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This document provides answers to commonly asked questions about malaria. The information within
this document was taken from three sources (see end of document) and collated in one document for
convenience sake. *Read the disclaimer at the end of this document.
Click on the question to see the answer.
Vector Control
• What is vector control?
• What is integrated vector management?
• What is indoor residual spraying?
• What is DDT?
• Does DDT used in IRS spraying programmes affect human health?
• Will mosquitoes develop resistance to DDT?
• Does the Stockholm Convention on POPs affect the use of DDT?
• Why not use alternatives to DDT?
• Are synthetic pyrethroids environmentally friendlier than DDT?
• If indoor residual spraying works, why doesn't every malarial country use it?
• What is an insecticide-treated net or long-lasting insecticide-treated net?
• Why not just use insecticide-treated nets to control malaria?
• Who is most at risk of getting very sick and dying from malaria?
Plasmodium falciparum most often causes severe and life-threatening malaria and this parasite is
very common in many countries in sub-Saharan Africa. Most at risk for dying from malaria will be
people who are heavily exposed to the bites of mosquitoes infected with P. falciparum. Young
children, pregnant women or travelers from non-endemic areas, tend to have little or no immunity
• How soon will a person feel sick after being bitten by an infected mosquito?
In most cases symptoms begin 10 days to four weeks after infection, however, a person may feel ill
from as early as seven days up to a year later. Two kinds of malaria, P. vivax and P. ovale, can
occur again and this is known as relapsing malaria. With P. vivax and P. ovale infections, some
parasites remain dormant in the liver for anything from several months up to about four years after
the person is bitten by an infected mosquito. “Relapse” occurs when these parasites come out of
hibernation and begin invading red blood cells, causing the person to get sick.
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• Which parts of the body does it usually infect (at both the organic & cellular levels)?
Mosquitoes inject sporozoite stage parasites into the skin capillaries of the human host. From there
the parasites travel via the bloodstream to the liver, where development and multiplication occurs in
the liver cells. Merozoite stage parasites then enter the blood stream again and undergo further
reproduction. From there other internal organs, such as the brain gets affected as clumps of heavily
infected erythrocytes block capillary blood flow.
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• Can a survivor transmit malaria to others after she or he has fully recovered?
Yes, as an asymptomatic carrier of malaria. People who have built up immunity to falciparum
malaria (see above), or people who suffer a relapse, after recovering from the primary attack of P.
vivax or P. ovale infections, are examples of this. Anti-malarial drugs such as chloroquine and
mefloquine used to cure malaria infections do not eliminate mature P. falciparum gametocytes from
the bloodstream. A successfully treated person may thus be healthy but infective for roughly two
months until the gametocytes die off naturally. Alternatively a drug such as primaquine, that does
eliminate the gametocytes, can be administered.
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• What is known about the long-term effects of drugs commonly used to prevent and treat malaria?
Usually the drugs used to prevent and treat malaria have been known to be well-tolerated for at
least one year or more.
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• What is DDT?
Dichlorodiphenyltrichloroethane, commonly known as DDT, is an organochlorine pesticide. It
became widely used in pest control after its insecticidal properties was noted in 1939. The discovery
was hailed as a major public health achievement, which provided a cheaper way to manage major
public health risks carried by mosquitoes, lice, and other vectors. DDT became an important tool for
malaria control around the world, saving millions of lives. In 1972, based largely on concerns that
DDT posed a threat to wildlife, the U.S. Environmental Protection Agency banned its use in
agriculture in the United States. This decision lead to a decrease in the popularity of IRS prorammes
amongst donors and programmes were discontinued. DDT was given an exemption for public health
use by the Stockholm Treaty on Persistent Organic Pollutants (POPs) in 1999. Due to the persistent
• If indoor residual spraying works, why doesn't every malarial country use it?
Recipient countries are not free to do whatever they want with donor funding. Although IRS is highly
effective and many countries want to use it, most donor agencies have been reluctant to sanction its
use. Policies have most likely been influenced by pressure from environmentalist groups, framing
IRS as unsustainable or unsafe for humans and the environment. In most cases these notions have
been proven false as more countries have adopted IRS programmes, which have proven to be quite
successful.
More countries require funding for malaria control that gives them the independence to determine
the best possible set of policies for their circumstances and not to simply adopt the policies that
donors or non-endemic countries wish to force on them. The malaria control programme in each
country must determine through research what would work best for their country, and unfortunately
IRS may not be applicable in every situation. Countries must ensure that they have the technical
capacity to run IRS programmes and use this intervention in the most appropriate settings.
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• If born in a malaria endemic country and if that person had malaria as a child, should that person
worry about contracting malaria when returning to their country of birth again?
Yes. Anyone who goes to a country where malaria transmission occurs should take precautions
against contracting malaria. During the time spent away from their country of birth, a person has lost
any malaria immunity that might have built up over time while living in their native country. Without
frequent exposure to malaria parasites, the body’s your immune system has lost its ability to fight
malaria and such a person is as much at risk as someone who was born in a non-endemic country.
NB – consult your doctor or health care provider about precautions to take against malaria.
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• If a woman plans to become pregnant after returning from a malaria endemic, how long does it
take for anti-malarial drugs to clear the body?
