Scott Hanselman

Arusha Tanzania 2006 Day 10 - Malaria

December 11, '06 Comments [10] Posted in Africa | Musings
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Malaria is an interesting bug. Lots of locals blow it off. "Sure, I've had malaria a number of times, sometimes every few months, but then I kick it in a month or two." However, it does kill 2 million a year, and if you do survive it's no fun to have. My mother-in-law just got it after only 3 months in Tanzania after moving from Zimbabwe. There's a lot less incidence of Malaria in Zim than in TZ.

Malaria kills more than 2 million people in Africa each year.  Between 300 and 500 million people suffer from malaria, the majority of which are young children; one out of 20 children in Africa dies of malaria before the age of 5.  Families are often forced to spend approximately 20% of their income on malaria treatments, and public health institutions spend up to 40% of their budgets on outpatient malaria treatment.  All told, in addition to the human loss and suffering, the disease results in an economic loss of $3 billion to African economies each year, slowing economic growth by approximately 1.3% annually. [SDP.org]

Here's what we're doing to prevent malaria while we're here. It's a fairly aggressive and multi-pronged series of techniques. Some may call it overkill, I call it thorough. We're fortunate enough to have enough money to be this thorough, although using any one of these techniques is better than doing nothing and taking your chances.

  • Physical
    • Mosquito Nets
      • Treated Mosquito Nets with Permethrin - You can use a standard Mosquito net, but I recommend taking it to the next level and treating the nets with a repellent. There are some concerns about Permethrin as it's technically a carcinogen, but for a short time, I'm willing to take the risk. We soaked our Mosquito nets in backs with Permethrin for a half-day before we came.
    • Treated Clothing
      • You can also treat clothing with Permethrin. We treated our jeans and shirts. It's a simple treatment. You pour the liquid into a bag, with 2 parts water to 1 parts Permethrin, shake, then wait for a few hours, then dry. You can buy pre-treated clothes, but that's a lot of money for something that will only last for 6 weeks or 6 washings.
    • Citronella Candles
      • Citronella smells pleasant enough, but apparently bugs don't like it. You can buy candles and smoking coils that will keep bugs out of your room.
    • Bounce Fabric Softener
      • You can just wipe these on a baby's clothes, and the rumor is that bugs will stay away. No proof yet.
  • Medical - Oral
    • Malarone anti-malarial
      • This is one of the more expensive and newer anti-malarials, but the cheaper ones like Mefloquine and Cloroquine are working less and less as the mosquitos are getting resistance. If you get malaria while you're on one of these anti-malarials it'll be a lot more difficult to treat. Malorone has fewer side effects than most any anti-malarial out there. When I was taking Mefloquine I had some horrible night-terrors - a common side effect. None of us, including Z, who had a specially compounded baby-dose of Malarone, have had any side effects. You'll need a prescription, and it won't be cheap.
      • UPDATE: There have been reports of VERY bad side effects from Mefloquine (Lariam) so do be aware of that.
    • Artemisinin - homeopathic anti-insect
      • This concentrated dose of "sweet wormwood" is supposed to make you less tasty to the mosquito. It's used to treat Malaria, but folks are starting to use it for a prevention. It's been used in China and outside the US, and is starting to get some attention in the US. You shouldn't use it for a long period of time as it can eventually bother the liver, but I've spoken to folks who've traveled in sub-Saharan Africa who swear by it. You don't need a prescription, but it may be hard to find, or behind the counter.
    • 100mg of Vitamin B
      • Loading up on Vitamin B can hurt the liver if you take it too long, but it also makes you less attractive to bugs.
  • Medical - Topical
    • Deet creams
      • We got a combination cream that is 20% deet and includes an SPF 20 Sunblock in one cream for convenience. If you're in Africa, get something with at least 20% deet, or more if possible. It's not something you should put on baby's face though, or anywhere that she might touch with her hand then put it in her mouth.
    • Citronella creams
      • Citronella creams are safer than Deet for children, and if you're not into Deet or if you're anti-chemical, a citronella-based cream is a reasonable alternative, although arguably less effective.

