John Crippen at NHS Blog Doctor has written about malaria prophylaxis for tourists not being covered by the NHS. I totally agree with you John.
Living in a high malaria zone and having had malaria too many times to remember (first time amost 25 years ago) I think I am somewhat qualified to comment.
Firstly, if you can afford to take a holiday in a malaria zone, then you can afford malaria medication. Secondly, if you don't, you put your once-in-a-lifetime holiday at risk. Five days into your fortnight's holiday you come down with it and, even if it's only a mild attack, your holiday is ruined.
MK Student in the post's comments complains that he is going to do community work in a hospital in Ghana and still has to pay for the medication. I did three years here as a VSO volunteer – VSO rightly picked up the tab for vaccinations and malaria prophylaxis. Any organisation sending people to malaria zones should do this – if they don't, they are irresponsible.
That said I don't take malaria prophylaxis any more – I've been here too long, I cannot take it my whole life. But most people here generally know the danger signs. If you have a fever, unusual aches, anything, you don't think the flu, you think malaria and get tested for it. You have to know how to bring your temperature down with paracetamol and cold showers as well - I've brought myself back from almost unconsciousness by lowering my temperature.
I also ensure I carry malaria treatment medication with me when I travel abroad - my first experience of malaria was six months after geting back to the UK in the early '80s - I sat at home for three weeks getting weaker and weaker trying to shake off the 'flu before heading back to my parents. Immediate hospitalisation and isolation. They even suspected leukaemia at one point! The second time I knew what it was but the doctor coudn't give me a prescription until the test results came back - several days. I believe awareness, diagnosis and treatment have improved alot since the '80s but if I have the medication on hand and the malaria strikes on Sunday night, I am prepared.
Yes, it is the biggest cause of death here, generally through people not treating it properly but public health campaigns, impregnated mosquito nets, changes to treatment regimes and most recently a country-wide insecticide spraying campaign are beginning to work now.