No evidence exist that chloroquine and mefloquine are associated with congenital defects when
used for preventing malaria, and the CDC does not recommend that women planning pregnancy
need to wait after using prophylaxis before becoming pregnant. However, if women or their doctor or
health care providers wish to decrease the amount of anti-malarial drug in the body before
conception, the following drug half-lives can be used as a guide: After two, four, and six half-lives,
approximately 25%, 6%, and 2% of the drug remain in the body. NB – consult your doctor or health
care provider if you are unsure of what to do.
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• If taking an anti-malarial drug and breast-feeding, will the baby be protected from malaria
because of the medication transferred in the mother’s breast milk?
No. The quantity of drug transferred in breast milk is not likely to be enough to provide protection
against malaria for the infant.
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• Can one give blood if they have been in a country where there is malaria?
It depends on what areas of that country were visited, how long ago it was visited, and if the person
ever had malaria. In general, most travelers to a malaria area are deferred from donating blood for
one year after their return. People who used to live in malaria endemic countries cannot donate
blood for three years. People diagnosed with malaria cannot donate blood for three years after
treatment, and they must have remained symptom free for that period. Blood banks follow strict
guidelines for accepting or deferring donors of blood for transfusions, who have been in malaria-
endemic areas. They do this to avoid collecting blood from an infected donor.
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• Is malaria airborne?
Not in the typical sense of the word. However, malaria-carrying female Anopheles mosquitoes fly to
reach a blood source to feed on and develop their eggs. These mosquitoes are not usually found
more than two or three kilometres from their breeding places, but strong seasonal winds may carry
them up to 30 km from their main breeding place. At times malaria has been transmitted near
airports in non-endemic areas, by mosquitoes that were carried in on aircraft coming from endemic
zones.
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• If a person gets malaria, will they have it for the rest of their life?
Not necessarily. Malaria is treatable. People who have malaria can be cured and all the malaria
parasites can be removed from their body, if the right drugs are used. However, the disease can
continue if it is not treated or if treated with the wrong drug. Some drugs are not effective due to
resistance of the parasite to them. Some people may be treated with the right drug, but at the wrong
dose or for too short a period of time.
Two types of parasites, P. vivax and P. ovale, have liver stages and can remain in the body for
years without any symptoms If not treated, these liver stages may reactivate and cause malaria
relapses after months or years with no symptoms. If diagnosed with P. vivax or P. ovale, a second
drug is often prescribed to help prevent these relapses. If not treated, another type of malaria, P.
malariae, has been known to sometimes stay in the blood of certain people for several decades.
However, generally if you are correctly treated for malaria, the parasites are removed and you are
malaria free.
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• If malaria can recur in a survivor (i.e. remain latent as opposed to a second infection), how does
this occur? (also see previous question).
Reinfection is always a possibility in endemic areas. However, P. vivax and P. ovale can remain
dormant in the liver for many months. Relapses caused by the persistent liver forms may appear
months, and sometimes up to four years after exposure. P. malariae may be present for many years
in untreated or partly treated blood infections before giving rise to a symptomatic episode, and can
be carried for a lifetime. In areas with emerging drug-resistant P. falciparum, recurrence of the
infection may occur up to a month or more after what seemed to be a successful clinical cure of the
infection.
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• What is the South African government doing to eliminate malaria in the country?
The South African government is working towards elimination of malaria within the country by the
year 2018. Malaria elimination involves the systematic process of developing strategies and
ensuring their robust implementation. The government has completed the first phase of elimination
that consisted of a programme review, the development of an elimination strategy, an
implementation plan, and a monitoring and evaluation plan. The country is currently busy with the
second phase, which involves the robust implementation of the interventions detailed in the strategic
plan, and monitoring its progress towards achieving the goal of malaria elimination.
South Africa has been making use of IRS in its national malaria control programme (NMCP) and the
WHO has authorised the use of DDT for this purpose. There is pyrethroid resistance in certain parts
of South Africa and in the late 1990s it led to one of its worst regional epidemics ever. No ITNs or
LLINs usage is recommended in the NMCP. Larviciding does occur in selected areas in some of the
endemic provinces. Malaria diagnosis and treatment with Artemisinin combination therapy (ACT) is
free in the public sector. G6PD testing is a requirement before treatment with primaquine may occur.
A system for monitoring of adverse reactions to anti-malarials does exist. The prophylaxis
mefloquine, doxycycline or atovaquone proguanil are recommended for use in areas where
indicated.
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Additional sites to visit or alternatively visit the Links page on the UP ISMC website
South African National Travel Health Network:
~ Malaria factsheet http://www.santhnet.co.za/index.php/factsheet
~ Malaria drug list http://www.santhnet.co.za/index.php/druglist
*Disclaimer: The information provided in this document is a compilation of questions and answers obtained from different sources (sources
are supplied) and in cases where treatment measures are mentioned, remember to always consult with your doctor or health care provider
first to determine what would best work for you in your situation. The UP ISMC is a research organisation that focuses on malaria-related
research, within a tertiary institution, supplying malaria facts towards health promotion, and may not be held accountable for any issues
that may result due to any parties practising treatments mentioned within these FAQs.