Seriously, long, long ago, the Romans thought that miasmic air from the surrounding swamps caused the illness we now know as malaria. (Latin malus aira, Italian malaria, meaning bad or evil air.)
Whether you’re a resident or tourist, we know you’d like updated information about the risk in this area, so we asked Dr Mark Barry to give us the lowdown on malaria risk in the Lowveld. Accordingly herewith the current facts about malaria in the region:
We Are White River: What is the current malaria risk for the White River / Nelspruit / Hazyview / Hoedspruit region – and if classified ‘low’ what sort of percentage is that – ie less than 10%?
Dr Barry: Malaria remains a risk throughout the Lowveld in all the municipalities that you mention. The degree of risk fluctuates seasonally, higher in the summer when it rains and there are puddles of water in which the Anopheles mosquito can breed; lower in winter. The peak incidence months are usually March and April, as the incubation period is 7-14 days after being bitten by an infected mosquito. The level of risk is certainly higher in the Kruger Park and the Onderberg/Nkomazi, where the average temperatures are higher, but remember that mosquitos can be transported in vehicles out of the park to White River and Nelspruit. Trying to put a percentage to the risk level is meaningless.
We Are White River: Given that malaria has a broad range of symptoms, when should one consider a malaria test, and is the quick test performed at a pharmacy of any benefit or should one visit a doctor for a full blood screen straight away?
Dr Barry: As you say the symptoms of malaria are broad; but essentially influenza-like: fever, rigors (shivering with cold sweats), headache, fatigue etc that do not resolve within a day or two and worsen; particularly with a history of recent travel to areas with known high endemicity eg KNP, Mozambique, the Lowveld of Swaziland. The rapid test available at pharmacies is certainly of value but malaria is notorious for testing negative despite being present in the patient, because the test is taken when the concentration of parasites – schizonts – is low in the bloodstream. Ideally it must be taken during a pronounced rigor which usually coincides with a release of parasites from the liver or the red blood cells. Often there may be one or more negative tests before a positive result is identified. A formal laboratory test is preferable, but the rapid test is certainly sensitive and worthwhile doing.
We Are White River: There is some confusion / myth about different types of malaria, for instance, that cerebral malaria doesn’t exist. Could you clear that up please?
Dr Barry: There are four different species of malaria parasite in Africa, of which only Plasmodium falciparum causes cerebral malaria, and this is the only one of the four commonly present in South Africa. So for all practical purposes the malaria that we are likely to contract in the Lowveld can turn into a case of cerebral malaria if it remains undiagnosed and neglected – labeled as “influenza” – for long enough. All the while the parasite load or concentration is increasing until small blood vessels in the brain become clogged up, or in the lungs causing the adult respiratory distress syndrome (ARDS), or the kidneys with renal failure. All these clinical pictures usually are associated with a high percentage of the red cells being parasitized, and all result in a high morbidity and mortality rate.
We Are White River: For White River residents that have breadwinners working and spending considerable time in Mozambique and high risk areas, what precautions would you recommend taking? Is there a quick test that one can keep on hand to self-administer?
Dr Barry: The human physiology is also able to overcome malaria by itself, or to keep it in check so that the person becomes a carrier. This is complex and has to do with previous exposures and the buildup of some level of immunity; this is the reason that folk who live in high risk areas appear to become immune to infection even though not taking any prophylaxis. A vaccine against malaria is a possibility and much research has already been done on this – and no doubt is on-going – but it is a difficult challenge as the parasite carries multiple antigens on its surface.
Visitors to high prevalence malaria areas are advised to employ all the barrier strategies eg cover up arms and legs in evenings and mornings when the mosquitos feed, chemical repellants, nets over beds etc; and certainly also should be on prophylactic medication – Malanil or Lariam. It is foolish to think it OK to contract malaria “as it will rapidly be diagnosed and treated once I show symptoms”, and so to forego prophylaxis. Pregnant women should simply not go to high risk areas; they risk their own lives as well as those of their unborn children. Malaria has a predilection for the placenta and is very likely to result in miscarriage if not dealt with speedily.
Fortunately, we have expert medical help at hand here. White River residents can obtain further information from Dr Katrina Reinecke (013 751 2987), she has recently completed a course in travel medicine. Dr Paul Theron (013 741 3642) and Dr Frans Theron (013 752 8363) both specialist physicians in Nelspruit, are experts on malaria as well.