PREVENTION IS KEY Preventing malaria requires a multi-faceted approach, including taking anti-malarial medications and further precautions to avoid being infected by mosquitoes. Common measures to prevent malaria include: • Using Environmental Protection Agency-registered insect repellent • Wearing long sleeves and trousers • Applying a permethrin spray on clothes • Using a mosquito net when sleeping • Always clearing stagnant water. While prophylactic medications available in the form of tablets exist, they come with their own set of challenges. These include side effects such as nausea, sun sensitivity, diarrhoea, vomiting and sleep disturbances which subsequently can impact a seafarer’s mental health while on board. Larium (mefloquine) is also strongly discouraged due to the mental health side effects it has including anxiety, depression, paranoia and hallucinations. The costs for prophylactic medication are also high. It’s worth noting that a malaria vaccine is now available, though not yet widely accessible. The disadvantage for seafarers is that it requires three vaccinations over a one-year period, followed by another dose one year later. For this reason, it may be difficult to administer all doses of the vaccinations to crew who are at sea. MALARIA AT SEA RISK WATCH | COMBATTING MALARIA | 1312 | RISK WATCH | HEALTH COMBATTING DR JANE OLIVIER MEDICAL CONSULTANT FOR ETIC SAS / AFRICA P&I Dr. Jane Olivier brings her expertise to address the crucial issue of malaria in maritime settings. With extensive experience in treatment of malaria, Dr. Olivier emphasises the importance of proactive measures in combatting this life-threatening disease. The maritime industry has been grappling with the impacts of malaria, as evidenced by the concerning trend highlighted by Britannia P&I. The Club’s claims department reported a rise in malaria claims and an upward trend in costs incurred over the past five years, driven by an increase in deaths due to malaria. This concerning pattern highlights the urgent need for heightened awareness and proactive measures to confront malaria effectively. RECOGNISING THE SYMPTOMS Early detection of malaria symptoms is critical for timely intervention. The early symptoms can include a cold, headache and a high temperature. However, some individuals, especially those who have previously been infected with malaria, may only experience minor symptoms. Other symptoms can include: • Flu-like symptoms such as fevers, muscle and joint aches • Fatigue • Nausea, vomiting, diarrhoea and abdominal pains • Dark or blood coloured urine • Confusion • Seizures and loss of consciousness • Coughing and difficulty breathing • Jaundice. Severe malaria can cause complications within hours to days from the initiation of symptoms such as: • Cerebral malaria • Severe anaemia • Decreased blood sugar levels • Acute renal failure • Pulmonary edema. Given the overlap of symptoms with other illnesses such as COVID-19 and the flu, diagnostic testing becomes imperative, with rapid diagnostic tests being the most practical option for ships at sea. Any flu-like illness should be assumed as malaria until proven otherwise. Therefore, testing every crew member presenting flulike symptoms is obligatory, with or without a fever. WHEN TO SEEK MEDICAL ATTENTION All cases of malaria require follow-up by a doctor to monitor for potential complications. If flu-like symptoms persist despite a negative initial RDT test, it’s important to repeat the test, e