We haven't been bitten yet.

About Scott

Scott Hanselman is a former professor, former Chief Architect in finance, now speaker, consultant, father, diabetic, and Microsoft employee. He is a failed stand-up comic, a cornrower, and a book author.

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Monday, December 11, 2006 8:34:53 PM UTC
God forbid the do-gooders in the West allow them to spray DDT and save countless lives.
Joe
Tuesday, December 12, 2006 8:39:01 AM UTC
DDT isn't the answer, but that's a post for another day.
Scott Hanselman
Tuesday, December 12, 2006 9:23:51 AM UTC
Scott - just 'cause you haven't had a bite that itches, it doesn't mean you haven't been bitten. You only know you've been bitten when the bite reacts and itches. ;)

I spent months travelling around South-East Asia, and Deet, mosquito nets and vigilance combined with a healthy dose of Anti-Malarials was the only way forward. Just make sure none of the little fellas are inside your mosquito net!

An old acquaintance of mine died on his 30th Birthday from Malaria. He'd been living in Bangkok for a couple of years teaching English and, so it would seem, got a bit lax with preventative measures when he went into Laos - he paid the ultimate price.

I'm glad to hear you are taking so many precautions, although I tend to use the strongest DEET going... it's nasty stuff, but nowhere near as nasty as Malaria. Wouldn't want my favourite blogger coming down with anything!
JayPee
Tuesday, December 12, 2006 4:08:00 PM UTC
Immtech Pharmaceuticals (IMM) has been trying to get a Malaria treatment to market for some time. They seem to be getting closer.
Todd
Wednesday, December 13, 2006 2:40:58 AM UTC
IMO you should update this post regarding Lariam (Mefloquine). Five years ago I took only two pills and still have (minor) problems today. Severe side effects are apparently rare, but to everyone reading, please take Malarone instead. Even if the chance is 1 in 10,000 it is not worth the risk because the side-effects can be so long term. Lariam prevented me from working for almost year, and not being able to work is no biggie compared to the side-effects.
Wednesday, December 13, 2006 7:50:11 AM UTC
Wow, Paul, I'm sorry to hear that. What side effects?
Scott Hanselman
Wednesday, December 13, 2006 7:20:00 PM UTC
Something that our guides in Africa told us to use was ThermaCELL Mosquito Repellent. This little item is suppose to work extremely well and it doesn't cause any damage to the wild animals or their surroundings.
Brandon Krugman
Thursday, December 14, 2006 2:51:30 AM UTC
Eventually I will write a comprehensive article regarding life following Lariam, but here is a brief summary:

Lariam's side effects are cyclical and as time progresses periods without symptoms increases and their severity reduced. My life-changing problem was anxiety (i.e. feelings fight-or-flight around most people). Even shopping in a supermarket was terrifying during the first six months or so. Luckily I was in a position to quit work and obtained a grant for a second Masters degree (AI + Robotics).

Even when returning to work after a year, in-person meetings were often terrifying; imagine sweat beading on your brow for no rational reason - even without a C-level exec in the room ;)

It is no exaggeration to say that I would rather die of Malaria than go through the first few two years of Lariam's side-effects again.

Guides on my overland trip had all seen several 'Lariam Looneys' before and not one of them touched the stuff. Apparently in some parts of Africa local teenagers treat Lariam like LSD and abuse it for the lucid dreams, obviously teenagers are equally dumb the world over :)
Thursday, December 14, 2006 10:48:48 AM UTC
Larium is known for bringing on mental illness, latent or otherwise. Sorry to hear that you had to go through that Paul.
JayPee
Saturday, December 16, 2006 4:34:38 AM UTC
rumour/hearsay: has anybody suggested quinine? http://www.straightdope.com/classics/a990813.html
Duncan
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Disclaimer: The opinions expressed herein are my own personal opinions and do not represent my employer's view in any way.