BootsnAll Travel Community

I've read many good comments here about malaria medication, and which one to use. Some people swear by one or the other, and everyone acknowledges that side effects will vary by individual. However, here is the real question:

Question:
Should an invividual in a known malarial region take malaria medication?

Choices:
YES! Not taking meds is not worth the risk that getting malaria would bring.
NO! Taking the meds is not worth the inherent risks involved.

 

How would you define "region"? It that a subcontinent? A country? A place within in a country?

To me, it depends on the region. I'm not a doctor, but my impression is that not taking malaria pills in Africa is dangerous and stupid. Don't risk it.

In other parts of the world, I still wouldn't recommend it, and I plan on taking medication despite the cost and hassle, but my impression is that the risk is less.

So no visits to Tunis or Capetown without malaria pills?

I would define a "known malarial region" as any region (subcontinent, country, or place within a country) in which a traveller has a substantial risk of Malaria.

Examples:

Thailand on the Laos border
Cambodia
Sudan
Most of Kenya
etc.

The reason I'm asking this question is because I've seen many people on this forum who say that their entire strategy for malaria prevention is mosquito bite prevention.

I also happen to know somebody who went from very-intelligent-person to mental-vegetable-for-the-rest-of-his-life solely because of Malaria medication. I know that this is probably extremely rare, but it can happen nonetheless.

quote:

Originally posted by static:
So no visits to Tunis or Capetown without malaria pills?

Well, the malarial regions of Africa obviously

quote:

Well, the malarial regions of Africa obviously

Seems like Malena knows what a Malarial region is.

I don't think there is one set answer, everyone needs to decide for themselves.

That said I do take it, although not Lariam/Mefloquine - I shell out the big bucks for Malarone. Its worth it to me knowing that I'm not risking setting off a mental illness, at the same time malarias sucks too and mosquitos seem to love the taste of me so bite prevention is impossible.

I just found out that Malarone would be totally paid for by my health plan. Still not sure if I want to do it though.

For every person out there who goes into a vegitative state because of Malaria, I guarantee you thousands more die from the actual disease.

Malaria is horrifying to see in action. I've known people who've had it and wasted away so quickly...it's a truly devestating disease.

So is it worth a sunburn, a few nightmares and the very rare chance of a serious side effect? Yup. I'd say so.

And I hate to play this card, because I get that it's about personal choice BUT:
For God's sake, malaria kills more people on earth then any other disease. It is the leading cause of death worldwide. Most people who get it cannot afford to prevent it. And yet, I promise you that every last person on this website right now can. And yet they still act like it's no big deal...ahhh just a little malaria. What a story it will make later! Or they feel like it's more 'pure' to travel without immunizations and medications.

Well, you go to Africa's malaria infested areas without malaria pills, get malaria, deal with Sub-Saharan Africa's fantastic hospital accomodations, and risk getting needle put in your arms in an area of high HIV infection, dont go cryin about it on these boards. Slowest buffalo and all...

Prisa, you've made some good points.

And while malaria certainly is NOT the leading cause of death worldwide (not even close), you are right that it kills many, many people - especially those who cannot afford to prevent it.

You are also right that anyone who ignores health risks in order to be able to tell stories or be more 'pure' is misguided.

What I am trying to figure out logically, is whether or not my chances of developing lasting and serious effects from malaria are greater than my chances of developing lasting and serious effects from medication.

Now based on statistics from the CDC, a traveler from a Western country to the worst of all malarial regions has about a 1 in 50,000 chance of contracting AND dying from malaria.

The chances of developing side effects from Lariam leading to death or long-term disability is about 1 in 10,000.

Just to put things in perspective.

here

here

here

here

here

here


That's some information that should help.
Malaria kills around 300-500 million people a year worldwide.
I guarantee you your chances of living in a malarial area in Africa and getting malaria are better then taking Malerone or Doxy and becomming a vegitable. I would bet my life savings on it.
My dad lived in Kenya for 2 years. He hated malaria medication and got malaria about 4 times. He eventually had to be shipped back to the US to get better since he was so stubburn about taking his meds.

4 times in 2 years. He's a statistical miracle! Or not.
Fact is a lot of people get malaria. And not a lot of study is done on those that travel and those that take meds.

Now I dont like malaria medication either. I hate it. Gave me horrible nightmares.
But one of the lasting side effects is death.
And that's kinda a big deal for me.
By the way, do a search for Kinga. She's a member of our boards that died from malaria not too long back.

Hi Prisa, thanks for posting - I read all of these. Maybe you should too: "1.5 to 2.7 million deaths worldwide." 300-500 million are affected.

Does anybody have some good insight into this issue?

Whoops! Typo alert. Meh.
With odds only at 2.7 million deaths per year and 500 million affected per year, people should have no problem not taking Doxy or Malerone (which have pretty easy going side effects compared to Larium). After all what's a few million dead every year?

But here would be my worry...so you may not die of Malaria. God willing you dont. But you're still in hospitals in 3rd world countries where they do not always use clean needles, and there is a massivly high AIDS epedemic. And if you really think you'll have the wherewithall to demand a clean needle from the doc in the middle of your malarial fever, then bravo indeed.
Not to mention the other contagious diseases one might get from spending any legnth of time in say....a Ugandan hospital.
Typhoid anybody?
Yes please.

--Then again I suppose that's only if you can get to a hospital. So maybe your odds arn't so bad.

Manchu, I'm not sure what you're asking for. You seem to have made up your mind. As Prisa says there is always a risk of secondary infection, not only because of sub par medical care but also because malaria can be a long, lingering disease that will kick the crap out of your immune system. In addition, some types of malaria are quite likely to come back, so no you won't die but you will have recurring bouts for the rest of you life. In addition the sickness itself can be much harder to bear than the possible side effects of larium.

