1

There is moderate risk of malaria year round in all of Tanzania below 1,800 m (5,906 ft). Risk is somewhat lower in Dar es Salaam than elsewhere. Most of it is P. falciparum, the species most likely to be fatal.

There is good information on long-term travel to malaria areas in section 7.11 of this from the UK Health Protection Agency.

This, from the US CDC, covers all health issues, not just malaria, Long-Term Travelers & Expatriates

I also reviewed a couple of scholarly articles on long-term travel & malaria. The consensus is that it is an individual issue, and the best thing to do is to consult with a travel or tropical medicine specialist. You may have a personal medical issue that might mean you will be at greater risk of complications should you develop malaria. Your living conditions might make a difference in what you do--a luxury apartment vs. a funky guesthouse, for instance. One scholarly article put it this way:

2

Gidday Nutrax, I am in a similar situation to Mark the Sparky.
I am going to Moshi for two years and it is a rather unknown area about the side effects of Malaria prevention over a long period. Everone, even yourself mentions the need for travel specialists to become involved on a case by case basis.

As I live in a ruralish community it is a little harder for me to access these travel doctors but the consensus here is 'try Larium ( mefloquine) and if it doesnt have side effects then you'll be ok.
What doesn't or hasn't happened is a study on long term malaria exposure using different drugs. Well, I havent been able to access this information and the one travel doctor I have seen was not able to answer this question.

Personally I have used mefloquine without side effects for a period of 5 months and I will do so again this time around but the question remains about long term health side effects from long term use. AND once this question is answered maybe it should become a sticky as this seems to be an ongoing issue on this board as you well know.

Thanks for your thoughts on this matter Nutrax, and I hope you can get some travel time again this year under your belt.

Cheers.

3

I have just clicked on and read the artical about Long term travellers and the Malaria section.

See what I mean, no consensus and endorses a stop start approach to malarial drug use.
What happens if you come down with cerebral malaria? Isnt this usually fatal? We had a girl on TT who died from this about 7 or 8 years ago now, was her name Kingi?

Thanks for the link all the same Nutrax. I will leave you alone now. hahaha.

Cheers.

4

I am too lazy to look it up right now, but there have been studies on Peace Corps workers and long term (at least 2 years) use of mefloquine. If the mefloquine was initially tolerated, then it was usually fine for long term use. Doxy is used long term for acne control & other disorders--a couple of years at least.

I suppose I could unearth long-term Malarone studies if you really want.

Prevention of Malaria in Long-term Travelers Very technical.

My personal comment--get that treated bed net. That's been shown to be highly effective in reducing malaria. With a treated net, you can use a larger mesh than with an untreated net, as the beasts will land on the net first before trying ot enter--and will be killed or repelled. I don't know what the climate of Moshi is like, but I have found small mesh bed nets intolerable in humid areas.

5

Hi, I have a very different oppinion about longtime use of anti malarias. I was in the early 80's one year in India and almost killed myself by using Fansidar and Resochin for this long period. I'm living now for almost 8 years near Arusha (including several months in Dar), and in this time I only got twice malaria. There are very good anti-malarias here, which are helping very fast. I don't know any wazungu here, who uses Lariam or Malarone or any other on a day by day basis.

6

Wow, no wonder I have been using LP all these years! The info and response was great and I really appreciate what you've all had to say.I had malaria twice, neither time was I on medication. First time about 1982 in South Africa. It was like a bad hangover, gone in a week. The second time in 2000 I picked up falciparum in Malawi. By the time the symptoms showed, I was in Comores (on honeymoon) and very nearly died. It took a while for my travel insurance to fly me out to a hospital in SA so it really had a grip on me. I still travel intermittantly for a week or two every month into various parts of Africa (I run a trucking company). Have sent all my drivers to the doc for malaria medication as we found the different drugs affect each person differently. At this point, none of us take anything, but we are aware of the symptoms and find the most important thing is to get to a doctor fast! We use treated bed nets and spray our living areas everynight. We also use Tabard/Peaceful sleep. We stay out of 'hotspots' at night. Again, appreciate all the info, forewarned is forearmed!

7

Simsy, I'm not saying that there is no risk or that Malaria is "no big deal". However, in the vast majority of cases, it is treatable if treatment starts early enough and usually doesn't develop into the potentially fatal cerebral Malaria.

That girl you mention, Kinga, not only didn't take prophylactic drugs, but according to the reports on the internet at that time, refused treatment when she came down with symptoms, until it was too late. Very sad, and most likely very avoidable.

What are you going to do in Moshi? It's a nice town, I really liked it a lot.

8

Wouldn't take pills for years - don't know what it would do to my kidneys etc and probably couldn't afford it anyway...especially when I worked as a volunteer.

Similar experience to Sparky (except caught it quick both times) - living in Zimbabwe (Hwange area) for 5 years and the Kenya for three, we (plus wife and daughter) never took regular prophylactics unless we were going to the Lake areas. Then we took Malarone and carried co-artem for treatment. Spray rooms & mosquito nets and burn mosquito coils in the wet seasons...take the same risks/preventative action as the locals.

9

Thanks you guys for such an informative post sbout long term effects of Malaria.
Thats why most of us are on this board because of the bloody decent people like you lot lending your advice and insights.
Yes, I have a Pyrethrum impregnated net and will likely do as you suggest.
No sweat about the long term studies now Nutrax, I didnt like the thought of overloading my kidneys with Larium either.

Thanks heaps.

10

Their efficiency in the long run is more questionable than their possible side effects. Anti-malarial pills are not generally efficient for continuous use in a long period of time. They are mainly meant to help when people are new to a certain malaria zone and their immune system is supposed to be vulnerable to the parasite. It is usually quite possible to contract malaria while religiously taking any type of anti-malarial. It is advised to stop consuming them following a three months period of continuous use and opt for the old adage for doing as the locals do.

BTW, make sure you buy an efficient spray. Some sprays are more efficient than others. Locals are usually experts on this aspect. Spray and leave the place for few hours.

On the other hand, reliable scientific researchers have recently concluded that burning mosquito coils has serious health implications.