Malaria is no longer endemic (constantly present) in S'pore, and the few cases that are seen are imported cases. But the mosquito that transmits the disease continues to breed here and thus the threat of the disease remains real.

The possibility of contracting malaria exists even after taking anti-malaria drugs.

• Anaemia.
• Lung damage marked by cough and bloodstained phlegm.
• Heart failure.
• Brain damage, resulting in fits, delirium, paralysis or coma.
• Blackwater fever characterized by the heavy destruction of red blood cells that results in severe jaundice, loss of consciousness and kidney failure.
• Death.

Only Anopheles mosquitoes spread malaria. Infection is by any of the four species of malarial parasites (protozoa) called plasmodium. The parasites enter a person's blood stream through the bite of an infected Anopheles mosquito, which is known to bite during the night, most often between 2200-2400hrs) and will bite people both indoors and outdoors.

You can recognise it by the position it adopts while resting- its body is tilted at a 45-degree angle to the surface on which it rests. It is black with pale strips on its wing and legs.

The importance of faithfully taking the medication in the 4 weeks "post-trip" period must be emphasized.

The medication does not directly kill the remnant parasites in the blood, rather it suppresses it during this time until it becomes exhausted and is too weak to establish itself in the body. If the 4-week time frame is not adhere to or the person is not consistent in taking his medication, the parasite can multiply and continue to infect the person involved. This will lead to full-blown infection a few weeks to a few months after leaving the country.

Common malaria prophylaxis includes Maloprim, Doxycycline and Mefloquine (G6PD Deficient). They are prescribed depending on the G6PD status, drug allergy and region of entry.

• 2 tabs to be taken within 24 hours before entry into malarious area
• 1 tab to be taken weekly during stay

• 1 tab to be taken weekly for 4 weeks after leaving the malarious area

• 1 tab to be taken within 24 hours before entry into the malarious area
• 1 tab to be taken weekly during stay
• 1 tab to be taken weekly for 4 weeks after leaving the malarious area

• 1 capsule to be taken within 24 hours before entry into the malarious area
• 1 capsule to be taken daily during stay
• 1 capsule to be taken daily for 4 weeks after leaving the malarious area

In additional to taking antimalarial tablets, precautions should be taken to avoid being bitten by mosquitoes.

You will not get malaria unless the Anopheles mosquito bites you so you must take the following precautions while training in malarious area to avoid being bitten. These would include the following:

• Servicemen should roll down their long-sleeved shirts and tuck in their trousers into the boots to minimize exposed skin surface area especially after sunset.
• Insect repellent should be used on exposed skin and re-applied at regular intervals of 6 hours.
• Mosquito nets should be used where possible.
• The setting up of field camps in marshy waterlogged areas should be avoided.

Repellents are more effective in a lotion than in roll-on or spray form. As with all chemicals, repellents should be applied in accordance with the instructions, especially on infants and young children. Do not depend on your repellent too much - it is much safer to avoid dangerous times and places.

Malaria is a preventable disease and even if infection breaks through, it is treatable if detected early. However, without early detection and treatment, the disease can be fatal.

Malaria is a serious problem but if you take these simple precautions you will avoid a lot of pain and suffering.

Most importantly, all personnel should be compliant with the preventive advice and prophylactic medication given to prevent the infection from occurring in the first place.

Travellers who become ill with a fever during or after travel in a malaria-risk area should seek prompt medical attention and inform their doctor of their recent travel history. Malaria can be treated effectively in its early stages, but delaying treatment can have serious consequences.

If you suspect exposure to malaria and have symptoms like fever, muscle aches, chills, headache, vomiting and diarrhoea, you should consult your unit/base Medical Officer as soon as possible.

Go to the A&E department of a hospital if the symptoms worsen or the conscious level deteriorates. The treatment of malaria involves anti-malaria drugs and various supportive measures.