managing long-term malaria exposure.
July 2, 2012 9:41 PM   Subscribe

Going to Kenya for ten or more months. How should one approach antimalarials for this length of time?

Lots of antimalarials seem to have possible nasty compund side effects from extended use.... Is it better to just take chances and treat the malaria when it comes, or take one drug or another for the duration?
posted by kaibutsu to Health & Fitness (12 answers total)
I lived in Uganda for two years, so hopefully that gives me some credibility :)

When you're there for that long, it makes more sense to treat the malaria when it comes. The reality is that malaria is eminently and swiftly treatable, and that the people it is a real danger to are either very old, very young (like, babies), or already immuno-compromised. (I assume you're none of those.) If you're going to for a short period of time, you don't want to waste any of that time treating malaria, but if you're there for ten months you also don't want to be pumping your body full of drugs the whole time.

That being said: where are you going in Kenya? Different climates/regions have different risk levels, and your distance from a medical clinic could be relevant too. (If you're going somewhere pretty isolated with a lot of malaria, it might be worth taking anti-malarials? But you'll be shocked how few places are actually 'isolated'.)
posted by Kololo at 10:01 PM on July 2, 2012

Response by poster: I'll be in/near Kisumu, working directly with a university. It's lower-elevation and certainly has a lot of mosqutos relative to Nairobi, but there's plenty of access to hospitals and such. Thanks for the input!
posted by kaibutsu at 10:06 PM on July 2, 2012

I'm just reporting another strategy that I've seen because this is not a disease to play with especially if you are located in an area with Plasmodium falciparum.Also speaking from the perspective that I spent a few yrs living in an African country(Gabon) and knew at least a few other adults who developed malaria during my time there.

To be honest, I would see a physician who works at a travel clinic or specializes in infectious diseases and tell them the exact region that you are traveling to and also find out about the hospitals in your area. Kenya is more developed, but I've been to other countries in Africa (Gabon, Malawi, otherS) where the average medical clinic has NO MEDICATIONS and the staff have a 6th grade education at most. So find out what this means specifically for your area. It may be fine but with 30 different African countries and a wide variety of conditions from town to town within countries, I can't guess the conditions of the facilities in your area.

Because we were going to be in the country for 2 years, we were recommended to take chloriquine fansidar combination as prophylactic medication (I'm sure it has changed since then because over time these organisms build up immunity). If you get malaria, you treated it again at a stronger dose and before you left(also at a higher dosage). Yes there are side effects as there are with every medication but in this case, the risk was worth it to me because falcipurum in particular is one of the few types that is associated with mortality and cerebral malaria. Most people that I knew were far away from clinics and it would have taken a few days minimum to get to a reliable clinical but YMMV. Although it does typically strike children and older people in the country, you do not have antibodies built up against this over your life time. Factors that I would use to make this decision would be: 1)Is the falcipurum type of malaria prevalent in your area (there are 4 types of malaria); 2) Will you be in a city or village (city -fewer mosquitos) and with mosquito nets; 3) Will you be near real medical facilities with medication and labs to assess whether you have malaria (you may not get treated until the collect samples and evaluate if you have malaria and that process takes a few days); 4) If you need serious medical intervention, where is the nearest hospital and how long will it take to get there? To be honest, the facility that you are visiting should have this info as well as a physician with travel clinical experience for your region of the world. I've been to Kenya too and it appears to be more developed than many other African countries, but if it were me I would be locating these resources before I left. YMMV.
posted by Wolfster at 10:50 PM on July 2, 2012

You might want to check with allkindsoftime.
posted by cashman at 10:54 PM on July 2, 2012

Fairly long time (3 years) Nairobi resident here - but my experience is very much based in the capital (where we take no anti malarials) and visits up and down country (where it's sometimes recommended but I rarely do) or elsewhere in Africa (where I still probably should taken them more often than I do).

10 months though is a long time to be on anti-malarials. I wouldn't fancy it.

allkindsoftime and infini are the other two Kenya MeFites - if they don't spot the thread, maybe drop them a message.

I'll also have a word with my doctor next time I see them, see if they've any particular advice for Kisumu - I'll let you know.
posted by Hobo at 3:07 AM on July 3, 2012

I took doxycycline for three months in Cote d'Ivoire and five months in Peru; the most irritating side effects were sunburning pretty easily (but I was in a forest, so it wasn't as problematic as Kisumu might be), and the inefficacy of birth control while taking it (but my partner was at home, so it wasn't as problematic as it might be?). Because it's a low-grade antibiotic, I didn't get any intestinal sadnesses while I was there.

Malaria is no fun to get (I hear); if you can take prophylaxis, I'd recommend it. That being said, travel clinics tend to be geared towards short-term visits and may not have sensible recommendations for longer term periods of time, or non-tourist trips, so I'd go with what you hear from ex-pats and residents over a travel clinic.
posted by ChuraChura at 4:32 AM on July 3, 2012

When you're there for that long, it makes more sense to treat the malaria when it comes.

