To prophylaxis or not to prophylaxis?

In Cameroon, malaria remains the first cause of morbidity and mortality among the most vulnerable groups. It is responsible for 35 - 40% deaths in health facilities: 50% morbidity among children below 5 years of age, 40 - 45% medical consultations and 30% in hospitalizations. So you first reaction upon arrival in this malaria infested country would be: YES, prophylaxis, absolutely, definitely! But making the decision isn’t all that easy. Do I want to take drugs for many years uninterrupted? Do I want my children to take drugs for many years uninterrupted? What do I take and what do I give my children? Lariam? Maybe they’ll get the nasty side effects – will this influence my children’s development? Malarone? Hardly affordable on a long term basis. Artemisia? Do I want to use the last weapon to kill malaria as a prophylaxis and so inevitably increase chances of drug-resistance?

Most of us (expats) don’t give our children, nor ourselves anything. We use all preventive matters to avoid being bitten in the first place (sleeping under nets, repellent, long sleeves after 6, etc) and hope for the best. But it’s not 100% safe, with its consequences: I (Griet) had malaria when still breastfeeding Lisa and so had to give up breastfeeding. Jara had malaria last year. Although it wasn’t very sure, because a blood test is not always reliable. Young children often don’t show malaria in the blood, or will not be very sick. So it took us some days before the doctor decided to treat for malaria, after which Jara’s headache and fever went in no time. But these are the good stories. We are lucky. A friend and classmate of Jara, had malaria 3,5 weeks ago. She is still in hospital, repatriated to her home country with failing kidneys and we’re all hoping the kidneys will resume work soon. If not, she may be on dialysis for the rest of her life.

So what do we do? In Yaounde itself (and especially Bastos, the quartier we are living in) malaria is not such a problem as in other regions of the country. Although – as you can read, we’re still at risk.

We decided that we don't want our children to be on drugs for many years, but we do give them prophylaxis when we're going to a malaria infested area (such as the beach). And then we become very creative, imaginative and convincing to get Jara and Lisa to swallow that bitter pill.