DOCTORS CORNER with Dr JOHN KABUNGOLAST Sunday, I discussed the role sport can play in the prevention of malaria. This time around it is important to look at the problems which athletes with malaria encounter.Malaria is always a worrying condition in sport because of the many effects it has on the performance of an athlete. it is always a matter of concern when a team, and in this case a football team, is preparing for an important game and then it is reported that one of the team’s best players is struck with malaria.The issue becomes even more complicated when the malaria which someone has is not simple but complicated. I will try to explain a few things on the presentation of either simple or complicated malaria.I am very sure that a majority of Zambians have had malaria at some point and it won’t be a big hustle for me to go through how we can actually tell that someone has a bout of malaria. However it will be important to differentiate between simple and complicated malaria.these two forms of malaria will have a great impact on a player in terms of time taken for recovery and when the player will be allowed to get back and fully participate in a competitive match.Malaria affects all age groups with more serious and life-threatening forms occurring in children and pregnant women.In sport, both athletes and officials can be affected. Nowadays there is a lot of movement of players and match officials to different countries and this is the reason why everything must be done to have maximum protection of our athletes from malaria.FIFA has actually classified malaria to be amongst the BIG THREE medical conditions of public health interest. The other two conditions of this group are Tuberculosis (TB) and HIV/AIDS.The world soccer governing body has joined the many organisations in recognising that the three conditions are a threat to mankind and deserve to be given priority in terms of awareness and therefore reduce on the sufferings that come as a result of infections with these conditions.Malaria is the main parasitic infection affecting more than 500 million people and causing more than one million deaths each year world over. about 40 percent of the world’s population is at risk of getting malaria, mostly those living in the poorest countries.In football, due to the wide and rapid travel required by international match schedules, teams from malaria-free areas are exposed to infection.All sports persons travelling to malaria-endemic countries even for a short period may be at risk of becoming infected with malaria.In Zambia, malaria is still one of the leading causes of morbidity (sickness) and mortality (death) in our health institutions.Malaria has been around us for such a long time and so many resources and research have gone into ways of reducing transmission, finding drugs, which the malaria parasite is more susceptible to, and more importantly prompt and effective diagnosis of malaria.The most commonly asked questions regarding malaria are how long does it take for an individual to suffer the symptoms of malaria after being bitten by a mosquito? How can someone suspect that they have malaria?What is it that has to be done when malaria is suspected? What are the main treatment modalities involved? What are the effective preventive measures? How long should someone stay away from participating in sport once they suffer from a bout of malaria?for the transmission of malaria to occur, an infected female anopheles mosquito has to be involved. The bite from an infected female anopheles mosquito is a must! The time taken from the time one is bitten up to the time the symptoms of malaria appear is what is referred to as the incubation period.The minimum period between getting an infective bite and becoming ill with malaria is at least six days. Malaria symptoms can actually occur many months after being bitten by an infected mosquito.The specific parasite that commonly causes malaria and of great importance in our country is plasmodium falciparum. The other types of plasmodia which are found include plasmodium vivax, plasmodium ovale and plasmodium malariae.The main signs and symptoms of malaria are a headache, fever, flue-like symptoms including bouts of feeling cold and shivery, profuse sweating, joint and body pains, loss of appetite and general feeling of weakness (malaise).Malaria is a great pretender and can present in many ways including a bout of diarrhoea, vomiting, muscle pain or just a backache.these symptoms can occur at intervals and they basically form the simple type of malaria. However, other complications can occur, including mild to severe anaemia, because of the massive destruction of red blood cells by the malaria parasite.The anaemia in most cases is accompanied by dizziness, headaches and the heart beating faster than normal.The other complications can involve the kidneys, leading to renal failure, cerebral malaria accompanied by convulsions and mental confusion.In some cases malaria can result in a player or person going into a coma and if not properly treated this can result in death.The blood sugar levels are drastically reduced (Hypoglycaemia) by the malaria parasite and therefore affecting the energy levels of the individual.Sport, especially soccer, requires a lot of energy and malaria will deplete the energy stores and will not just allow the player to take part in training or a game. Malaria affects almost all systems of the body because of the said primary infection of red blood cells, which are vehicles to deliver oxygen to the many body tissues and organs.it is for this reason that a player or athlete suffering from malaria will not be able to participate in sport for some time.their participation in sport will depend on the improvement of their clinical picture after receiving appropriate treatment. there is no specific time frame with which return to normal physical activity is allowed, however careful monitoring and follow up of players with malaria are of great importance, especially if they are to participate at a very high level.at times recovery can take 10-14 days before an athlete returns to competition.Malaria is mainly diagnosed using a thin or thick blood smear on a glass slide and then competent laboratory personnel have to examine the slide.However, this type of examination or sending of a blood slide to the lab is not practical when the team is out where laboratory facilities are not easy to get.Nowadays the use of RDTs (Rapid Diagnostic Tests for malaria) has extremely made life easy. The tests mainly target the products from the malaria parasite in the blood stream.these tests are very easy to do and can be done by any person who has been oriented in skills of obtaining a drop of blood and the results are ready within a few minutes.Prevention of malaria has to be prioritised if sportsmen and women want to enjoy their sport.it must be emphasised that all camping facilities for sportspersons should have surroundings that are clean and not overgrown with grass.Overgrown grass and stagnant water are perfect breeding sites for mosquitoes.All sportspersons should make sure that they sleep under a treated mosquito net whether in camp or at their respective homes.The use of insect repellents either as applied directly to the skin or sprays has to be encouraged though this might prove to be costly in the long run.Sportspersons should be encouraged to wear long-sleeved clothing to cover the exposed areas and thus prevent the mosquito bites, especially at night when the malaria-causing mosquitoes are active.Another preventive measure is the use of drugs, especially when one is moving from a place where the incidence of malaria is lower than where they are visiting.This is known as chemoprophylaxis against malaria and this is done when an individual travels to a malaria zone (e.g. from Europe to Sub-Saharan Africa).The preventive measures have to target breeding sites for mosquitoes or areas where mosquitoes are likely to be found. In all the districts of Zambia, the Indoor Residue Spraying (IRS) is currently being done to help get rid of mosquitoes.The use of Rapid Diagnostic Tests kits by all teams’ must be encouraged because these are portable and easy to use.The recommended drug of choice for malaria as per our Zambian policy is the artemesinin-based combination therapy and the drug of choice is Coartem for treatment of all forms of simple malaria.many countries in our region have put this as the first line of choice for simple malaria for it has proved to be very effective and with no known serious side effects.The use of fansidar is only reserved for pregnant women in Zambia. The switch from the old chloroquin and fansidar has been due to the many malaria strains which do not respond to these drugs.My role now is to warn sportspersons to be wary of the fansidar they buy off the counter in chemists, BEWARE!!!You might take the fansidar with no response to your suspected malaria.The recommended anti-malaria for complicated malaria is QUININE.  The quinine can be given via the intravenous route or can be taken as an oral drug in tablet or capsule form.it is always important that an early diagnosis and treatment of malaria are instituted so that sportspersons can get back to their normal activities in the shortest time possible.Malaria can be such a huge drawback for an athlete and the entire team. Malaria can be prevented, so all sportspersons must make an Insecticide-Treated Net their number one training partner.Malaria will definitely affect an athlete in training or in competition and full recovery has to be allowed before resuming full activity.For questions and contributions write to: Dr Kabungo Joseph e-mail:

