The malaria parasite grows in the mosquito for at least a week before the malaria can be passed to another person. After a week when the mosquito finds its next target, the parasites go from the mouth into the target’s blood. The parasites then move to the infected persons liver, enter the liver cell’s and grow and multiply. Whilst the parasites are in the liver, the person does not feel sick. Parasites leave the liver cell and move to the red blood cells where they grow and multiply further. The red blood cells burst, allowing the parasites to attack more cells. Toxins from the parasites are released into the blood making the person feel ill. What are the signs and symptoms of malaria? The signs and symptoms of malaria include fever and flu like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting and diarrhea may also occur. Malaria may cause anaemia and jaundice (yellow colouring of the skin and eyes) because of the loss of red blood cells. Infection with one type of malaria, P. falciparum, if not promptly treated, can lead to further complications. How soon will a person feel sick after being bitten by an infected mosquito? In most people, symptoms will begin 10 days to 4 weeks after infection, although a person may feel ill as early as 8 days or up to a year later. Treatment and Prevention There are quite a few drugs used for treatment of malaria as well as those that can be taken preventively. Usually these anti-malarial tablets or pills are taken daily or weekly at a lower dose than would be used for treatment of a person who actually has malaria. The use of these prophylactic drugs is not often a practical solution for people who live in malaria risk areas as there can be side effects with long term use. Anti-malarial drugs are usually prescribed for those on short visits and travellers. The most commonly available anti-malarial drugs used for prophylaxis include; Doxycycline, Mefloquine and Delatprim. Doxycycline is an antibiotic and is used for the prevention of malaria. It is taken on a daily basis; and the patient has to start taking the medication two days before travel, continue taking it whilst in the endemic area and continue for four weeks after returning. Doxycycline can only be taken for periods up to six months. Personally, I think it is rather tedious to take Doxycycline and patients tend to forget to take it on a daily basis. Hence I would recommend using prophylactic medication that has to be taken on a weekly basis rather than a daily basis. Mefloquine on the other hand must be started two and a half weeks before travel, continued throughout the visit and must be continued for four weeks after return. Mefloquine is quite popular throughout the travelling community but does have some side effects associated with it including vivid hallucinations. Mefloquine can be taken for periods up to one year. Mefloquine is a drug that is tolerated well by some and not so well by others. My advice would be that if Mefloquine has been taken in the past with no major side effects then it can be continued. If side effects were experienced, the third option would be to use Delatprim. Delatprim is a combination of Pyrimethamine and Dapsone. It is used on a weekly basis and should normally be started two weeks prior to the trip, continued throughout the trip and taken for two weeks after returning. It is the one I would personally recommend to travellers because it is easy to use and has a much smaller side effect profile compared to the others. Recent studies have also shown a successful re-introduction of Chloroquine for Malaria prophylaxis. The usual dose for adults is 2 tablets once a week starting one week before departure and continuing 4 weeks after leaving the malarial area. It is important that the dose is taken at the same day of the week. It is rather scarce in Malawi, as it was removed from the market due to resistance, but as it hasn’t been used for quite some time, it is proving to be effective as a prophylactic measure. In terms of the treatment of malaria, the options in the market include; Artemether-lumefantrine (commercial names include Lonart or Lum-artem). This combination is available in many different brands and many different pack sizes. It is extremely important to read the insert or speak to your local GP or Pharmacist about the instructions for utilising this medication. It is the first line treatment in Malawi and proven to be very effective with very little resistance noted. Another option for the treatment of malaria includes Artesunate - Sulfadoxine – Pyrimethamine (Commercial names include Spafil or Co-arinate). This is a combination that is used widely and proven to be equally as effective as Lonart. Again it comes in many different brands and the instructions vary according to the brand of the medication. A very close combination to the above mentioned is a combination of Dihydroartemesinin-Sulfadoxine-Pyrimethamine (Commercial name is Alaxin Plus). This treatment is a one-off treatment, where three tablets are taken at once. It is extremely popular due to the ease of taking the medication and it is widely available. It is important to note that the treatments discussed in this section of the article all contain sulphur so if you are aware of any sensitivity towards sulphur, it is best to stay away from these options. The last treatment I will discuss is the combination of Dihydroartemisin and Piperaquine (Commercial name being Duo-Cotecxin). This is a new combination available on the Malawian market. This combination was developed in the Chinese market and is making its presence in Malawi. It is an extremely successful treatment and the duration of the treatment is three days. It is well tolerated by patients and no major side-effects have been recorded. It is important to note that before starting any treatment, a doctor or a pharmacist must be consulted. This is especially true if one is taking more than one drug. In addition it is advisable to keep malaria home test kits if going to areas where hospitals or doctors are not easily accessible.