The Safari Experts

Malaria when travelling in Africa


... is an infectious disease caused by a parasite transmitted by mosquitoes, causing symptoms that typically include fever and headache, in severe cases progressing to coma or death. It is widespread in tropical and subtropical regions, including much of sub-Saharan Africa, but with the notable exceptions of much of South Africa and Namibia.

Almost all travellers on short and medium duration trips to malarial areas are prescribed anti-malarial pills, which generally provide a high level of protection. There are also several practical measures that you can take to further the reduce the chances of infection, as well as avoid the general discomfort of mosquito bites. In this section we discuss the various issues relating to malaria and its avoidance.

If you only read two pages in this health section then this it should be this one and the one on vaccinations.

If you do not wish to expose yourself to malaria then your trip needs to be restricted to the parts of South Africa, Namibia and Seychelles that are not malarial, but note that your safari options will be severely restricted to the Madikwe reserve to the north of Johannesburg or to much smaller fenced such as Sanbona, Addo, Shamwari and Kwandwe in the Cape.

If you do choose to go into malarial areas, then please note that here is presently no vaccination against malaria, but it can usually be prevented by taking a course of malaria prophylaxic pills, usually prescribed by a doctor.

Whether or not you choose to take pills, all practical efforts should be taken to avoid being bitten by potentially infectious mosquitoes, most notably sleeping under good insect nets.

It should be noted that if diagnosed and treated promptly malaria does not usually represent as serious a threat to health as one might imagine, although smaller children are at great risk. However if left untreated malaria can quickly become a potential killer. Awareness leading to prompt and appropriate action is the key.

We do not able to offer medical advice, for that you need to seek to a medical professional, your family doctor will usually be able to handle any such questions and provide any necessary drugs. What we are able to do is convey some of the basic fasts and let you know how we deal with this issue personally, which we do in some detail below.

Read more about common malaria in Wikipedia.

Areas ...

Malaria is endemic to most safari countries, with the notable exceptions of large parts of South Africa and Namibia. The map below shows the theoretical climate suitability for malaria across Africa ...

Malaria in Africa map

It may be worth noting that above 1400m altitude malaria is much less prevalent and virtually absent about 1800m. At medium altitudes and in naturally drier areas malaria tends to be seasonal, posing the greatest threat during the green season, often fading to only a very mild threat during the dry season. Low-lying areas such as those along the coast, inland depressions and areas with more reliable year-round rainfall tend to be at risk year round.

The malaria parasite also needs humans in its life cycle, so tends to be more prevalent in areas where the population is more dense. Conversely in less habited areas malaria is much less common. The classic example is the Okavango Delta in Botswana, which one might have suspected as being heavily malarial due to the large expanses of standing water, but in fact there is very little malaria out in the wild areas due to the very low human population density.

This map takes into account the number of people living in each area and also the fact that in areas to the south the risk of malaria has been much reduced by public health programs. Note that endemic is a higher risk category than epidemic ...

Malaria in Africa map

Malaria is also highly seasonal in many areas, as the next three maps illustrate. Note that these maps are theoretical models based on available long-term climate data. Although they are reasonably accurate, they are not based on actual malaria data and may not reflect the real malaria status. They are based on the theoretical suitability of local climatic and therefore the potential duration, onset and end of the malaria transmission season in the average year. Climatic conditions and therefore malaria transmission vary substantially from year to year. Malaria control activities can also dramatically alter the malaria transmission situation ...

Malaria in Africa map

Malaria in Africa map

Malaria in Africa map

The links below lead to country maps created by the organisation Malaria Action Plan, which are the kind of resource that your doctor will use in assessing the malarial risk.

The following countries are largely malarial and preventative measures need to be taken in virtually all areas. The only exceptions are very arid areas during the dry season and areas higher altitude, although to access these it is usually necessary to pass through malarial areas. Travellers are usually advised that anti-malarial pills is strongly recommended ...

Kenya : Malawi : Mozambique : Rwanda : Tanzania : Uganda : Zambia : Zimbabwe

The following countries are only partially malarial and travellers to the non-malarial areas may be advised that anti-malarial pills are unnecessary ...

Namibia : South Africa

The following countries are claimed to be completely from from malaria ...


Contraction ...

Malaria is transmitted by the bite of an infected female anopheles mosquito.

Even people who are taking malarial prophylaxis pills can contract malaria, either by encountering a strain which is resistant to the drugs, by missing a dose or by losing a dose by vomitting.

We have heard it said that the type of mosquito that transmits malaria is only usually active during the night. Research in different areas has revealed that in some places the risk is only between midnight and 5am. In areas where mosquito nets are in common usage we have heard that the mosquito has been found to extend this period to maybe 9pm to 6am.

