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Prevention of Malaria Infection:

Prevention may be carried out either by interrupting transmission in vector control, or by giving the patient prophylactic drugs. As yet, there is no widespread effective vaccination scheme. Vector control effectiveness has declined in recent years, due to lack of personnel, inefficient insecticide usage, and mass population movements and other factors alluded to in the first section (16). Simple means such as insecticide impregnated mosquito nets remain effective.

The use of prophylactic drugs has been generally effective, both for travellers and people living in endemic areas. There are several considerations when prescribing chemoprophylactic drugs, such as duration of travel, species of parasite, and parasite transmission intensity in the specific area. It is very hard to advise prophylactic drugs for South East Asia due to the high degree of resistance there (31). In Africa, chloroquine resistance is widespread, so chloroquine does not offer effective prophylaxis. For prophylaxis against chloroquine sensitive malaria, a course of 300mg chloroquine per week could be prescribed before travel and followed through the whole time the person is at risk in an endemic area. For resistant malaria, more expensive drugs such as mefloquine could be used at a dosage of 250mg weekly. It is important to know the degree of malarial drug resistance in the particular area of destination. A recommended combination for areas with resistant P.falciparum consists of 300mg chloroquine weekly, with 200mg proquanil daily - but protection even with this regimen is limited in the region of interest for this project (31). Specific issues relating to prophylaxis are discussed in the following sections.

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