Malaria Gains as Control Efforts Become More Expensive
By Jane Brody
The New York Times
	New York - One-third of the world’s population lives where the 
malaria parasite and its carrier mosquitoes thrive, and malaria is 
gaining ground annually as control efforts become more costly and 
cumbersome.
	Worldwide there are 300 million to 500 million cases of 
malaria and 2 million to 3 million deaths from the disease each year. 
Why should anyone die of a disease that doctors have long known 
how to cure?
	Because many people outside the endemic areas do not take 
malaria seriously and ignore the measures recommended to prevent 
it or are careless about them. In addition, outside of endemic areas, 
doctors often fail to recognize the symptoms of malaria or treat the 
disease quickly enough to cure it.
	Complicating matters, preventive measures have gotten trickier
and much more costly in re-cent years, ever since the malaria parasite
in most areas developed resistance to chloroquine, the inexpensive and
well-tolerated medication that had long been used to prevent and treat
malaria. Current options cost a lot more and are associated with 
potentially more serious side effects.
	For most endemic areas where chloroquine-resistant parasites 
flourish, the Centers for Disease Control now recommends 
mefioquine, sold under the trade name of Lariam. This drug is taken 
one time a week before departure, each week while in the malaria 
area and for four weeks after returning. It is extremely effective
but expensive about $7 a tablet. The cost for a two-week trip is about $50.
	Lariam can sometimes cause depression, hallucinations and 
insomnia. In one in 10,000 to 15,000 cases these side effects are 
incapacitating. After taking the drug, a trip mate of mine to Panama 
developed sky-high blood pressure, fever, severe anxiety, and 
hallucinations. She was also unable to walk on her own. It took her 
months to recover.
	An equally effective alternative to Lariam is doxycycline which
is recommended for northern Thailand, where mefloquine resistance has 
been detected. Doxycycline has to be taken daily, starting one to two
days before departure and continued for four weeks after returning. 
Anyone who chooses doxycycline must be very conscientious about taking
it every day. If you miss a couple of days, you are unprotected. Among
the possible side effects are upset stomach, yeast infection in women
and increased sensitivity to the sun which means you must remain 
covered to avoid a severe sunburn.
	A standby treatment is the drug Fansidar, which can cause 
rather severe skin rashes. It is used only as an emergency treatment 
should malaria-like symptoms develop when the person is far from 
medical care. But even if one takes Fansidar, it is vital to get to a 
doctor for thorough treatment as soon as possible.
	Trenton Ruebush, a malaria expert at the US Centers for
Disease Control and Prevention, emphasized that preventive medication
is only one measure. Travelers should be aware of the habits of the
Anopheles mosquito, which typically reigns in rural areas and bites 
between dusk and dawn (although in heavily shaded jungle areas, it may
bite in daylight). Use of protective clothing and insect repellent and
a mosquito net, preferably first dipped in a solution of insecticide,
over the bed at night are important parts of malaria prevention.
	Anyone who develops a fever a week to a month after being in 
an area where malaria is a problem must report immediately to a 
doctor who should do a blood smear right away. As Dr. Ruebush said, 
Malaria is eminently curable if it is caught early and treated 
appropriately.