Nowadays, most people travel whether with friends, family or alone. Most of them travel to relieve themselves from stress, pressures in life, escape reality, or merely to have fun. Indeed, traveling is one of the most exciting things one can do, but this excitement also needs preparation. There are many things to prepare, from plane tickets, clothes, and a list of things to do when you’re at your destination, among others. But most importantly, you also need to know your destination’s health safety, like what vaccines you need or what medication you need to take before going to that place.
There are a lot of fantastic travel destinations around the world. And over the years, the Philippines has gained popularity among travelers since it offers beautiful white sand beaches, amazing natural sights, exciting culture, good food, and beautiful people.
The Philippines is a beautiful country. It is an archipelago that has about 7461 islands and is part of Southeast Asia. One of the exciting things about the country is its mixed culture. However, despite its beauty, the Philippines have suffered from various diseases brought by mosquitoes, such as malaria.
Malaria in the Philippines
In the past, the Philippines had high malaria cases. Still, according to the Philippine Department of Health – National Malaria Control and Elimination Program, infections and deaths have significantly lowered in recent years. They are now on their way to eliminating the disease. The Department of Health – National Malaria Control and Elimination Program’s vision are to free the Philippines from malaria by 2030 hence their unrelenting efforts to ensure that the country has a universal coverage health system with quality malaria diagnosis treatment as well as accurate information management. According to the Department of Health, 42 out of the 81 provinces in the country are malaria-free. In 2019, there are still four provinces in the Philippines with local malaria transmission, preventing the government from being declared malaria-free. However, the Department of Health is still optimistic that they will achieve their vision by 2030, freeing the Philippines from malaria. Although the three other provinces have lower local transmission cases, one of the four areas has the highest malaria cases in the country, which is more than 90%, and that is in Palawan. The risk of malaria in Palawan is higher, especially in wet seasons. The other provinces that have malaria transmission are Sultan Kudarat, Occidental Mindoro, and Sulu.
What is Malaria?
Malaria is a severe and, at times, a deadly disease. This disease is caused by a parasite that infects mosquitoes. There are four kinds of malaria parasites: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. Out of these parasites, the P. falciparum usually results in severe infection and can be deadly if left untreated. But just like other diseases, malaria can usually be prevented and cured. Malaria can generally be found in countries with tropical and subtropical climates where parasites can live and thrive.
What are the symptoms of malaria?
Just like any other disease, malaria also has its signs and symptoms. These signs and symptoms can range from uncomplicated to severe malaria. Here are some of the common signs and symptoms of the disease.
- Fever
- Chills
- Headache
- Muscle aches
- Tiredness
- Nausea
- Vomiting
- Diarrhea
- Anemia
- Jaundice
If malaria is not promptly treated or left untreated at all, it may cause severe infection that may lead to death. Here are some of the possible severe results if the disease is left untreated.
- Kidney failure
- Seizures
- Mental confusion
- Coma
- Death
Most people begin to see its signs and symptoms, usually around ten days to four weeks; however, it could also be as early as seven days or as late as one year. Sadly, once a person is infected with P. vivax and P. ovale parasites, it can remain in the person’s liver for several months up to four years, which may cause a relapse.
How is malaria transmitted?
A person can get infected with malaria if a female Anopheles mosquito has bitten him or her. According to research, around 400 species of Anopheles mosquitoes and approximately 30 are malaria vectors. And all of these malaria vectors bite from dusk to dawn. When someone is infected with malaria, the parasite enters the bloodstream and attacks the red blood cells, making the person sick. Since the parasite gets into the red blood cells, malaria can also be transmitted through blood transfusion, organ transplant, or when you share needles or syringes with someone who has malaria. Also, when a pregnant woman is infected with malaria, she can pass it to her unborn child before or during delivery, and it is called congenital malaria. The intensity of malaria transmission also depends on the place. Its transmission is more intense when the mosquitoes in that specific country or place have a longer lifespan since the parasite has the time to complete its development. The one good thing is that malaria is not contagious, meaning it cannot spread from person to person like the flu or be sexually transmitted.