We have also heard that only the female of this type of mosquito can transmit malaria and that she flies silently. If this is true then that awful buzzing sound of a mosquito bothering you at night is one not to worry about, it is the silent ones that you need to worry about.

We will look into these rumours and see if we can discover a few more reliable facts. In the meantime we recommend that you try to avoid being bitten by all mosquitoes at all times.

It is important to note that malaria can occur anything from seven days after arriving in a malarial zone to a year after leaving the malarial zone.

Prevalence ...

Reading about malaria can really put the wind up you, so for balance we feel that we should point out that if you take suitable precautions, the chances of contracting malaria are very slim.

Here at ATR we spend a lot of time travelling in Africa, during which time we have never, touch wood, contracted malaria. Some of us have had malaria, but in all cases it was contracted whilst living and working in Africa, during which time we were not taking malaria prophylaxic pills, but were instead treating the symptoms as and when they arose. The only one of us to have had serious problems with malaria is Greg, who was unfortunate enough to contract malaria and salmonella together whilst working in a very remote area removed from medical assistance.

We have many friends who live and work in malarial areas, who have had children and raised their families there and who rarely if ever have a problem with malaria.

So it is worth trying to keep this thing in perspective ... malaria is all about being aware of the risks and taking the necessary precautions. It should not be about worrying yourself sick.

Children ...

Malaria prophylaxic pills are available for small children, although this should not necessarily be taken as a green light to travel.

Our personal view is that we do not advise travelling to malarial areas with small children. Here at ATR we have a range of different opinions on this, but we are all agreed that we would not expose babies or infants under two years old to the risk. The more cautious amongst us would prefer to wait until our children are seven or eight years old and even then take them to areas of naturally lower risk and at times of the year which are also lower risk.

Our Greg and Tracey took their boys to non-malarial South Africa until the youngest was four, after which they travelled to the wilder areas of Namibia during the dry season. When Billy got to five they took them to Tanzania during the dry season, but felt in retrospect that it might have been a little bit too soon.

Obviously people travel and live with their young children in these areas. The issue for us is whether we could ever forgive ourselves for exposing our young child to the risk when we had a clear option to avoid it.

Please feel free to call up and chat about this issue before you even get to thinking about the detail of your trip, it is perhaps the most important decision in planning a family safari.

Pills ...

The vast majority of visitors who are staying in Africa for 6 weeks or less should almost certainly take the pills. The most common exception would be if you are staying to the non-malarial areas of South Africa, Namibia and Seychelles.

Completing the course of pills for the prescribed period after leaving the malarial zone is absolutely essential.

For those people who intend to spend longer in Africa then the prospect of taking such a large amount of medication becomes less attractive and the temptation is to approach malaria more like a resident. This means not taking medication in advance, but keeping a close eye out for symptoms and getting a blood test as soon as malaria is suspected. A larger shot dose of similar medication can then be used to flush the parasite out of the system, the resulting sickness usually being no more severe than a nasty cold. Out in the bush many of the guides work on the basis that ... "if you feel like you have a cold, take a course of Coartem pills and if you are not better next day then you have a cold". We cannot recommend such a plan, but it may be worthwhile knowing how the locals deal with such things.

Every now and then you may bump into people who will advise you against the necessity of taking drugs for malaria prevention or cure. They may even say that not taking the drugs enables them to build up a natural immunity. These people are often driven by extreme religious convictions. Their advice is extremely misguided ... it is not possible to build immunity to malaria ... and we strongly recommend that you disregard such sentiments.

There are several different types of anti-malaria prophylaxis pill. The appropriateness of each depends on the destintation, duration of travel and specifics of the traveller's health, the latter being particularly important in pregnant women, children and those with medical conditions.

Malarone, a mix of atovaquone and proguanil hydrochloride, is the one we tend to use most often. It is generally regarded as being as effective as any dru against malaria. It only needs to be taken for a two days before and seven days after the trip and is therefore well suited for shorter trips, although it is said that it can be used for up to three months. We have noticed no side affects, although we have heard some people attributing serious stomach upsets. The pills are quite expensive though, usually working out around $5 to $10 per day. Child doses are available.

