How to prevent malaria in kids and adults

Here's what I hear from expats in Abuja: 

"Those malaria pills have too many side effects." 

"I just drink a gin and tonic for malaria prevention."

"Is there really that much malaria in Abuja?"

Here are other things I hear:

"We've been here a week and two out of three of us got malaria, including our 3 year old."

"Our three year old got malaria in February and got it again in April." 

"4 of the 15 people at our embassy have gotten malaria in the last month."

"My healthy girlfriend was just airlifted out and hospitalized for three months for malaria with severe liver and kidney disfunction." 

"A young defense attaché at our embassy was just hospitalized with malaria for a month." 

If you're travelling to an area that has a lot of mosquitoes, you'll want to prevent bites anyways because it's so damn annoying to get bitten all the time. Especially if you're like me, and get allergic reactions to mosquito bites and those bites always develop into big angry red patches and they keep you up for a week at night trying not to scratch and yeah, I don't like mosquito bites. 

But if you're travelling to an area with a lot of malaria, there's more than just reducing bites. 

You should do everything you can to prevent yourself and your children from getting malaria. 

The bad news first: Sub-Saharan Africa has 90% of the world's deaths from malaria. Most malaria found in sub-Saharan Africa is caused by a variety of the parasite called P. falciparum, which is the one most likely to kill people. And guess what? Most deaths due to malaria happen in children under the age of 5. The disease course in "normal" malaria can last weeks, and while symptoms can be very different, the classic malaria symptoms include a "cold" stage, followed by a "hot" stage of 6-10 hours that can include seizures in young children, followed by a "sweating" stage where body temperature returns to normal. Severe disease with malaria tends to sneak up on people; you can deteriorate to requiring hospitalization within a matter of hours. Severe disease can include permanent brain, lung, kidney, and liver damage, coma, and death. 

So of course, the first thing you should try and do is ask if you really need to travel to malaria prone areas with your kids. But if you need to, read on. 

The good news, though, is that there are many strategies to help you prevent it.  

No one way to prevent malaria works 100%, so you need to layer up prevention strategies. 

First, make sure you are familiar with all the ways to prevent getting mosquito bites that actually work. That covers about half of all the things you need to do when it comes to malaria prevention. 

But while these are great, you need to still prevent the disease. A lot of bites from the malaria-carrying mosquitoes are silent, meaning you don't feel anything and don't notice you've been bitten. 

The three-pronged strategy to prevent malaria 

1. Take anti-malaria medication, even if you are going for a long time. These medications have been proven to be safe and generally reduce the chance of getting malaria by 90%. Those are pretty good odds to me. In general, atovaquone/proguanil (Malarone) has fewer side effects than the others, but you have to take it every day and it's expensive. Kids might tolerate a weekly pill like mefloquine better, but check with your doctor that you're not going to an area where the malaria parasite is resistant to mefloquine. 

Feeling hesistant? I understand. It's hard to think about putting an unknown chemical substance willingly in your body. But if you don't want to subject yourself and kids to months or even years of a drug, consider the risks involved if you do get malaria (especially if your kids get malaria), and consider that drug companies are obligated to state all the side effects but in reality most people tolerate these medications very well. We took Malarone for the whole nearly 2 years we were in Abuja with zero side effects. 

2. Know how to prevent mosquito bites, including using air conditioners, bednets, mosquito spray. Don't go out between 6pm and 6am when the malaria-carrying mosquito is active. If you do go out between these times, you better douse yourself with mosquito repellent with the highest DEET concentration available. 

3. If you have any fever even within 1 year of coming back, make sure to get tested for malaria. malaria can have a long incubation period (period between getting infected and showing disease), especially if you take anti-malaria medication which suppresses the disease for a while. 

For those living long-term in malaria-endemic areas, choosing a house or apartment without many trees around or standing bodies of water around will help, as mosquitoes love breeding and hanging around in these places. 

Also consider, especially if you are going to a rural/remote area or doing safari: 

- Rapid malaria diagnostic tests. These don't widely exist in high income countries but you can find them readily in pharmacies where malaria is prevalent. To be honest because these tests are not very accurate, I would only take these with you if travelling somewhere very rural where you can't access a hospital on the same day. In a big city, it's much more advisable to drive to the hospital and get the more accurate blood test. 

- Pills for emergency treatment. This can be either malarone or mefloquine, but the best option for children (over a certain weight limit) and adults is an artemisinin combination therapy. You can find artemether in most pharmacies in malaria prevalent countries. Try to go to private pharmacies. 

Good luck. With the proper precautions you can ensure your malaria risk is minimized. It might sound like a lot but you will be glad you did it. Especially if you have kids. 

Consulted sources: 

1. CDC: Malaria. https://www.cdc.gov/malaria/about/disease.html

2. Samdi et al. Seasonal Variation of Malaria Parasite Density in Paediatric Population of North Eastern Nigeria. Glob J Health Sci. 2012 Mar; 4(2): 103–109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777043/