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From New York Times -


Malaria on the Rise In Southern Africa

DATELINE: December 19, 1999, Sunday, Late Edition - Final

SECTION: Section 5; Page 3; Column 1; Travel Desk


A FEW weeks into its holiday tourist season, Southern Africa is bracing for its biggest battle with malaria in decades.

In South Africa, primarily in the country's northeastern provinces, cases of the potentially deadly mosquito-borne disease have surged in recent months. From the beginning of July to the end of October, the country recorded 8,229 cases of malaria, a 180 percent increase over the same period last year, when 2,937 cases were recorded.

Now, with the onset of the seasonal rains that spawn malaria-carrying mosquitoes and mark the beginning of the high-risk season, the numbers will only go up, authorities say. Experts attribute the sharp jump to the warmer-than-usual winter, a growing influx of immigrants from neighboring Mozambique, where malaria is rampant, and the spread of drug-resistant strains.

This month the South African Department of Health issued a malaria advisory urging anyone planning to visit the northeastern part of the country, including Kruger National Park, to take precautions and be on the lookout for symptoms of infection. Kruger, the country's biggest game reserve, took the unusual step of issuing a similar advisory several weeks ago. The 4.9-million-acre park, which borders Mozambique, usually registers 300 to 600 malaria cases a year, a fraction of the 25,000 cases the country has averaged annually over the last three years, said the park's conservation general manager, Dr. Leo Braack. But this year the country has already recorded more than 44,000 cases -- the highest number since record keeping began almost three decades ago, according to Danette Lombaard, an assistant director of the national department of health.

Kruger will feel the effects of this year's increase, Dr. Braack said, but he maintains that the vast wildlife preserve is safer than the surrounding areas. Fear that some visitors would panic when they read reports of the country's malaria epidemic prompted the park's message to the public. "Otherwise," Dr. Braack said, "all they know is what they see in the media about the country as a whole, and we end up getting a lot of cancellations."

Dr. Stephen Toovey of the British Airways Travel Clinic in Johannesburg, an expert in tropical diseases, said that public awareness plays an important role in pushing the tourism industries to encourage visitors to take precautions. More and more frequently, he said, travelers who contact the clinic (, ask for information about places like Pilanesberg National Park, which is malaria free, or Gemsbok National Park in Botswana, where the risk of malaria is usually very low.

Pilanesberg, a 134,000-acre park 110 miles northwest of here and not far from Sun City, has noticed the interest, too, said Luke Sacco, who manages three of the park's private lodges, Tshukudu, Bakubung and Kwa Maritane. "Our marketing drive used to be that we're close to Sun City, but no longer," Mr. Sacco said. "Now all of our advertising emphasizes that we are malaria free."

In Kenya, one of Africa's most popular tourist destinations, public health authorities have issued renewed warnings about malaria. The disease, which was already a significant problem in Kenya, has been spreading into previously malaria-free highlands and showing an increasing resistance to chloroquine, once the malaria prophylactic of choice.

The Centers for Disease Control (, the British Airways Clinic and the South African National Parks ( recommend anti malarial drugs for anyone visiting reserves like Kruger or Chobe National Park in Botswana. Mefloquine, better known by its trade name Lariam, is the most widely recommended because it is taken just once a week, beginning a week before the visit and continuing for four weeks after the visit. The primary alternative, doxycycline, must be taken every day, beginning a couple of days before the visit and continuing four weeks after leaving the malarial area. A new Glaxo Wellcome drug, Malarone, available in some 30 countries as a treatment for malaria and in Denmark as a preventive as well, has not yet been approved in the United States by the Food and Drug Administration. None of the drugs is completely effective, and each has potential side effects.

Consulting a physician specializing in tropical medicine is the best way of sorting out which is the safest and most effective option, said Dr. Toovey.

The health department considers the risk of contracting malaria almost nonexistent in South Africa's biggest cities, Johannesburg, Cape Town and Durban, as well as in the wine country outside Cape Town.

>A traveler should be aware of the symptoms of malaria: chills and fever, aching muscles and headache. Perhaps most important is avoiding mosquito bites. The Anopheles mosquito, which carries malaria, bites from dusk to dawn. Experts recommend going outdoors at that time only if necessary and then wearing long sleeves, long pants and socks and using strong mosquito repellent. Indoors, screens and bed nets should be used. "You can never reduce the risk to absolute zero," Dr. Toovey said, "but you get pretty close to it by doing everything correctly."

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