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Health Scan: Higher malaria risk for elderly tourists
By JUDY SIEGEL-ITZKOVICH
05/05/2012
Elderly tourists to countries with endemic malaria at higher risk of death than younger ones.
 
Israeli tropical disease researcher Prof. Eli Schwartz was the first in the world to discover and report a decade ago that elderly people who visit a country where malaria is endemic are almost 10 times more likely to die from the disease than younger people. Later, a European study reached the same conclusion, and just recently the London School of Hygiene and Tropical Medicine and the University of Oxford did the same.

“They have confirmed our Israeli findings from 10 years ago,” said Schwartz, who runs a travel clinic for tropical medicine and tourist diseases at Jerusalem’s Shaare Zedek Medical Center. “These elderly people are usually businessmen who go to Africa and do not like taking prophylactic medication against malaria. They are not aware of their increased risk, even though I have several times tried to persuade them,” said Schwartz.

The medications may have some side effects, so people try to avoid taking them. “Their apathy is unfortunate.”

The latest study, published in the BMJ (British Medical Journal) found that foreign tourists aged 65 and over are at much higher risk of death from malaria than those aged 18 to 35. The death rate among tourists was found to be particularly high when returning from a “winter sun” holiday in the Gambia, West Africa.

The UK study was based on 20 years involving over 25,000 patients. They looked at the comparison between fatal and nonfatal cases of malaria and found that risk of death was almost tenfold compared to those of African heritage who traveled to meet friends or family. Most cases of travelers' malaria in the UK affect people of African heritage, the authors said, but their risks of dying from the disease are relatively low. “This may be due to early exposure to malaria or to greater awareness of the symptoms and a tendency to seek medical help earlier,” they suggested.

Some 250 million cases of malaria occur worldwide each year, with over 800,000 associated deaths.

Travel to infected countries, as in the African continent, is increasing.

The authors noted that for tourists, low rates of taking protective drugs and low awareness of the dangers of malaria are probably factors for death from malaria. There is also a higher death rate in December with over a quarter of deaths occurring then, which may be due to travelers mistaking symptoms for common winter viruses, or getting less rapid diagnosis over the holiday period. The more commonly malaria is seen in an NHS region, the lower the death rate suggesting familiarity with treating the disease may lead to better outcomes. Delay in seeking care may well be a major factor; treated early the outcome for malaria should be good.

They stress the importance of interventions from doctors who should give pre-travel advice encouraging prompt presentation when returning travelers have a fever and the need for taking antimalaria drugs. They say doctors must make holiday makers aware that malaria is common, fatal and needs early diagnosis, but they should also be targeting those of African heritage.

WHOLE-GRAIN RICE HELPS REDUCE DIABETES RISK
If you like eating rice, prefer the whole-grain type to white rice to significantly reduce the risk of developing type 2 diabetes, according to a study published recently in the BMJ (British Medical Journal). The authors from the Harvard School of Public Health conducted a metaanalysis based on studies conducted in the US, Australia, China and Japan. Their study aimed at finding out whether this risk was dependent on the amount of rice consumed and if the association was stronger for the Asian population, who tend to eat more white rice than the Western world. All participants were free of diabetes at study baseline.

White rice is the predominant type of rice eaten worldwide and has high glycemic index (GI) values; high GI diets are associated with an increased risk of developing type 2 diabetes. The average amount of rice eaten varies widely between Western and Asian countries, with the Chinese population eating an average of four portions a day while those in the Western world eat less than five portions a week.

A significant trend was found in both Asian and Western countries with a stronger association found among women than men. The results also show that the more white rice eaten, the higher the risk of type 2 diabetes: the authors estimate that the risk of type 2 diabetes is increased by 10 percent with each increased serving of white rice. White rice has a lower content of nutrients than brown rice including fiber, magnesium and vitamins, some of which are associated with a lower risk of type 2 diabetes.

The authors report, therefore, that a high consumption of white rice may lead to increased risk because of the low intake of these nutrients.

The authors conclude that a higher white rice intake associated with a significantly elevated risk of type 2 diabetes applies for both Asian and Western cultures, “although due to findings suggesting that the more rice eaten the higher the risk, it is thought that Asian countries are at a higher risk. “They recommend eating whole grains instead of refined carbohydrates such as white rice, which they hope will help slow down the global diabetes epidemic.

However, even though there is certainly no danger in following the advice, Dr. Bruce Neal from the University of Sydney writes in an accompanying editorial that more and larger studies are needed to substantiate the research hypothesis.
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