Malaria is a parasite that is spread by the Anopheles mosquito. The mosquito must bite a person that is infected with malaria. The parasite matures inside the mosquito. Then, about a week later the mosquito bites another person, infecting them with malaria. It takes another 10 days to 4 weeks before the infected person starts showing symptoms. There are several types of the malaria parasite. One type can lay dormant in the liver for up to four years before showing symptoms. Fortunately, there are several things that we know about malaria that can help us prevent it.
The Anopheles mosquito is the only type of mosquito that spreads malaria. These mosquitoes bite from dusk to dawn. Therefore, we must be most vigilant in protecting ourselves from mosquito bites at night.
If out in the evening, dress the kids in long sleeves and use mosquito repellent.
Studies show that sleeping under an insecticide treated mosquito net greatly reduces the chances of getting malaria. I would encourage you to provide mosquito nets for your employees as well. You can purchase pre-treated nets. Some people get wooden frames made with nets that reach down to the ground. If you do this, you can soak the nets in insecticide. Fendona is a WHO approved insecticide that can be used. In Lilongwe, it can be purchased at the garden shop at Gateway Mall. Follow the directions on the bottle for dilution and treatment.
The World Health organization notes that malaria is more prevalent when both the lifespan of the mosquito is longer and the conditions are more wet. We see a spike in malaria during rainy season when mosquitos can grow in puddles.
According to the World Health Organization, adults that have grown up in a malaria endemic area build up at least partial immunity. While they can still get malaria, they rarely get severe disease. However, children and travelers remain at high risk for severe disease. The CDC recommends that foreigners that travel to Malawi take a malaria prophylaxis. NHS recommends that anyone traveling to Malawi for 3 years or less, should be on malaria prophylaxis. As part of the prenatal care in Malawi, patients receive malaria treatment. If patients are not routinely taking malaria prophylaxis, I encourage them to take it before they go on a camping trip or to the village.
Here is a guide adapted from the CDC that is helpful for malaria prophylaxis dosing.
While malaria is not directly spread from person to person, the mosquito has to have bit an infected person. A Malawian public health worker shared with me that they stress early detection and treatment to reduce the risk of transmission. It is not uncommon to have more than one person in the household test positive for malaria at the same time. Most likely they were both bit by the same mosquito.
I don’t see a lot of malaria cases on the private side of the clinic. I think patients are doing a good job of sleeping under mosquito nets. Also, most of my patients live in individual homes more spread out than in a village. I did a bush clinic on the outskirts of Lilongwe and was surprised that every child that checked in had a fever. Of those, more than 50% were positive for malaria. Therefore, it’s understandable that if one is outside in the evenings in a densely populated area they are at an increased risk of getting malaria than if they are in a home in a less densely populated area. Those traveling to the village, should take extra precautions.