Just as another perspective on this, I know someone in his 50s who is still dealing with long term severe health consequences of having caught malaria in his teens or 20s. It can be a very serious disease, though people often talk about it quite casually.

I've taken antimalarials with no side effects other than vivid dreams; some people have severe side effects and would probably be smarter to just try and minimize mosquito contact and be ready to treat the disease. Until you are there and know the details of your life, it will be hard to make an informed decision about this -- it's not just how many mosquitoes are there in the town, but how much contact will you have? Bug filled house and working in a malaria-ridden neighborhood at dusk every day? Might want to take the pills. Living on a windy hilltop in a screened house, and with no reason to go into buggy places more than once every few months? Different decision.
posted by Forktine at 5:33 AM on July 3, 2012

Forktine makes a good point - get a prescription, start taking the pills, and if after spending some time there you think it makes sense to stop, stop!
posted by Kololo at 5:48 AM on July 3, 2012

Four year resident of western Africa here, the first two in a small village as a Peace Corps volunteer.

The three main types of prophylaxis you hear about here are Mefloquine, doxycycline, and malarone. The first can have pretty noticeable psychological side effects, and if you have any history of anxiety issues I strongly recommend you discuss it with a medical professional before considering. The second, I was on for those two Peace Corps years and, as was someone else's experience above, the only real side effect I had was sun sensitivity (and even that went away in about three months) ... except when I made the mistake of taking it on an empty stomach - don't do that. I stopped taking it after I actually GOT malaria - it started making me feel ill after that. Though after a dry season off it, I'm back on it now and don't have any troubles (one nice thing about being in this region is that you're pretty safe only taking prophylaxis in the wet season). It's also by far the cheapest of the three. The third my girlfriend is on and she has experienced no side effects after about 6 months, but she has to be even more careful than I am about what food she takes it with, or its effectiveness is greatly diminished.

10 months is not a scary long time to be on prophylaxis. That said, anti-malarials are pretty good these days, and just carrying around three days' worth of Coartem to take if you start displaying symptoms isn't an awful strategy either. Though pretty much EVERYTHING you get here (again, can't speak for that side of the continent) has similar symptoms anyway, so you walk a fine line doing that. The clinics, by the way, (here at least) often give false negatives when you first get malaria because they are only using a quick screen with relatively low sensitivity. So just because they say you don't have it doesn't mean you shouldn't treat it like you do. In fact, that's exactly what is done in village clinics where they don't even have those quick-strips - anyone who comes in with chills, aches, and a fever (or even just a sufficiently high fever with no other symptoms) gets malaria medicine on top of whatever else they might receive care for.

Remember, though, your first line of defense is way more important than chemical prophylaxis - sleep under a net, and wear bug repellant and long sleeves/pants in the evenings! You really don't want to get malaria, it is super not fun.
posted by solotoro at 8:48 AM on July 3, 2012 [2 favorites]

I'd recommend doxycycline: it's cheap, available, and has very minimal, manageable side effects in general. I took it for about two years while living in Kampala, Uganda and suffered no ill effects; I got bitten hundreds of times and never got malaria. Try to wear sunscreen when you can because you'll be right near the equator and with increased photosensitivity you want extra protection (assuming you're fair-skinned). But as solotoro says, keeping mosquitos away is a crucial first-line defense accompaniment to chemical prophylaxis and treatment. And as kololo mentioned, the sort of malaria you'd be most likely to get is highly treatable, but it's better to not get it at all.
posted by clockzero at 9:33 AM on July 3, 2012

Yeah, sunscreen is key when taking doxy in an equatorial zone. By the way, if you're using a DEET based insect repellant, it may be a good idea to separate the applications of the two by at least 30 minutes.
posted by solotoro at 2:05 AM on July 4, 2012

10 months is not a scary long time to be on prophylaxis.

See, I got exactly the opposite message from my travel doc when I was first leaving the states for Africa. I was going for 8 months the first time and they said that would be a long time, advised me to only take it when I was going to particularly infested areas if possible (and of course you have to start taking it before the trip and it lasts thereafter as well). They told me 3 straight months on it would be the longest they'd advise. Long-term liver damage was what you were apparently risking after that.

I'm no doc but I'm also not nearly kind enough to my liver to start with. When it became clear I was becoming a long-term resident (5 years now) of Africa (Kenya for the last 4), I went of prophylaxis altogether.

solotoro has my recco down already - don't get bit in the first place. Lots of places around Kenya can be a bit hot for the long sleeves/pants recco, so if you're like me, take lots of bug spray and apply liberally when outside NBO.
posted by allkindsoftime at 6:28 AM on October 8, 2012

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