Had a really interesting conversation with a doctor here the other day. Basically, it was a (friendly and salient) lecture about white kids 'going native' in Africa. 'Going native' in this conversation pertained specifically to internationals opting not to take malaria meds when living in endemic zones, making me part of the subject; the white kids.
To take malarial prophylactics or not is a tough decision when you plan to live in a malarial region for the long term. On the one hand you have the side affects of taking the preventative drugs. Long term affects not noticeable on the daily, like wear on the liver or pancreas, and short termers that can range from sun sensitivity to depression to manic dreams to yeast infections all factor into deciding not to take them regularly.
But, on the other hand, you have malaria. Being beaten down twice - one gentle beating, one fairly severe - in three weeks by the parasitic demon brought in the question of how smart that approach really is. Having intense fever, cold sweats, severe exhaustion and the like for 3 - 4 days sucks the life out of you almost as hard as the drugs to exorcise the beast: artesonate (ACT) taken with amodaquine is the recommended dosage here. The chest infection I developed after this, and a brief scare that the drugs failed and it had become cerebral malaria add other unpleasant dimensions.
Which brought me to the doc.
His argument was as such: While it is true that not a huge percentage of otherwise healthy Liberian adults die from malaria, this means nothing to someone who grew up in Canada (where the mosquitoes be plenty, but not dangerous). Infant mortality rate and death of kids under 5 in Liberia have been among the world's worst 5 for years, says UNICEF. Though not all due to malaria, the disease does account for a large percentage of these deaths, and children make up the bulk of the almost 1 million malarial deaths worldwide. Thus, stands the argument, those that make it through to adulthood are naturally stronger in relation to malaria. Canadians, Americans and Eurpoeans, having largely rid their continents of the disease centuries ago, are naturally weak, leaving them exponentially more susceptible to the consequences of gittin' bit by the wrong 'skeeter.
I'd always thought of it along the lines of if anti-malarials give you hard time, you are careful and go to the doc whenever the early signs show up, it should be fine. Now I am reconsidering.