Malaria-as a parent what should I know?

School holidays are upon us and South Africans generally head north to the warmer areas and in particular to our game parks. As an avid bush and wildlife lover I fully understand the drive to sit and watch the sunset over the Letaba River. As a paediatrician I am also acutely aware of the risk of malaria, particularly during the magical hours of dusk and dawn.  This is the most beautiful time in the bush but it is also the time that mosquitoes bite and hence the risk of contracting malaria becomes very real.

If I ever asked my children what they wanted for their birthdays, the response was always the same “Kruger Park”. I guess the bush, with the sounds, smells and promise of adventure is what gets us. I love the saying that Africa is like Malaria “once it is your bloodstream it never leaves”. The saying is not medically correct but the sentiment hits every chord in my body.

As a paediatrician practicing in South Africa I have a responsibility to educate my patients about malaria while resonating with their desire to experience our wildlife.

What are the current recommendations?

    1. Children under the age of 5 years should not enter a malaria area unless absolutely necessary or unless they reside there.
    2. Anti-malarial drugs are recommended in high risk areas including the Kruger National Park. It is a good idea to look at a map which indicates high risk areas.
    3. Clothing that covers the body is recommended especially at dusk and dawn.
    4. Insect repellents should be applied to the skin at all times. Creams and sprays are better than the sticks.
  1. Insect coils or mats should be burnt in the rooms.
  2. Keep windows and doors closed.
  3. It may be an idea to spray with an insect spray a couple of hours before going to bed.
  4. Consult your doctor or travel clinic to receive the most-up-to date information on the malaria status in the area you intend travelling to.

What are the signs of malaria?

If you have traveled to a malaria area and develop any symptoms that resemble flu, it should be taken seriously. These include:

  • Fever
  • Headaches
  • Muscle pains
  • Chills
  • Upset tummy
  • Tiredness

When do symptoms occur?

Symptoms may occur as soon as one week after being bitten by a mosquito. The usual time period is between one and four weeks but there have been cases of malaria which only present a year after the person has been bitten.

How is malaria diagnosed?

Malaria is diagnosed by a blood test. The first test may be negative, however if your doctor suspects malaria a second test may be required.

What now?

Malaria is a serious disease that requires treatment. Quinine, Chloroquine or artesunate may be used. The type of malaria and severity of the disease will determine what course of action is taken.

In conclusion

Malaria is a real disease with devastating consequences if not treated. I am including a letter from a very dear patient who has experienced malaria first hand. This family has lived the African dream. The children have run free along the banks of rivers, have lived with the beauty of the African bush but have also starred death in the face because of a tiny insect known to us as “a mosquito”

From: “Wim Ebersohn ”
Date: April 25, 2018 at 12:32:30 PM GMT+2

 I was planning to write only a few words, but after 16 years of living with this disease I found that I had much more to write. Dr Maraschin and his wife Robyn have been with us all these years and have been incredibly supportive while we received the very best medical care.Our story with Dr Maraschin started 12 and a half years ago when my gynie introduced us. I was an anxious expectant mother at the time. I needed a first-class pediatrician to be at my c-section and to be there always for my unborn child. My apprehensions however where not due to becoming a mother for the first time nor due to my very complicated pregnancy (due to a bio-cornea uteruses), it was however due to where I live and the dangers therein…

A few years before falling pregnant my husband and I decided to move to Northern Mozambique, to the Niassa Reserve. We are avid conservationists and once seeing the vast wilderness we fell instantly in love with the amazing place. In the reserve we have no tar roads, no telephones and above all no hospitals or doctors. We have all kinds of animals roaming free as there are no fences: lions, elephant, hippo and buffalo to name a few. It is very isolate, 14 hours away from the closest “ town” which is little more than a village “with tar roads”. The tranquility is serene and the local people are amazing to live alongside BUT there is one huge downfall in our paradise, MALARIA! (Plasmodium falciparum). Malaria is an illness transmitted by mosquitoes. Not just any old mozzi gives you malaria. It is only the female Anopheles that carries malaria. Malaria kills more people in today’s world than any other disease. If left untreated malaria caused by one of the four parasites, Plasmodium falciparum, results in death. Children are the most vulnerable. Hence my anxiety and need for a very, very good pediatrician.

Pregnant woman should avoid malaria areas if possible and seek immediate medical attention if suspected. During pregnancy, malaria infection in the mother can cause low birth weight and result in infant death. This is vital advice. Unfortunately when I fall pregnant I thought my continuous morning sickness was malaria … luckily I got hold of a home pregnancy test and quickly realized my error and was grateful there was no detriment to my baby. I stayed in the bush until I was six months pregnant and then move to South Africa to have my baby.

When my gynie asked if I knew of which pediatricians I wanted, I never had a clue… all I wanted was someone who knew about malaria and how to treat it. In my experience at the time, I learnt that a few doctors in malaria-endemic countries know about the illness, but most doctors in areas without malaria have very little experience with it. I was introduced to Dr Maraschin. He was honest enough to tell me just that, at the time he had very little firsthand encounters with malaria patients but he promised that he would learn everything about the disease and he has done just that!

