The safe way to see the world

Malaria cases are rising in Britain, but many of us are wary of the toxic effects - and the price - of preventative medicine. So what's a traveller to do? Catherine Nixey reviews the options

Benedict Allen, the film-maker, author and dashing explorer, is something of an expert on malaria. He has had it three - or, as he modestly puts it, "two and a half" - times. On the first two occasions he was in the middle of the Amazonian jungle and suffered from the disease for weeks without treatment. The third time he managed to get treatment promptly - hence it being a "half" bout. It all started with the crocodiles.

Benedict Allen, the film-maker, author and dashing explorer, is something of an expert on malaria. He has had it three - or, as he modestly puts it, "two and a half" - times. On the first two occasions he was in the middle of the Amazonian jungle and suffered from the disease for weeks without treatment. The third time he managed to get treatment promptly - hence it being a "half" bout. It all started with the crocodiles.

"I was 24, and in New Guinea," explains Allen. "I was going through an initiation ceremony to become 'a man as strong as a crocodile'. It was a traditional ceremony for the young men of that tribe, and no one from outside had been through it before, so it was a great privilege." It was also painful. "Hundreds of cuts were made with bamboo blades on our chests and backs, to represent the markings of a crocodile. And we were beaten every day." Allen could cope with that, but he was then faced with the more serious choice of having to give up either his malaria tablets or the ceremony.

"The initiation was all about forgetting your differences with the other men, so everything you had had to be shared. Which included my malaria tablets. So I shared them round, and as a result, sadly, I got malaria again."

The majority of travellers don't want to become like crocodiles, and won't be caught on the horns of Allen's dilemma. But many of us do agonise over whether or not to take malaria tablets on our travels. Last week, it was reported that deaths from malaria have doubled in the UK since 2002. The UK is now one of the biggest importers of malaria among industrialised countries, with 2,000 cases on average each year.

Matt Jenkins, 34, decided to stop taking his malaria tablets while on a visit to China two years ago. "I started off taking Malarone," says Jenkins. "But after a while I began to feel really quite ill. So after a week and a half I stopped taking them."

Like Jenkins, many travellers are familiar with the more common side effects of antimalarials, which include diarrhoea, abdominal pains, increased sensitivity to the sun and headaches. But some antimalarials carry the risk of more dramatic - and far more unpleasant - side effects. In the late Nineties, there was a health scare over the use of Lariam, the brand name of the drug mefloquine hydrochloride, after it was reported that some people taking it had suffered from insomnia, convulsions, vivid dreams, panic attacks and "frankly psychotic episodes".

Many antimalarials are also quite expensive. The extremely efficient Malarone costs about £34 for 12 tablets, which you have to take daily - meaning that, for most people, they are prohibitively expensive for all but quite short trips. Moreover, the efficacy rates of some antimalarials are not particularly high, with some of the older drugs being only about 70 per cent effective. More modern drugs can claim better rates - Malarone, for example, is thought to give 97 per cent effective prevention against the most common form of malaria - but it is still not 100 per cent.

All of which has led many people to stop taking antimalarials when they go on holiday - unnecessarily, says Professor Peter Chiodini, a consultant parasitologist at the London School of Hygiene and Tropical Medicine. 'The vast majority of travellers actually get on with these prophylactics very well," he says. "And there is a wide choice of drugs for the traveller to choose from; you don't have to take any particular one. Each drug has its pros and cons, so if a person finds one difficult to tolerate they can just try another."

It is a great worry to Professor Chiodini that many travellers are choosing not to take antimalarials. "Deaths from malaria in this country nearly doubled from nine in 2002 to 16 last year," he says. "These are not large numbers. But the point is that there could be none at all: malaria is an entirely preventable disease." And, if treated properly, a completely curable one. It is no longer true that if you have malaria once, you have it for life.

But if the side effects of antimalarials are not nice, the disease itself is even nastier. Malaria is caused by an infection of the red blood cells by the Plasmodium parasite. Four different species exist: falciparum, vivax, ovale and malariae. However, the only type of malaria that is usually fatal is falciparum, by far the most virulent variety of the disease. "If you or I get any of the types of malaria the only one that is going to kill us is falciparum," says Professor Chiodini. "But that usually will."

