Tribal dances around the campfire, tented camps, lions and Landrover adventures… A family safari is the stuff of many kids’ dreams, but how do you combat the risk of malaria when travelling with children?
Let’s be straight about one thing: malaria is an extremely dangerous disease – particularly in small children and during pregnancy – and there is no vaccination against it, so going to a malarious region is a decision that requires a lot of thought. According to a recent World Helath Organisation report, children under five years of age are one of most vulnerable groups affected by malaria. Infant, WHO reported that there were an estimated 584,000 malaria deaths around the world in 2013, of which approximately 78% were in children under five.
The illness is caused by infection of red blood cells with a parasite called Plasmodium and it is transmitted by mosquitoes. While Africa is a hotbed, much of Asia-Pacific and South America have high risk areas too due to their ambient temperatures and high humidity. The risk of being bitten is year round in some destinations and seasonal in others, but anywhere the risk is present, travelling in the cooler months won’t mean you’re scot free.
Public Health England (PHE) recently produced a set of guidelines for malaria prevention in UK travellers. In it they emphasise that no regimen is 100% effective, but a combination of preventive measures can give significant protection against malaria.
So if you’re considering a family holiday to a malarious region, make sure you know the facts – and the most effective malaria prevention for kids.
If you don’t have a destination in mind yet and want to see what your options are head to www.malariahotspots.co.uk. But if you know what you want and don’t want to miss out on the migration, just do your homework. Much of South Africa – as well as the southern regions of Namibia and Botswana – are low risk. The NHS site Fit For Travel is an authoritative place for research and includes a malaria risk map for each country.
If you go anywhere where there is a risk of malaria, you can do a lot to prevent bites. Dusk and dawn are the most prevalent times of day for mosquitoes so take extra precautions then, but also be aware of specific regional variations. PHE say that in Africa the hour around midnight is the peak for biting, while in South America and South-East Asia it’s sundown. Make sure ankles and arms are covered with socks and sleeves as well as using repellant to fend off unwanted bugs. The NHS recommends spraying skin with repellant before dressing and then clothes afterwards as thin cotton won’t prevent bites.
The PHE Advisory Committee suggests that DEET-based insect repellents (with concentrations over 20%) give a longer duration of protection than currently available formulations of other agents, and that few alternative preparations are as effective at preventing bites. Bear in mind that sunscreen and DEET work against one another and so if you are combining both, use a higher factor than normal and apply the DEET after the sunscreen. Check the product for information but most DEET repellants are suitable for children over 8 weeks.
Travel with two lightweight mosquito nets per child and a roll of string. If they are in a travel cot you can easily drape and secure both nets over the cot to add a second layer of protection. Likewise with beds, tuck the net under the mattress – draping it around the bed is not sufficient.
You might have been told to eat garlic and take Vitamin B or slather on the tea tree oil to repel mosquitoes, but it’s all unsubstantiated. Likewise expensive electronic buzzers (which emit high frequency sound waves) are entirely ineffective and companies selling them have been prosecuted and fined under the UK Trades Descriptions Act – ultrasound devices do not prevent bites, whatever the marketing sell on the packet.
Most commonly, symptoms are flu-like and include fever, headache and vomiting. While they can develop as quickly as 7-15 days after the mosquito bite, it can take up to a year. Often the symptoms start out mild and so they are tricky to diagnose, but be extra-cautious because in the initial stages of malaria, you might notice your child being a bit cranky, or they could suddenly fall into a coma.
Small children are likely to sicken more quickly depending on the strain, so it is important to seek help as soon as possible, especially if they are ill while travelling or within the first three months of returning home. Depending on how remote you are, getting good medical assistance quickly can be a challenge so, as a rule, it’s better to act fast.
If you are a believer in homeopathic remedies just bear in mind that even The Faculty of Homoeopathy does not promote the use of homoeopathic remedies for malaria prevention. There are a number of suitable antimalarial preparations designed for kids, but they are not all reliable.
Over-the-counter chloroquine syrup actually gives very minimal protection in malarial Africa, while ‘doxycycline permanently disfigures growing teeth’ according to Dr Jane Wilson-Howarth, a GP and the author of ‘Bugs Bites & Bowels: the essential guide to travel health’. Which leaves two effective and suitable preparations: Lariam and Malarone.
- Lariam (mefloquine) has suffered from alarmist reports highlighting that some adults experience side-effects ranging from mood alteration to nightmares.They don’t seem to be an issue for children, though. Kids must weight 6kg, the tablet is taken weekly for a month after leaving the malaria risk region. It is relatively inexpensive.
- Malarone (atovaquone and proguanil) comes in pink paediatric tablets. It is taken daily for a week after getting home. Children must weigh at least 10kg. This is a much pricier option.
Once You Get Home
Don’t forget to be vigilant once you return from holiday. If your children develop a fever, even up to one year after your return, you should seek medical attention and tell the doctor that you have been in a malarious area.