By Theresa Adebola-John
The European explorers of the middle ages called Africa the “white man’s grave”. Africa may still be the white man’s grave if he does not take care to protect himself. The pregnant white woman is even more at risk. Any traveller going from Europe or the United States to Africa and other parts of the world where malaria is endemic needs to protect himself or herself with prophylactic drugs to stop him or her from getting malaria.
For this, the drug proguanil (Paludrine in oral tablet form) is used. It is taken at the same time daily from one week before travelling, during the entire stay in malarial area and continued for four weeks after leaving the malarial area.
Even with drug coverage, one should not take risks. Vulnerable persons should also dress to prevent mosquitoes from reaching their skin. If skimpy clothing are worn, a mosquito repellant product should be applied on the skin. The bedroom should be protected from mosquitoes with window screens and insecticide spray. Vulnerable persons should sleep under a mosquito net.
Pregnant women should always seek the advice of a doctor on what drugs to use in pregnancy especially during the first trimester when drugs can easily cause birth defects.
Proguanil (Paludrine) is only used during pregnancy if the physician decides the antimalarial benefits outweigh the risks.
Proguanil inhibits an enzyme called dihydrofolate reductase. The enzyme reduces dihydrofolic acid to tetrahydrofolic acid, which is important for living processes including synthesis of amino acids and nucleic acids found in DNA. Folate supplements are needed by pregnant women taking proguanil.
Some persons (including Africans) that are resident in malarial parts of the world such as in Africa may lack adequate immunity against malaria and may need to take preventive medication, especially during times when they are most vulnerable such as during the raining season. The combination medication sulfadoxine and pyrimethamine is generally used (e.g. Fansidar® tablets by Swiss Pharma and Amalar® tablets by Elbe Pharma). Fansidar should be avoided during the period of breastfeeding. Users should be wary of side effects especially developing skin rash and should notify a doctor if such occur. Some people are allergic to sulfa drugs can develop severe reactions. Pyrimethamine is active against plasmodium that causes malaria and other protozoans that may be picked up from unhygienic environments. This antiparasitic combination is thus a candidate for your medicines cabinet. However always ask your doctor’s advice on how to use it. Large doses of pyrimethamine can cause blood disorders. Folate supplements can limit this effect. The combination drug should be taken with plenty of water to protect the kidney.
Pregnant women are vulnerable to malaria. The risk of harm caused by severe malarial (especially death) may be greater than side effects of drugs. Proguanil may be used as a preventive medicine if necessary. Sulfadoxine-pyrimethamine is avoided in the first trimester. During the first trimester mefloquine or quinine plus clindamycin may be used as treatment and when these drugs are not available, artemether-lumefantrine combination may be considered. Other drugs that may be used in the treatment of malaria during pregnancy are chloroquine, and atovaquone-proguanil. Mefloquine is avoided in the first trimester.
Breast feeding mother should not take drugs that can be excreted in milk or that may influence breastfeeding adversely. Proguanil, chloroquine, and mefloquine are some of the drugs that are used during breastfeeding.
All drugs have their side effects and adverse effects, therefore, even if antimalarial drugs are available over-the counter, one must obtain advice from a health care provider about the usage.
Dr. Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis. For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635
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