhaL Lhe medlcaLlon LhaL we
Look for your lasL Lrlp wlll be advlsed for your nexL Lrlp even Lo Lhe same counLry 1here ls a
changlng paLLern of reslsLance Lo some medlclnes by Lhe paraslLes uocLors nurses
pharmaclsLs and Lravel cllnlcs are updaLed regularly on Lhe besL medlcaLlon Lo Lake for each
counLry

We musL Lake Lhe medlcaLlon exacLly as advlsed 1hls usually lnvolves sLarLlng Lhe medlcaLlon
up Lo a week or more before you go on your Lrlp 1hls allows Lhe level of medlclne ln our body
Lo become effecLlve lL also glves Llme Lo check for any sldeeffecLs before Lravelllng lL ls also
essenLlal LhaL we conLlnue Laklng Lhe medlcaLlon for Lhe correcL Llme advlsed afLer reLurnlng Lo
our home (ofLen for four weeks) 1he mosL common reason for malarla Lo develop ln Lravellers
ls because Lhe anLlmalarlal medlcaLlon ls noL Laken correcLly lor example some doses may be
mlssed or forgoLLen or Lhe LableLs may be sLopped Loo soon afLer reLurnlng from Lhe [ourney

age | 13

ymptoms of ma|ar|a (to he|p w|th prompt d|agnos|s)
SympLoms are slmllar Lo flu 1hey lnclude fever shlvers sweaLlng backache [olnL palns
headache vomlLlng dlarrhoea and someLlmes dellrlum 1hese sympLoms may Lake a week or
more Lo develop afLer you have been blLLen by a mosqulLo Cccaslonally lL Lakes a year for
sympLoms Lo develop

1hls means LhaL we should suspecL malarla ln anyone wlLh a feverlsh lllness who has Lravelled
Lo a malarlarlsk area wlLhln Lhe pasL year especlally ln Lhe prevlous Lhree monLhs
pec|a| s|tuat|ons
O regnanL women are aL parLlcular rlsk of severe malarla and should ldeally noL go Lo
malarlarlsk areas lull dlscusslon wlLh a docLor ls advlsable lf you are pregnanL and
lnLend Lo Lravel MosL anLlmalarlal medlcaLlons are LhoughL Lo be safe Lo Lhe unborn
chlld Some such as mefloqulne should be avolded ln Lhe flrsL Lwelve weeks of
pregnancy
O nonpregnanL women Laklng mefloqulne should avold becomlng pregnanL ou should
conLlnue wlLh conLracepLlon for Lhree monLhs afLer Lhe lasL dose
O lf you are glven doxycycllne and are also Laklng Lhe comblned oral conLracepLlve plll
(CCC) or uslng Lhe paLch Lhen you should use alLernaLlve conLracepLlon for Lhe flrsL
Lhree weeks of Laklng Lhe doxycycllne 1hls ls because doxycycllne may lnLerfere wlLh
Lhe effecLlveness of Lhe CCC (or paLch) AfLer Lhree weeks you wlll noL need Lo use any
addlLlonal conLracepLlon
O lf you have epllepsy kldney fallure some forms of menLal lllness and some oLher
uncommon lllnesses you may have a resLrlcLed cholce of anLlmalarlal medlcaLlon 1hls
may be due Lo your condlLlon or Lo posslble lnLeracLlons wlLh oLher medlcaLlon LhaL we
may be Laklng
O lf we do noL have a spleen (lf you have had lL removed) or our spleen does noL work
well Lhen we have a parLlcularly hlgh rlsk of developlng severe malarla ldeally we
should noL Lravel Lo a malarlarlsk counLry Powever lf Lravel ls essenLlal every efforL
should be made Lo avold lnfecLlon and we should be very sLrlcL abouL Laklng our
anLlmalarlal medlcaLlon
O 1ravellers golng Lo remoLe places far from medlcal faclllLles someLlmes Lake emergency
medlcaLlon wlLh Lhem 1hls can be used Lo LreaL suspecLed malarla unLll proper medlcal
care ls avallable





age | 16

keferences
O hLLp//wwwmayocllnlccom/healLh/malarla/uS00473/uSLC1lCncompllcaLlons
O hLLp//malarlaemedLvcom/malarla/malarladlagnoslsp2hLml
O hLLp//wwwmalarlaslLecom/malarla/CompllcaLlons2hLm
O hLLp//enwlklpedlaorg/wlkl/Malarla
O hLLp//wwwpaLlenLcouk/healLh/MalarlarevenLlonhLm
O hLLp//wwwgooglecom/lmghp?hlenLabwl