Hi waterfall,
Madagascar is loaded with insects of a wide variety, including malaria carrying mosquitos. The first step in prevention is to minimize bites. In this regard, you may find the following informative:
Avoiding Mosquitoes and Other Bothersome and Disease Carrying Insects
http://www.awoosh.com/Doc Vikingo's Resource Page/Avoiding_ Insect_Bites.htm
The next step is chemoprophylaxis. Be aware that when necessary it is possible to take certain antimalarials over very long periods of time without undue concern.
There are serious concerns regarding taking Lariam while diving. You may become acquainted with these by reading the following article which I wrote for my column in Scuba Diving magazine:
"Lariam (mefloquine) is an effective drug used to prevent and treat malaria, but can give rise to unwanted side effects, including hallucinations, anxiety, depression, confusion and forgetfulness.
The US package insert indicates that "...caution should be exercised with regard to driving, piloting an airplane, and operating machinery as dizziness, a disturbed sense of balance, neurological or psychiatric reaction have been reported during and following the use of Lariam," and states that "dizziness, sensory & motor abnormalities, headache and fatigue have been recorded in patient's taking the drug." These cautions are consistent with suggestions by some in the medical and dive communities that mefloquine may produce side effects which mimic DCS.
Interestingly, the German package insert adds it should not be used for "certain activities which have a need for full attention and undisturbed motor activity," with a specific direction that pilots should not use Lariam for the prevention of malaria during their work.
Of most concern to the diver are the positions of some medical professionals that the drug should not be taken for malaria prophylaxis by those who are actively diving. These sources include "Rodale's Diving Doc," Dr. Samuel Shelanski, and the German Society for Tropical Diseases. This later group, whose policies can be used as a basis for professional and legal action in cases of harm resulting from a physician's failure to follow them, states that people with a special need for three-dimensional orientation, for example pilots, scuba divers and others, should not take mefloquine as prophylaxis.
The above information suggests it would be prudent to take this drug only after detailed discussion with a physician who is fully aware of its current status, and to closely monitor for any adverse reaction."
Also, in mid-'03 the FDA issued the following warning and Medication Guide for Lariam
http://www.fda.gov/bbs/topics/NEWS/2003/NEW00921.html
Fortunately, drugs like Malarone
http://www.malarone.com/ are equally or more effective for the Madagascar region and have more benign adverse reaction profiles.
The traveler/diver will want professional advice on this important issue. Such may be obtained by contacting:
International Society of Travel Medicine
http://www.istm.org/
Travel Clinic Directory
http://www.astmh.org/scripts/clinindex.asp
Helpful?
Regards,
DocVikingo