The components of Malaria prevention are often described as the ABCD of Malaria. All travellers to Malarial areas need to:

a. Be aware of the risk of Acquiring malaria infection b. Know how to avoid the bites c. Take chemoprophylaxis d. Understand the need urgently seek medical advices for Diagnosis and treatment if they have a fever

Prevention Risk AssessmentRisk of acquiring Malaria- Malaria transmission occurs primarily between dusk and dawn, corresponding to the biting habits of anopheline mosquitoes. - The risk of transmission is increased in rural areas and varies seasonally in many locations, often being higher around the rainy season.The travel to urban and tourist area of Southeast Asia, and Central and South America are considered to entail minimal risk

Host Assessment- The health of individual (eg, age, pregnancy, current medications and chronic illness such as HIV) - Travellers should be aware that reliable Malaria diagnostic and treatment options may be available in many travel destinations.- Self-diagnosis of malaria using symptoms only, without lab diagnostic testing, is considered suboptimal. Exposure Assessment- The travel itinerary should be reviewed in detail and compared with known areas of Malaria transmission within a country to determine the likelihood that the traveller will be at risk of acquiring malaria. Factors to consider in determining risk of exposure include the following:Level of endemicity in the area covered by the travel itineraryPresence of Plasmodium FalciparumDuration of exposureRural, periurban, urban travelSeasonality (rainy vs dry)Night-time exposureAvailability and likelihood of use of other interventions

Remember to use :

Impregnated mosquito net Wear attire that cover most of the body Mosquito repellant cream ( DEET) Preventive medicine - Chloroquine and Proguanil - Mefloquine ( more than 3 months old ) - Doxycycline ( more than 12 yrs old ) - Primaquine ( 11kg 40kg )

* Administration by crushing with food , bottlefed , or syrup formulation .

MALARIA PROPHYLAXISPREVENTION!STRATEGIESRisk managementBite preventionChemoprophylaxisRapid Dx and RxMEDICATIONVACCINESDisruptivePrevent parasite from binding with RBCSupressiveKill the parasite onceit has entered the RBCCausal Target the blood stage and the initial live stageREGIMENDoxycycline100 mg once dailyMefloquine250mg once weeklyAtovaquone/Proguanil1 tablet daily

RTS,SExperimental recombinant protein based vaccineInfection is prevented by inducing high antibodytitersBlock parasites from infecting the liverFun fact: it is funded by Bill and Melinda Gates Foundation

CONCLUSION

Malaria Prevention in Pregnancy

Evidence-based medicine recommendationsEBM ratingIf possible, pregnant women should avoid travel to areas with significant transmission of malariaC IIIPersonal protective measures, including the appropriate use of DEET and pyrethroid-impregnated bednets, are safe and should be strongly encouraged for all pregnant women who travel to malaria-endemic areas.A IPregnant women travelling to or residing in chloroquine-sensitive areas should use chloroquine as chemoprophylaxis.A IMefloquine is recommended where exposure to chloroquine-resistantFalciparummalaria is unavoidable from conception through the first trimester (A II), as well as the second and third trimesters (A I).A II, A IThere are no currently approved drugs to prevent malaria in pregnant women travelling to mefloquine-resistant regions. Atovaquone-proguanil (Malarone) after the first trimester in women who cannot avoid travel to mefloquine-resistant areas (e.g., border areas between Thailand and Cambodia/Myanmar) may be considered after careful discussion of the benefits and risksB IIAlthough safe in pregnancy, chloroquine and proguanil are inadequate and cannot be recommended in chloroquine-resistant areas

PREVENTION CHEMOPROPHYLACTIC REGIMENSSensitive regions: Chloroquine/Hydroxychloroquine

Resistant regions: Doxycycline, Mefloquine

Chloroquine and Mefloquine-resistant: Doxycycline, Atovaquone/Proguanil

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