Q Our children love animals and are now old enough,at three and five, to enjoy a safari. We'd like to visit a game park but I have heard how there are problems giving malaria pills to children. Would it be safest to give them a homeopathic preparation? P Sims, Manchester
A It is possible that health stores may offer non-pharmaceutical products that claim to protect against malaria, but they shouldn't. Channel 4 recently reported that a popular cosmetic brand, Neal's Yard, had been reprimanded by the Medicines and Healthcare Products Regulatory Agency for selling Malaria Officialis 30c, which was intended as a treatment or preventative for malaria.
The MHRA stopped sales of this product on the grounds that travellers are mislead into thinking they are protected, and the concern is that this could lead to serious illness or even death.
Interestingly the British Homeopathic Association (www.trusthomeopathy.org) an association of health professionals who are also qualified in homeopathy, is clear on warning against relying on homeopathy for malaria prevention. The idea of prophylaxis and immunisation is actually contrary to homeopathy theory. Homeopathy aims to cure using the idea of treating like with like, so it can't be used before the disease has struck.
The first task is to identify whether a destination is malarial. Statistics just released about the cases of malaria imported into the UK for 2007 state that of the 844 cases for which there was information, 81 per cent (704) of travellers had not taken malaria prevention tablets, and a high proportion of the remainder took tablets that were inappropriate for the destination.
The authoritative site which includes a malaria risk map for each country is at www.fitfortravel.nhs.uk. Good information is also available on www.nathnac.org and www.malariahotspots.co.uk. It is important to be clear that malaria is a very dangerous disease – and it is life-threatening especially in small children and in pregnancy.
The big problem of malaria is that symptoms in children can be very hard to recognise. Serious malaria can – initially, at least – make a child cranky, or a child can simply slip off into a coma. Travelling with the under-10s is challenging because they can just get very sick very fast. And then how do you find a competent medical opinion?
Families planning to travel to Africa can avoid malaria by choosing a non-malarial destination; much of South Africa as well as the southern regions of both Namibia and Botswana are considered low risk. If that isn't possible, bites need to be prevented between dusk and dawn, and – with the help of a travel health advisor – a suitable antimalarial preparation chosen.
Over-the-counter chloroquine syrup gives very little protection in malarial Africa and doxycycline permanently disfigures growing teeth so the choice is between just two effective and suitable preparations: Malarone and Lariam.
Lariam (mefloquine) has suffered from alarmist reports highlighting that a minority of adults experience side-effects ranging from mood alteration to distressing nightmares. These side-effects do not seem to trouble children and the tablets are generally well tolerated by youngsters. Lariam can be taken by anyone weighing six kilos or more and tablets can be cracked into pieces for ease of swallowing. Its advantage is that it is only taken weekly, and it is relatively inexpensive. It needs to be taken for a month after leaving the malaria risk area. Malarone (atovaquone and proguanil) comes in pink paediatric tablets. It is taken daily but only for a week after getting home. It can be used by people weighing more than 10 kilos and is the most expensive of the available malaria prophylactics.
Dr Jane Wilson-Howarth
The writer is a GP and author of 'Bugs Bites & Bowels: the essential guide to travel health' (Cadogan, £9.99).
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