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Last month I spent 2 weeks in Rwanda with my wife & daughters, visiting two friends who have been there for about a year. One of them has also spent a lot of t

by jtheory 12y ago

Last month I spent 2 weeks in Rwanda with my wife & daughters, visiting two friends who have been there for about a year. One of them has also spent a lot of time in Tanzania and elsewhere in Africa. Rwanda is land-locked and largely high-altitude, so malaria is not nearly so prevalent there, but it's still around. It's already preventable -- we came with a sufficient supply of antimalarial pills, but they're so expensive it's obviously not a solution. We got yellow fever vaccinations before coming -- that was a no-brainer -- and we actively avoided mosquito bites, esp. for the little ones. My friend who has traveled widely in Africa doesn't take anti-malarials -- too pricey -- has gotten malaria, once, and it put him in the hospital for a couple of days. He says many of the people he knows have had it, multiple times -- it's just a fact of life, and it sucks, but (probably) you'll live, and then have some protection against getting it again. Gates talks about it as being debilitating -- apparently it's not always so bad, if you've had it before (and people talk about having "a touch of the malaria"!), but generally he's on the mark about the costs.

peterwwillis 12y ago
The most common victims of diseases like malaria in countries without access to basic medical resources is children and the elderly. Most of the people who die from malaria are under 5 years old. Out of the 207 million people who got malaria in 2012, only 0.3% of those people died. In contrast, diarrhea kills more children under five each year (760,000) than all of the people killed by malaria each year. But it's much harder to combat diarrhea because of both the varied nature of its cause/transmission and a lack of clean drinking water. (It is comparatively much easier to treat/prevent malaria than it is diarrhea)
benro 12y ago
We did the same thing when we lived in Uganda. Most westerners staying in the country for more than a few months stop taking anti-malarials. However most places where the expats live have access to antibiotics and to at least 1 or 2 Western (usually British) Doctors/Nurses.
- xenophonf 12y ago
  It really depends on your appetite for risk. One of my colleagues has been taking Lariam for about 25 years, and I usually carry two weeks-worth of extra Malarone doses when I travel (might switch to Lariam for my next trip).
  - shabble 12y ago
    If you've not taken it before, be extremely careful with Lariam, it has been well-established to cause numerous kinds of really unpleasant psychological side-effects in some people. Even got an FDA Black Box warning for it[1] recently. I have personal experience of taking it for ~4 months as directed and suffering from extremely vivid hallucinations and extreme insomnia. I also managed to contract Malaria whilst taking it, twice. Anecdote, pinch of salt, etc. But do some research yourself, ask your doctor, and definitely think twice. (The other nice thing about Malarone is that it's also good for treating an actual infection, as well as for prophylaxis, assuming wherever you're travelling isn't resistant to it. And it's just gone generic, in the UK at least, and also worldwide, I think?)) [1] http://www.fda.gov/Drugs/DrugSafety/ucm362227.htm http://www.fda.gov/Drugs/DrugSafety/ucm362227.htm
masklinn 12y ago
> It's already preventable -- we came with a sufficient supply of antimalarial pills There's just one problem with that one — aside from costs for third-world regions: http://phenomena.nationalgeographic.com/2014/03/25/can-we-beat-drug-resistant-malaria-at-its-birthplace/ http://phenomena.nationalgeographic.com/2014/03/25/can-we-be... > Gates talks about it as being debilitating -- apparently it's not always so bad At the social level it is debilitating, without good treatments there's a high risk of acute respiratory distress and renal failure, and more importantly in children cerebral malaria causes direct brain damage and regular malaria causes anemia, leading to increased risks of cognitive deficits and behavioural disorders.
- jtheory 12y ago
  > > It's already preventable -- we came with a sufficient supply of antimalarial pills, but they're so expensive it's obviously not a solution. > There's just one problem with that one — aside from costs for third-world regions: http://phenomena.nationalgeographic.com/2014/03/25/can-we-beat-drug-resistant-malaria-at-its-birthplace/ http://phenomena.nationalgeographic.com/2014/03/25/can-we-be... Good point -- the expense is serious, but also widely using low levels of drugs that are effective treatments as antimalarials means giving the parasite lots more great opportunities to evolve resistance (which is already happening, and is a serious upcoming problem). > At the social level it is debilitating... Yup, I agreed with Gates' conclusions; I was trying to share some direct experience.

by jtheory 12y ago

peterwwillis 12y ago

The most common victims of diseases like malaria in countries without access to basic medical resources is children and the elderly. Most of the people who die from malaria are under 5 years old. Out of the 207 million people who got malaria in 2012, only 0.3% of those people died. In contrast, diarrhea kills more children under five each year (760,000) than all of the people killed by malaria each year. But it's much harder to combat diarrhea because of both the varied nature of its cause/transmission and a lack of clean drinking water. (It is comparatively much easier to treat/prevent malaria than it is diarrhea)

benro 12y ago

We did the same thing when we lived in Uganda. Most westerners staying in the country for more than a few months stop taking anti-malarials. However most places where the expats live have access to antibiotics and to at least 1 or 2 Western (usually British) Doctors/Nurses.

xenophonf 12y ago
It really depends on your appetite for risk. One of my colleagues has been taking Lariam for about 25 years, and I usually carry two weeks-worth of extra Malarone doses when I travel (might switch to Lariam for my next trip).
- shabble 12y ago
  If you've not taken it before, be extremely careful with Lariam, it has been well-established to cause numerous kinds of really unpleasant psychological side-effects in some people. Even got an FDA Black Box warning for it[1] recently. I have personal experience of taking it for ~4 months as directed and suffering from extremely vivid hallucinations and extreme insomnia. I also managed to contract Malaria whilst taking it, twice. Anecdote, pinch of salt, etc. But do some research yourself, ask your doctor, and definitely think twice. (The other nice thing about Malarone is that it's also good for treating an actual infection, as well as for prophylaxis, assuming wherever you're travelling isn't resistant to it. And it's just gone generic, in the UK at least, and also worldwide, I think?)) [1] http://www.fda.gov/Drugs/DrugSafety/ucm362227.htm http://www.fda.gov/Drugs/DrugSafety/ucm362227.htm

masklinn 12y ago

> It's already preventable -- we came with a sufficient supply of antimalarial pills There's just one problem with that one — aside from costs for third-world regions: http://phenomena.nationalgeographic.com/2014/03/25/can-we-beat-drug-resistant-malaria-at-its-birthplace/ http://phenomena.nationalgeographic.com/2014/03/25/can-we-be... > Gates talks about it as being debilitating -- apparently it's not always so bad At the social level it is debilitating, without good treatments there's a high risk of acute respiratory distress and renal failure, and more importantly in children cerebral malaria causes direct brain damage and regular malaria causes anemia, leading to increased risks of cognitive deficits and behavioural disorders.

jtheory 12y ago
> > It's already preventable -- we came with a sufficient supply of antimalarial pills, but they're so expensive it's obviously not a solution. > There's just one problem with that one — aside from costs for third-world regions: http://phenomena.nationalgeographic.com/2014/03/25/can-we-beat-drug-resistant-malaria-at-its-birthplace/ http://phenomena.nationalgeographic.com/2014/03/25/can-we-be... Good point -- the expense is serious, but also widely using low levels of drugs that are effective treatments as antimalarials means giving the parasite lots more great opportunities to evolve resistance (which is already happening, and is a serious upcoming problem). > At the social level it is debilitating... Yup, I agreed with Gates' conclusions; I was trying to share some direct experience.