is there a symptom that makes swine flu stand out? if so, what? alot of people at my school might have it, and one guy on the football team already DOES! (he could have spread it by playing football!) and what can we do to prevent it? other than the vaccine that hasn't come out yet?

"is there a symptom of the swine flu (H1N1 influenza) that makes it stand out from regular flu?" — H3N2 flu can cause nausea, vomiting & diarrhea in small children but rarely in adults. with H1N1, you'll see these symptoms show up more often in adults as well.

"what can we do to prevent it?" — you may not be able to prevent the flu but you can certainly try. Avoid people who are obviously sick. Don't ever share food/drinks with ANYONE because there's a thing called the incubation period. This is the period of time that elapses from the moment you become infected and the moment the first symptoms appear. you don't yet know that you're infected (and contagious) because you feel fine. Wash your hands. make it your business to know and understand how flu viruses are transmitted. there are more than 24 million websites about swine flu on Yahoo! alone. This is an opportunity to educate yourself.

Yes!! Analysis of the Spring & Summer infections of 2009 H1N1 show that: "approximately 40% of infected individuals have experienced symptoms that include gastrointestinal distress and vomiting". that is 50% higher than "seasonal" influenza. (New England Journal of Medicine v360 p2605.)
"Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections," WHO said. "In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays."

There is no difference in symptoms.