How Is Malaria Diagnosed?
Suppose a traveler comes home after a visit from a country or a place known to have malaria transmission and develops symptoms. In that case, he or she should seek medical evaluation as soon as possible. Microscopy is the most important diagnosis for malaria diagnosis since it can check the presence of parasites, the kind of malaria parasite, and the density of the infection. The result of this test is usually available within a few hours. However, if microscopy is not available rapid diagnostic tests (RDTs) can also be used. This kind of test can detect malaria antigens with 2-15 minutes. The only downside of this test is, it cannot distinguish the type of malaria parasite that has infected the patient, nor can it quantify the density of infection.
How Is Malaria Treated?
When one is infected with a malaria parasite, they can be treated effectively at the onset of the disease, which can protect the patient from possible fatal complications due to the disease. Treatment of malaria depends on which kind of parasite has infected the patient, how severe the infection is, drug resistance (because depending on where the infection was acquired, the parasite can be resistant to certain types of malaria medicines) as well as the patients age and if he or she is pregnant. These are the reliable malaria treatment that the U.S Centers for Disease Control and Prevention (CDC) recommends: Atovaquone – Proguanil, which contains 250 mg of Atovaquone and 100 mg of Proguanil for adult tablets and 62.5 mg of Atovaquone and 25 mg of Proguanil for kids. Artemether – Lumefantrine is also a reliable malaria treatment containing 20 mg Artemether and 120 mg of Lumefantrine.
How can you prevent malaria?
The saying “prevention is better than cure” is applicable in everything, especially when it comes to diseases that can be prevented with proper precautions. Malaria infection is one of those diseases that can be prevented when taken seriously. Prevention of this disease is usually a combination of mosquito avoidance and chemoprophylaxis. Chemoprophylaxis refers to the use of drugs to prevent disease. Although the suggested preventions highly efficacious, it does not give a 100% assurance that one cannot be infected with the conditions as with other preventions for other diseases. One intervention is Mosquito Avoidance. Malaria transmission happens primarily from dusk to dawn. To avoid contact with mosquitoes, a traveler should stay in a well-screened area, sleep under treated mosquito nets if available, and use insecticide spray in the living room and sleeping area, especially during evenings. Wearing long-sleeved clothes and pajamas that cover most of the body and using insect repellents are also ways to avoid mosquitoes. Another intervention is Chemoprophylaxis. This kind of intervention requires a traveler to take medicine before, during, and after travel from areas where there is Malaria transmission. A prophylaxis regimen is taken before traveling to allow the antimalarial agent to be in the blood before being possibly exposed. However, before starting chemoprophylaxis, a traveler needs to consult his or her physician for proper evaluation. You can think about some factors before being prescribed an antimalarial medicine: length of travel, pre-existing medical conditions, allergies, medications being taken because there will be a potential drug interaction, and the traveler’s destination there is drug resistance of malaria parasites depending on the country.
Chemoprophylaxis Medications
Here are some medications for prophylaxis. Before starting the prophylaxis, a traveler needs to consult their physician for a proper evaluation to be prescribed the right prophylaxis medication.
- Atovaquone – Proguanil
This medicine is a combination of Atovaquone and Proguanil, and prophylaxis should be taken 1-2 days before travel. It should be taken daily (same time each day) while in the destination and 7 days more, every day, after leaving the destination. This medication is not recommended for prophylaxis for children weighing less than 5 kilograms, pregnant women, and for those who have severe renal impairment. This medicine’s common adverse side effects are abdominal pain, nausea, vomiting, and headache, although these are rare.
- Chloroquine and Hydroxychloroquine
Again, this prophylaxis medication is only to be used where Chloroquine resistance is not present. And it should be noted that the Philippines is Chloroquine-resistant. This medication should be taken 1-2 weeks before the actual travel. This medication needs to be taken once a week on the same day of the week during the trip and 4 more weeks after the travel. This medicine’s most common side effects are gastrointestinal disturbance, headache, dizziness, insomnia, blurred vision, and pruritus (severe itching of the skin). Still, these side effects usually do not require discontinuing the medication.
