Jan 26 2012
As someone who spends a fair amount of time worrying about tropical diseases and offering advice to visitors to Cambodia, I figured there’s no better way to combine the two than talking to doctors in Phnom Penh about new things for everyone to worry about.
Dr Nick Walsh is a public health physician and tropical disease specialist based in Melbourne and Phnom Penh — you might remember him from the excellent advice he gave about the risks involved in taking drugs in Cambodia. He’s back to answer questions you might have about malaria in Cambodia.
Where in Cambodia is malaria a problem?
Dr Nick: In all areas of rural Cambodia adjacent to forested areas. Resistant malaria occurs mainly in forested areas in western Cambodia near the Thai-Cambodia border.
Do travellers to Cambodia need to take anti-malarials?
Dr Nick: Avoiding being bitten by mosquitoes is the main priority (DEET, nets, long sleeves, particular care at dusk), but if you are travelling in forested areas in rural Cambodia then you should take malaria prophylaxis. Doxycycline or Malarone are the most common.
If you choose not to take malaria prophylaxis, it is a good idea to carry 12 Malarone tablets (atovaquone and proguanil combined pill) for treatment as this medication or an equivalent is not always available. Always sleep under mosquito nets in these areas, preferably one which has been treated with insecticide.
If travellers choose to take anti-malarials, what are the recommended types?
Dr Nick: Doxycycline — though photosensitivity can be a problem for some people — or Malarone (atovaquone and proguanil combined pill), which is significantly more expensive.
Doxycycline and Malarone can’t be taken by pregnant women; pregnant women are recommended not to visit malaria infested areas. Malarone is recommended in kids, as doxycycline can’t be taken until eight years of age. Paediatric anti-malarials are not widely available and are best brought with you before you arrive in Cambodia.
Counterfeit anti-malarials are a problem in Cambodia. It’s best to bring your own medications, though legitimate medications are available. [Lina's note: The U-Care chain and Pharmacie De La Gare on Monivong Blvd are known for their real, and expensive, medications.]
Do travellers who are only visiting Phnom Penh and Siem Reap need to take anti-malarials?
Dr Nick: Malaria occurs in rural Cambodia though not in the Tonle Sap Lake and river belt which includes Siem Reap and Phnom Penh. If you are visiting Phnom Penh or Siem Reap it is not necessary to take malaria prophylaxis, though it is necessary to take care to avoid being bitten by mosquitoes by applying a DEET-containing mosquito repellent and wear long sleeves if possible.
Dengue is common in both Phnom Penh and Siem Reap and is also mosquito-borne. There is no treatment for dengue fever.
Is dengue a bigger risk than malaria, then?
Dr Nick: Dengue is a disease of urban environs, whereas malaria is a disease of rural environs. Most people travel to cities so dengue is a much bigger risk. There is no prophylaxis for dengue, only preventing mosquito bites. Although dengue does occur all year round, the wet season is the high risk season.
[Ed's note: For further general tips on malaria across Southeast Asia, please see a 2007 Travelfish.org feature, which remains highly relevant, here.]
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