guidelines for the prophylaxis of malaria

ABSTRACT
Malaria remains one of the most serious tropical diseases in many parts of the world. Resistance to antimalarial drugs is increasing and has become more widespread, influencing the choice of drugs to be taken when visiting these areas. Resistance to the former widely used drug, chloroquine, is also present in South Africa and necessitated changes in the chemoprophylaxis policy. The use of precautionary measures against mosquito bites is emphasised as the most important way to prevent malaria.

These guidelines are issued by the SA Department of Health:
The objective is to provide all those involved in giving advice to visitors to or residents of malaria risk areas with clear guidelines for the prevention of malaria.

The outcome aimed for is higher awareness of the malaria risk and fewer malaria infections as a result of appropriate prophylactic measures.

The basis for these guidelines is the World Health Organisation's recommendations for the prophylaxis of malaria.  Extensive literature surveys have been undertaken and all available widely used chemoprophylaxis regiments were considered.  The efficacy, safety and the impact on resistance emergences patters of the various prophylactic options were evaluated.

The development of these guidelines was initiated by the Department of Health and the national Malaria Advisory Group (MAG).  The Subcommittee for Chemoprophylaxis and Therapy (SCAT) of the MAG consisting of experts in malaria was responsible for the compilation of the guidelines.  The members of the SCAT are Dr Frank Hansford, Department of Health (Chairperson); Dr Karen Barnes, Department of Pharmacology, University of Cape Town; Ms Elske Smith, Roche Ethical Assistance Line, University of Cape Town; Dr Lucille Blumbergh, Department of Microbiology, South African Institute for Medical Research; Ms Lee Baker, Transvaal Pharmaceutical Society Drug Information Centre; Dr Dirk van den Bergh, Department of Internal Medicine, 1 Military Hospital and Drs Andrew Ross and Harvey Williams, Mosvolt Hospital, KwaZulu-Natal.

The draft guidelines were also subjected to review by Dr Dave Durrheim, Department of Health, Welfare and Gender Affairs, Mpumalanga Province And Dr Jan van den Ende, Department of Microbiology, De Buisson and Partners (Chairperson of the MAG). Dr Dave Le Sueur of the National Malaria Research Programme of the Medical Research Council assisted with the compilation of the malaria risk map for South Africa, based on ta GIS database of malaria cases of the past 10 to 15 years compiled by the National Malaria Research Programme. The malaria risk areas were also confirmed by the malaria control programmes of the departments of health of the malaria affected provinces. The final concept was compiled by Ms Danette Lombaard, Directorate for Communicable Disease Control, Department of Health, in collaboration with the SCAT.

The contents deal with the global and local distribution of malaria, the parasites involved, prophylactic measures against malaria, recommendations for South Africa and other countries, factor5d influencing the selection of antimalarial drugs, comments on drugs used in chemoprophylaxis, standby emergency treatment of malaria and a summary of the diagnosis and treatment of malaria. The recommendations for all countries worldwide are provided in a table and mao, a map of South African risk areas is provided, as well as tables containing the drug regimens and patient factors influencing the choice of drugs.

The malaria risk areas are divided into chloroquine-sensitive, and chloroquine-\ne-resistant areas. In the chloroquine-sensitive areas, chloroquine is the regimen of choice for chemoprophylaxis and in the chloroquine-resistant areas, either chloroquine together with proguanil or mefloquine alone are recommended.  In areas where resistance to both chloroquine and mefloquine exists, doxycycline is the drug of choice.

The guidelines are endorsed by the Medical Association of South Africa.

Compiled by the Department of Health in collaboration with the Subcommittee for Chemoprophylaxis and Therapy of the National Malaria Advisory Group.
October 1996