The first time Allen got malaria he managed to catch two varieties in one go: vivax and falciparum. He was 22 and walking through the Amazon jungle. "I had a heavy, heavy fever, which was coming and going - a classic symptom. I was sweating and had terrible cramps in my stomach. My hand was shaking so much I couldn't even look at my compass to check my bearing. It was a torturous time for me mentally and physically - I just wanted to die."

And falciparum is on the rise in the UK. In 1977, it was responsible for 17 per cent of malaria cases. Last year, it was responsible for 78 per cent, an increase that is thought to be due to increased travel to west Africa. So what should the average traveller do? "I believe that homeopathy is effective," says Jenkins, "so I take homeopathic remedies." The homeopathic Malaria Compound comes in either pill or drop form, and is made from the four different types of parasites that cause malaria - the idea being that it works like a vaccine. Treatment is started two weeks before travelling and continued for four weeks after returning.

Ananti Shaw, the superintendent pharmacist at the Royal London Homeopathic Hospital, stresses that the Malaria Compound should also be teamed with repellents, essential oils and mosquito nets in high-risk areas, although she concedes that some people may not choose to take the extra protection."That is a very individual decision each person makes for themselves after weighing the pros and cons of taking conventional antimalarials."

No trials or figures are available to prove the efficacy of homeopathic protection, but the anecdotal evidence is good, says Shaw, who uses the treatment herself. "I haven't taken a single traditional antimalarial in the last six or seven years, and I've travelled all over Nepal, Kenya... Even if I were to go to Thailand I would only use homeopathy."

But the mere mention of homeopathy is enough to get most medical professionals frothing at the mouth. "I am afraid that homeopathic measures just don't work," says Professor Chiodini. "Nor do vitamin supplements, or peppermint oil." Nor, apparently, as was reported earlier this year, does Marmite deter mosquitoes. "Such things are untrue - and frankly quite dangerous. Nice as it is, Marmite will not stop you getting malaria."

The Health Development Agency's website advises that the first line of defence against malaria is to avoid getting bitten at all. Cover up with long sleeves, and trousers and socks if you are going out after sunset. Light colours are less attractive to mosquitoes. Use a safe and effective mosquito repellent on clothes and skin: those containing DEET are recommended. Sleep in rooms that have properly screened doors and windows. If you are sleeping in an unscreened room, use a net that has been impregnated with an insecticide such as perethrin. Mosquito coils (rather like joss sticks) can be used overnight to help deter mosquitoes.

There is no need to stuff yourself with pills the minute you leave these shores. The Health Protection Agency's guidelines talk about the importance of "balancing the risk of malaria and the risk of adverse reactions to antimalarials". So if you are going to a very low-risk area, such as Egypt or Uzbekistan, it is sufficient simply to avoid mosquito bites. If you are going to New Guinea, however, where the risk is high, you should take an appropriate antimalarial. And, of course, you should avoid being bitten. And probably ceremonies involving crocodiles.

The Health Development Agency: www.malaria-reference.co.uk

'I THOUGHT IT WAS SUMMER FLU'

"THE FIRST time I had malaria I was 18 and on a marine conservation project in Mtwara, Tanzania," says Fred Martineau, 24. "I'd been taking my prophylactics - Lariam - but one day, about eight weeks into the project, I started to feel really weird. In the morning, I was headachey and took an aspirin, but, by the end of the afternoon, I was really tired and had joint pains. By about eight o'clock, I'd developed a fever. By midnight, my temperature had reached 40C, and by 2am, I had diarrhoea."

I was taken to hospital, where they put me on a week's course of quinine. For the next few days, I was totally spaced. The doctors said it was difficult to say whether it was the malaria or the side effects from the quinine, but I had really bad tinnitus for days. I also got some crazy hallucinations.

After the quinine, I was given a 24-hour course of Fansidar to clear the parasites from my liver and, by the end of the week, I felt fine. I'd lost a stone, but on the plus side I was given Ribena to keep the hypoglycaemia at bay.

Four years later, in 2002, I got it again. I'd been in Mozambique the previous summer, and I suspect I'd been infected there. Again, I'd taken my prophylactics - Doxycycline this time - as prescribed, but, after a few days of what I'd thought was summer flu, I knew I had malaria again. This time, I just took three days' worth of Malarone without going to hospital. I was dizzy, tired and anaemic for a few days, but was better in a couple of weeks."

Nisha Diu