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  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

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    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

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    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

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  • Volume 1

A life-threatening experience with Lariam

By Adeleke Adeyemi- Nigeria

What do you do when a drug meant to protect you against malaria threatens instead to take your life? That question will forever remain on the lips of UK-based engineer Martin Fredericks whose choice of Lariam anti-malaria prophylaxis gave him an unpalatable, life-changing experience.

Originally from South Africa and presently in Lagos, Nigeria, to supervise a critical shoreline engineering project, Martin had set out to take pre-emptive action against the killer tropical disease that, historically, led to the designation of Africa as “the white man’s grave”.

Before coming to Nigeria, Martin’s doctor prescribed Lariam, a widely-administered anti-malaria prophylaxis for expatriates and tourists travelling to malaria-endemic regions of the world.

But following his doctor’s order was like having one foot in the grave. Martin’s life has not remained the same.

 

Lariam (Mefloquine) is used to treat and prevent malaria.

“I started using Lariam 14 months ago on the advice of my General Practitioner, GP, in the UK when planning to undertake a job in Nigeria. I used the drug up until two months ago when I returned to Nigeria after a three-month break in the UK. That was when I started investigating the side effects of this dreadful drug.”

Right at the beginning of his liaison with Lariam, Martin – like a character caught in the mind-bending plot of a Ted Dekker thriller (he’s an avid reader) – started having “absolutely vivid dreams. They have persisted. It’s sometimes not even discernable where reality ends and the lurid dreams begin or end.”

“I never realized why or what caused the effects, and so continued to use the drug, until recently.”

This came about mainly from the efforts of his wife, who carried out extensive research on Lariam on the Internet. She found forums with countless testimonies by Lariam survivors. She suggested he does the same.

Martin soon realized “the extent of the damage to my system from Lariam toxicity. I wasted no time giving it up completely.”

Lariam is proprietary to pharmaceutical giant Roche USA. Inquiry on its website returned the following:

Search for: lariam - No results found. The query failed due to an unexpected error”.

Later, however, a spokesperson mandated by Roche USA admitted, sequel to a telephone interview, that patients on Lariam “have experienced untoward events such as headache, dizziness and nausea. Psychiatric reactions have been reported but serious psychiatric reactions are rare.”

One common Lariam delirium effect Martin found out online is mood swings. “Coming from a family with a history of bi-polar disorder I had associated this with it, but now realize it’s a direct function of the drug as this particular side effect has reduced significantly since I discontinued use of the drug,” Martin declares.

But others have persisted, “like dizziness and vertigo, or vestibular disorder. In my career, I have had to work on very high structures, 18- and 20-storey buildings, and have never had a problem with heights but now find that even looking over the quay wall [his present project], which is a matter of a couple of metres, I start feeling dizzy and sense the need to support myself. Also, sometimes if I turn around too quickly I feel quite dizzy.”

He has also been in the grip of insomnia, “a huge problem which I have overcome with the use of alcohol. In fact, all of the symptoms that I’ve had have been alleviated by the use of alcohol.” It turned out to be a Trojan horse “and has now become my number one problem as I have become dependent on the stuff to get off to sleep. It is my one goal now to give it up completely.”

There’s yet another pesky bit in the mix: anger. “That has also been a problem. But I have not been able to determine what level of it is attributable to the drug and what to the frustrations of my present environment in Lagos.  I must admit that there have been incidents where I have overreacted to some minor incidents which have been noted by my colleagues. These have been completely out of character. I feel confident ascribing them to this drug.”

True to British statesman Ernest Bevin’s quintessential quip – “If you open Pandora’s Box you never know what Trojan horses will jump out” – Lariam users around the world have been reporting a wide assortment of side effects like seizures, panic attacks, outright psychosis, suicidal ideation, violent urges, diarrhea and depression, among others.

Roche is not rattled by resounding reports of the unintended consequences of its beleaguered, mixed blessing of an antimalarial, fatefully long relied on by trusty medical practitioners to help relieve malaria fears and fevers plaguing patrons and patients.

 

An email from Roche South Africa spokeswoman, Dorothy Mwangu, brims with statistics: “Lariam has been used effectively for treating and preventing malaria by more than 25 million people worldwide over the past 17 years. More than two million have received Lariam for the treatment of acute malaria. Data from well-designed studies have shown Lariam to be safe and well tolerated.”

Generically, Lariam is mefloquine (also available as Mefaquin). It was developed in the 1970s by the US Army as an equivalent to quinine (the legendary antimalarial forerunner). They taught the world to rely on Lariam for the treatment of chloroquine-resistant falciparum malaria (the deadliest strain of the disease), until resistance spread to undermine its efficacy and dependability. 

Now that institution has shelved it as a matter of procedure. In February 2009, Lieutenant-General Eric Schoomaker, US Army Surgeon-General, issued a directive that states: “In areas where doxycycline [a substitute] and mefloquine are equally [available] in preventing malaria, doxycycline is the drug of choice.”

However, Roche maintains that “Lariam remains one of the drugs of choice for the prevention and treatment of malaria by leading public health authorities, including the Centers for Disease Control (CDC) and the World Health Organisation (WHO).”

According to a recently issued “Guidelines on Malaria Prevention” from the American CDC, “Mefloquine is no longer the drug of choice to treat malaria (and it is not necessarily the best drug to prevent ‘chloroquine-resistant’ malaria).” An email addressed to the Office of the WHO, Director-General seeking clarification on Lariam’s purported drug-of-choice status with it went unanswered.  

It behooves health regulatory authorities everywhere to investigate mounting reports of the menace of Lariam. Will they rein it in urgently enough, with the lasso of pharmacovigilance? Furthermore, the fact that it has been so universally thumbed-down in the war on malaria begs the question: Why do doctors continue to prescribe it?

“I am sure there are other side effects that I still suffer,” Martin moans. “But as I don’t know the whole range of Lariam side effects, I don’t even realize they’re attributable to this dreadful drug.

“It should be removed from the market and its manufacturers prosecuted,” says Martin, giving indication he has given thought to tort, defined by Black’s Law Dictionary as “[a] private or civil wrong or injury, including action for bad faith breach of contract, for which the court will provide a remedy in the form of an action for damages.” 

However, from a study he conducted after he and other British doctors saw Lariam problems with much greater frequency, Dr. Paul Clarke, an infectious disease specialist and the medical director of a large network of travel clinics in Britain, insists: “If you've taken it in the past and never had a problem with it I, for one, would be very sorry to see it go, because it's a good drug.” 

Dr. Clarke’s only concern is that people be better informed. His stance seems to be supported by the U.S. regulatory Food and Drug Administration which once issued a statement saying in effect that Lariam’s benefits far outweigh its risks. 

Nevertheless, Martin is raring to go for redress over his near miss with Lariam. His is a simple line of action: “I will most certainly be confronting my doctor in the UK when I return.”

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