Zameer, a 25 year old journalist, hailing from Mohakhali area of the metropolis presented to medicine OPD seeking advice regarding malaria prevention. Zameer had been assigned from the newspaper he works for; to do a bit of investigative reporting in the Bandarban district which will require him to stay in Bandarban for a few days.
   The first and most fundamental part in counselling a person travelling to Bandarban or any other malaria endemic zone is to speak emphatically about the need to prevent mosquito bites as much possible.
   Avoidance of bites is important, particularly because chemoprophylaxis is never 100% effective, problems of drug resistance are increasing and there is evidence that the risk of contracting malaria is proportional to the number of bites. Bites occur mainly between dusk and dawn, although some species of mosquito which can transmit dengue fever; bite during the day also. Bite prevention may be achieved by the following simple steps:
In order to prevent bites special care should be taken between dawn and dusk.
1. Wearing full sleeved garments and long trousers when out of doors is necessary.
2. Using mosquito repellent creams and sprays.
3. Making sure that the facility where the person is residing has netted windows or mosquito nets are available for the night.
A person coming from a malaria endemic zone may fall ill days after leaving the particular area. That’s why it’s important to start preventive treatment prior to travelling to the endemic area although chemoprophylaxis is never 100% effective. Starting treatment days or weeks before entering the malarious zone will also allow the side effects of drug therapy to wear off before the journey commences. The drugs most commonly used these days are given below:
Chloroquine is a prophylactic agent which requires long term therapy and the drug is mostly reserved to treat Falciparum malaria; one of the most aggressive versions of the parasite capable of producing cerebral symptoms and severe illness.
But the resistance of Plasmodium Falciparum to Chloroquin is almost universal nowadays and not beneficial for travellers going to Chittagong or other endemic zones of the world.
  Mefloquin is another drug which has shown significant promise in preventing malaria in sub Saharan Africa but it’s efficacy in our part of the world is not encouraging. The use of Quinine these days is reserved specifically to treat cerebral malaria or other severely debilitating forms of the parasite, resistant to agents like Chloroquin.
Among the agents which are most effective in our country’s context Doxyclycline, Mefloquine and combination drugs like Aovaquone–Proguanil should be prescribed as per World Health Organization’s directive.  
Recognizing malaria early on can help patients report for medical assistance before it’s too late. The early signs are given below:
1. Fever
2. Sweats
3. Chills
4. Headaches
5. Body aches
6. Muscle pain
7. Nausea and vomiting
Failure to recognize and seek medical help for these early symptoms can very well lead to cerebral malaria which will cause:
1. Irritability
2. Confusion
3. Convulsion
4. Coma
Although preventing mosquito bites in one of the most densely populated and polluted countries of the world can be an impossible task; our accumulated efforts for environmental sanitation can greatly ease the impact, infectious diseases like malaria pose on healthful living.
Caution, protection, prophylactic medication and early recognition of malaria are fundamental steps to contain the disease in our country until sustainable solutions emerge to eliminate the female anopheles mosquito from our endemic districts. 
 [Reference: Dhaka Shishu Hospital Journal H J 2011; 27 (2): 83-87]
The writer can be reached at [email protected]