I have had two children since Dr Maraschin and my first meeting and we have been through a lot together. Babies and small children can become seriously ill with malaria and are at a very high risk .You should not take small children to malaria areas, but unfortunately that is where we live and work. I only moved back home when my children where three months old. We used every possible preventative to avoid our children and ourselves from getting malaria but some times just one mozzies can get you.

As mentioned Dr Maraschin was with us from the beginning. My son would not breast feed and was a “bottle baby”. This helped in a way as I was able to provide the prophylaxis mefliam (1/4 of a tablet) to my son in his bottle. Prophylaxis are a must especially in rainy season when the mosquitos are at their worst. Unfortunately even if you take prophylaxis you still can get malaria. My son got his first bad case at 18 months old. It is very difficult to diagnose a small child with malaria as the symptoms are very similar to other childhood illnesses eg colds and flu (Symptoms are: Tummy pain, nausea, fever, pains in joints and headaches).The other problem is a small child cannot tell you where they are feeling ill. (We did then and do now use malaria test kits but these can be very unreliable as you often get a false negative). We used a rectal treatment for my son but the fevers got continuously worse and the vomiting was terrible. We had to call a medevac from South Africa (this is an air ambulance service with a doctor and paramedic on board. They collect a patient from a faraway place and take them to a proper hospital for treatment). We waited anxiously for hours for the aircraft to arrive. Eventually it did arrive, and my son transferred to Morningside clinic for admission. He was given quinine by continuous intravenous drip. This is the treatment for acute falciparum malaria. Dr Maraschin was amazing and always on call for us when we needed him. His wife Robyn often came to visit. The support and warmth from both of the them was much appreciated.

Since that first time in hospital my son has had many other malaria incidents but only twice has he had to be hospitalized. The above mentioned incident and once when we went to Mauritius. The doctors in Mauritius incorrectly diagnosed him and he ended up in ICU in Morningside clinic. Once again, Dr Maraschin was there to help us with his wonderful care and insight. My son is now 12 and preparing to go to high school but he still goes to Dr Maraschin for his yearly checkups. He luckily has had no long term effects from the malaria due to wonderful and professional care from both Dr Maraschin and his staff.

Our daughter was unfortunately much more complicated than our son. Firstly, she was allergic to mefliam and was put on zithromax antibiotic for children as a malaria prophylaxis. She had her first bout of malaria when she was two, this was misdiagnosed by a doctor up here as tonsillitis as the symptoms are very close. We almost lost her as she started having febrile seizures, also known as convulsions, body spasms, or shaking. She stopped breathing! Luckily, I have had first aid training and was able to resuscitate her. It was a very long night as I could only get a medivac flight out the next day. Hours and hours later we were in Morningside Clinic. My daughter had been put on a drip during the flight and was watched over continuously throughout the flight. She did have a second fit on the plane and had one more in the hospital. When the nursing staff called Dr Maraschin on the phone I happened to look out the window and saw him sprinting from Rochester Place to be by her side.

The second time she was medevacked she had malaria and a UTIs (urinary tract infection). This caused sepsis. From my understanding it is a condition where the immune system goes into overdrive when fighting an infection. If we had been 24 hours later we would have lost our daughter. The third medivac was last year but luckily the malaria was caught quickly. She had started hallucinating and we were very concerned that the malaria had gone cerebral.

We do not have our children on antimalarial drugs all the time because of the long term side effects. We only use the prophylaxis in rainy season when the mozzies are at their worst. The children sleep under very good quality mozzies nets and we use Peaceful Sleep mosquito repellents. Our house is well screened. We use tangle foot all around the house to catch mozzies. We make our children come inside before sunset. We use Coartem to treat malaria at the moment. Unfortunately malaria often becomes resistant to the drugs so over the years we have had a few changes. We also have a problem in that the manufactures in India were not putting the correct amount of the ingredients into the treatment. There is no vaccine for malaria at present, but this will change lives.

I have learnt a few home ticks in dealing with fever and headaches over the years. Vinegar soaks, to reduce fevers. These work amazingly well. Peppermint drops for headaches. Ice chips to suck on. Be very careful of a secondary infection while having a malaria episode. Severe anemia often follows a case of malaria.

Common symptoms of malaria include:
o Shaking chills that can range from moderate to severe.
o High fever.
o Profuse sweating.
o Headache.
o Nausea.
o Vomiting.
o Abdominal pain.
o Diarrhea.

I have personally witnessed all these symptoms. While I would never change the lifestyle we have given our children, I am extremely aware of the dangers that living so remotely have posed. In all, malaria is most certainly one of the greatest dangers we have encountered. I am eternally grateful that our children are able to live this life while still having access to first world medicine.

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