From what I've heard it is often quickly apparent who will have the harsher side effects of larium and that is why doctors often urge you to take a trial run at home to see how you do so that they may tailor your dose, change medications or otherwise advise you.

As with nearly anything regarding your health this is your choice but I really don't understand what you want here. It looks like you're just picking a fight. Many medical statistics can be argued this way and that, it comes down to educating yourself as much as possible and making your own decision. I don't think anyone here can change your mind.

Furthermore, if this topic is designed to educate anyone but yourself maybe you could elucidate what 'regions' you are talking about and where the borders of these 'regions' are. Static asked you about this earlier and you gave a vague answer. I'd really like to see a table of "regions" with corresponding recommended malaria prophylaxis, I know that strains in various areas respond to different prophylaxes. I haven't looked through every link posted so forgive me if I've missed it.

Callilucy, if I had made up my mind, I wouldn't be asking. I've seen a lot of wisdom on these boards and am trying to tap some of it.

Looking through discussions on malaria on this forum I've seen many people who have said that they don't engage in malaria prophylaxis - even when travelling to regions for which a doctor would probably prescribe such treatment. My reason for starting this post is to find out what reasons these people could have for doing so.

So far none of these people have responded, but I have learned some good things from others. Prisa has raised the point that maybe people refrain from chemoprophylaxis because of wanting to be able to tell a great story later, or to travel more 'pure.'

I raised the point that maybe people refrain from chemoprophylaxis because of the risks of serious side effects. Perhaps, another reason could even be that travellers don't want to have their trips marred by more minor but "trip ruining" side effects. I'm certainly not saying that all of these reasons are good ones, but I'm trying to learn more about the motivations of people who don't take malaria medication.

Though none of these people have responded, others on this post have raised some good points for the other side (risks of HIV contamination from shoddy hospital hygiene practices, horrible lingering effects of malaria, etc). These have been very informative to me and weren't all issues that I had thought about before.

I still don't think that a discussion of specific regions is relevant to what I am trying to find out. What I am talking about here is a region where a travel doctor would usually advise antimalarial medication. A great link I found on this site for malaria maps is here:

http://www.fitfortravel.scot.nhs.uk/destinations/maps/worldmap.htm

This site has great maps for every country I believe with areas shaded where antimalarials are usually advised.

So to the people who keep asking me about what region I am talking about, are you saying that of two regions that a doctor would usually advise antimalarials for you would consider taking his advice for one, and not for the other?

Thanks again to everyone who has responded so far - obviously some of you know a lot more than me about the disease. Maybe the answer that I'll end up with is that anybody who ignores the advice of their doctor and doesn't take antimalarials of some sort is a moron.

To all you people who don't take antimalarials in regions where they would usually be advised, are you morons or do you have a good reason? (Note: the preceeding question is intended to help educate myself and others reading this - not to rile people up or pick a fight)

Also Note: If you are not one of those people but still have some insight into reasons why others wouldn't take medication, please share. We've already seen some good reasons why people DO take the medication.

Here are some of the reasons for not taking malaria medication that I have seen folks post in the past:

• No one medication option seems to offer their desired balance of reasonable cost, tolerable side effects, and adequate regional coverage. Since no one medication really fits all of their needs, they choose "none of the above."
  
• They will be gone for quite a long time and their preferred medication is contraindicated for long term use or they feel it will be a major pain to acquire the proper meds while on the road.
  
• There is sufficient anecdotal evidence of people who contract malaria even when taking a medication, and then there are the people who have never contracted malaria even when not taking a medication. Adding to those that you still need to be vigilant about mosquito bites anyway due to other diseases, people figure it's just not worth the extra hassle and expense.
  

You might classify these as excuses, not reasons, but that's what I've seen cited in the past. I have not traveled to any malarial areas, so I've not had to make this choice for myself yet. I'm still hoping for a nice, tidy vaccine.

Thanks for the good thoughts Liforce. A nice tidy vaccine is everyone's dream.

Malaria strains in the regions differ..so the kind of medication you might be prescribed will be different. So if you mix medications which work in one region do not necessarily work in other. Not only region but malaria types in India differ from one area to the other...and the medications you have to take differ.

I lived in India for 21 years...did not ever get malaria. Visited for another 15 years (sometimes more than 2 weeks) and still no malaria.

I'm not a moron ;-) I choose not to take malaria medication because of the side effects....one i'm already photosensitive and one of them would have made me more. Also the hallucinating side effects I did not need as I was already feeling a little depressed at that time in my life. I trust one person medically he told me I will not die from the strains in Asia.He was worried a little though when i was traveling in Tanzania.

Basically so far I have not traveled outside "tourist" areas which tend to be cleaner, more hygenic than any of hte malaria prone areas. The day I have to spend more than 2 weeks in a rural area in Asia or Africa I will think 20 times about my risk.

So that was my reasoning....its a gamble I choose to take. One time that I gamble.

I have a warning about a post like this ( mine own)..do not take my word, you don;t know me and thus no reason to trust my judgement so do you own research, trust your judgement and make a decision for yourself. Nobody should base their decision on a forum response...however intelligent we might sound as a group of people.

I think its not wise to have a poll on such subjects..its not a simple decision and hope people who are on borderline not take somebody word here on about a medical decision.

Great response Madhu. Thanks for posting your personal reasons for not taking the medication.

You're also very right about how people should not take any body's word over their own judgment - especially in matters involving their own health and safety.

This is actually the very reason I started this post. I'm trying to bring to light both sides of this issue - allowing people to see more facts and opinions and be more able to make their own decisions based on more information.