Malaria prevention is crucial to sickle cell disease management

Malaria remains one of the most common triggers of sickle cell crises in patients living in malaria-endemic regions, while sickle cell disease (SCD) also predisposes patients to frequent malaria infection. As a result, malaria prevention has become one of the mainstays of SCD management in these areas.

Malaria is a parasitic infection caused by Plasmodium falciparum and transmitted by female Anopheles mosquitoes. It is life-threatening, causing high levels of morbidity and mortality in Africa.

The epidemiology and disease distribution of SCD and malaria are similar, as both conditions are prevalent in tropical regions, including sub-Saharan Africa, South and Southeast Asia, the Mediterranean, Central and South America, and the Caribbean. Because SCD mostly occurs in malaria-endemic areas, there is a hypothesis that the creation of hemoglobin S may have been nature’s way of protecting against malaria, as research has shown that people with sickle cell trait (genotype AS) have partial protection against malaria.

However, people with SCD are not protected against malaria; in fact, they’re more susceptible to frequent malaria infections. This is because they are already in a state of chronic anemia, which only worsens the situation. Malaria can also trigger crises in sickle cell patients, with the possibility of exacerbating one’s condition. Therefore, malaria prevention is essential for optimal health outcomes in people living with SCD in malaria-endemic areas. They are often put on lifetime malaria prophylaxis, or preventive treatment.

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Ways to prevent infection

In sub-Saharan Africa, where I live, malaria is a widespread health concern that affects almost everyone, but those of us with SCD are particularly vulnerable and must actively prevent malaria to optimize our health. Mosquitoes are ubiquitous in this region, and the risk of malaria is ever-present. The pervasive presence of these insects influences many lifestyle choices and decisions. For instance, many people — including those in my household — avoid building houses near stagnant water, which serves as a breeding ground for mosquitoes. We have window nets to prevent their entry and use insecticide-treated nets on our beds.

Additionally, we spray our rooms with insecticides every three days, sometimes wear long clothing in the evenings to prevent bites, and apply mosquito-repellent creams. Despite these efforts, malaria remains a significant threat; most of my family members treat malaria about every two months. This highlights the need for continued vigilance and effective prevention strategies to combat malaria.

In malaria-endemic regions, people living with SCD are often prescribed lifelong antimalarial prophylaxis to prevent malaria infections and their complications. I have been on antimalarial prophylaxis since my SCD diagnosis at age 1. Over the years, my medication regimen has evolved to suit my needs. I started with daily proguanil as a child, which helped prevent malaria infections. As I grew older, I requested a change to a weekly prophylactic drug, and my doctor prescribed pyrimethamine. More recently, I switched to sulfadoxine/pyrimethamine, which I take once a month.

In addition to antimalarial prophylaxis, I rely on insecticides, environmental sanitation, and mosquito repellent creams. While insecticide-treated nets are very effective, they affect my breathing and make me uncomfortable, so I have to use other methods.

Despite these preventive measures, I do not hesitate to seek treatment if I suspect I have malaria. Prompt medical attention is essential to prevent complications and ensure effective treatment.

Both malaria and SCD can cause severe morbidity and mortality, so it’s crucial for SCD patients to prevent frequent malaria infections. To recap, here are some effective prevention methods:

• Prophylactic antimalarial drugs
• Insecticide-treated nets
• Insecticides
• Protective clothing
• Environmental sanitation
• Topical mosquito repellent cream
• Electrical mosquito-killing gadgets.

By combining prophylactic drugs with other preventive measures, SCD patients can reduce their risk of malaria and SCD-related complications and improve their overall health outcomes.

Note: Sickle Cell Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Sickle Cell Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to sickle cell disease.