- Doxycycline
Doxycycline should be taken 1-2 days before travel and should be continued once a day simultaneously during the travel and four more weeks after the trip. Some of its side effects are photosensitivity, nausea, vomiting, and increased vaginal yeast infection frequency. If the traveler plans to get a Typhoid vaccine, the vaccine administration should be delayed for 24 hours or more after taking a dose of Doxycycline.
- Mefloquine
This type of prophylaxis should be started two weeks or more before travel and should be continued once a week on the same day of the week during travel and four more weeks after the trip. This medicine’s most common side effects for prophylaxis are a gastrointestinal disturbance, insomnia, headache, abnormal dreams, anxiety disorder, depression, and dizziness. However, Mefloquine should be avoided for people who have psychiatric problems or a history of depression.
- Primaquine
Primaquine can be used as a prophylaxis for places with P. vivax parasite and presumptive antI-relapse therapy. However, this medicine is only for people with normal G6PD as it can be fatal for those with G6PD deficiency. When taken for prophylaxis, Primaquine should be taken 1-2 days before the travel and then daily at the same time during travel and seven days more after the travel. The most common adverse side effect of this medicine in people with normal G6PD (glucose-6-phosphate dehydrogenase and enzyme that helps the red blood cells to work correctly) is gastrointestinal upset. Still, it is usually resolved or minimized if the medicine is taken with food.
- Tafenoquine
This medicine can also be used for prophylaxis for adults as well as presumptive therapy for 16 years old and older. For prophylaxis usage, it is taken 3 days before the travel, and weekly during travel, and the last dose is in the week after travel. These doses should be taken the same day each week. This type of prophylaxis is fatal for people with G6PD deficiency like Primaquine, so laboratory testing is needed to ensure the person has normal G6PD. Its common side effects are headache, dizziness, gastrointestinal disturbance, and decrease of hemoglobin for prophylaxis. It should also be taken with food and not be administered to people who have a history of psychotic disorder.
These prophylaxis are only suggested for destinations with high malaria transmission. But for places with low risk, the Centers for Disease Control and Prevention only use mosquito avoidance prevention. Like adults, children who will visit malaria transmission areas should start prophylaxis aside from mosquito avoidance prevention. However, just like adults, before starting prophylaxis, consultation with a doctor is necessary for proper assessment. And for pregnant women, it is better not to travel to areas with malaria transmission since no prophylaxis regimen is completely effective, which means it can give adverse effects that may affect the unborn child, such as prematurity and stillbirth. Travelers should also understand that there is no 100% protective antimalarial drug, so prophylaxis should always be paired with mosquito avoidance.
Famous People who contracted malaria
- Cheryl Cole
Cheryl Cole is a singer, dancer, and television personality from England and was a judge in the popular singing competition The X Factor UK. She was confirmed to have been treated for malaria after a trip to Tanzania on Africa’s east coast in 2010.
- Ross Kemp
Ross Kemp is an English actor, presenter, author, and investigative journalist, who rose to fame for his role as Grant Mitchell in BBC’s show EastEnders. He was infected with malaria in 1999 and was believed to have contracted the disease from his visit to Tanzania in Africa.
- John F. Kennedy
John F. Kennedy was the 36th president of the United States of America from 1961 until his assassination in 1963. The former president contracted malaria while in the Solomon Islands during World War II.
- Mother Teresa
Mother Teresa was a Roman Catholic nun and missionary. She was known for her charitable works and honored by the Catholic Church as Saint Teresa of Calcutta. She contracted malaria in 1996 in India.
Indeed, the quote “Health is Wealth” is true because no matter our status in life, no one is excused when it comes to illnesses and diseases. That is why it is of high importance that we prioritize our health over everything else. Some illnesses and diseases are out of our control, but when it comes to those that can be prevented, like malaria, we should do everything we can to protect ourselves and prevent contracting such disease. Life is meant to be enjoyed, and traveling is certainly one way to enjoy life; however, it can only be enjoyed and appreciated to the fullest when we are healthy.