Lariam, whose active component is mefloquine, was the drug we used to take before Malarone, but at least half of us are convinced that it was responsible for giving us nightmares, paranoia and other mind-bending experiences, effects which have been widely quoted elsewhere. The pills usually have to be taken for weeks either side of time spent in infected areas. It may be a good idea to start taking this drug at least three weeks before you depart in order that you can find out if you have any adverse reactions. You will probably want to stop taking it immediately if it seems to cause depression or anxiety, sight or hearing issues, severe headaches, fits or changes in heart rhythms. Side affects such as dizziness or nightmares may be considered worth enduring. Probably best to avoid this drug if you are being treated for depression or psychiatric problems, has diabetes controlled by drugs, or who is epileptic or related to anyone who is epileptic.

It is worth noting that some dive operators now refuse to service guests who are taking Lariam.

Doxycycline is an antibiotic which tends to be recommended when both of the above are not considered appropriate. Like Malarone it only needs to be started a few days before departure. Unlike Malarone it can be used by travellers with epilepsy, although if they are taking any drugs for that condition then they may impair the level of protection. There is a 1% to 3% chance of allergic skin reactions developing in sunlight, in which case the drug needs to be stopped. The drug may also reduce the effectiveness of contraceptive pills and is not suitable for pregnant or breast-feeding women. Often available without prescription. We have little personal experience with this drug.

Chloroquine and Proguanil are rarely recommended these days since some mosquitoes have developed a resistance and the drug is therefore no longer offering effective protection. However they may still be considered if the above drugs are considered inappropriate.

Testing ...

Malaria usually manifests itself with flu-like symptoms, often with headaches, flu-like aches and pains especially to the outer limbs, shivers, a rapid rise in temperature, a general sense of disorientation, with possible nausea and diarrhoea. Some of us also associate malaria with vivid bad dreams and anxiety, although these may be symptoms only of people who have had malaria before.

We have commonly heard it said that if your temperature exceeds 37.8C or 100F then you should immediately consider malaria a possibility, although it is probably not worth waiting around to reach this arbitrary level, lower temperatures could presumably be a reasonable sign.

As soon as you suspect malaria you need to get yourself immediately down to a medical centre for a blood test. These are widely available in urban and rural areas, can usually be done very quickly and cost next to nothing.

A positive result means that you have malaria and need to start a course of treatment. The good news is that even strains of malaria which are resistant to the prophylaxis pills can still be killed off by the higher cure dose.

A negative result is a good indication, but does not necessarily put you in the clear ... the malaria parasite may not show up or may be held in abeyance by the prophylaxis pills that you are taken. We have heard it said that the blood sample should be taken during a surge in your temperature and other symptoms, since this is when the parasite is more active in your blood, but we are not sure whether or not this is true. Either way, after a negative test you need to remain vigilant and if symptoms persist or worsen then you should return for another test. There is a possibility that you may have typhoid, which also needs immediate treatment, the medical centre should also be able to test for this.

If you are travelling in remote areas where a testing facility may not be on hand, such as in game reserves and hiking areas, then you may choose to take a course of treatment with you. It is generally accepted that the most likely consequence of travellers carrying pills in this way is that some of them will end up taking them when not actually needed, although for each individual traveller taking too many pills would almost certainly be preferable to leaving a genuine case of malaria untreated.

The cure treatment is usually either a higher dose of Malarone (the standard prophylaxis packs contain instructions as to how to use it as a cure) or co-artemether, which we have most often encountered under the name CoArtem. A combination of quinine and doxycycline can also be used, or a combination of quinine and Fansidar. It is even possible to use Fansidar on its own. One cure that seems to be worth avoiding is Halfan, which can be dangerous, especially if you are using Lariam as a prophylaxic. It is apparently better to avoid using the same pills as both a prophylaxic and a cure, so if you are taking Malarone as a prophylaxis, then you might like to carry a cure dose of CoArtem, for example, although medical advice needs to be sought on such serious issues.

In severe cases the patient may vomit the cure dose back up, in which case they may need to be removed to a medical facility to be put on a drip. Try to get to a private medical facility if you can. Failing that a regular hospital will have to do ... any concerns that you have about the place should be offset by the knowledge that even the most rudimentary facilities are at least very experienced in dealing with malaria.

Avoidance ...

Just to re-emphasise, the most important thing that you can do to avoid malaria is to take malaria prophylaxis pills, as described above.

After that, the most important weapon in avoiding malaria is to avoid getting bitten by mosquitoes in the first place, especially between the hours of dusk and dawn. Here are our top tips ...

1. From late afternoon you should change into clothes which cover your skin, including long pants/trousers and long sleeved shirts. Since many areas can be quite warm, it may be better to wear all-cotton clothing.

2. Cover all exposed skin with a strong insect repellent spray, preferably with 30% or 50% diethyltoluamide (DEET) as the active ingredient. Also bear in mind that mosquitoes will bite through thinner layers and are particularly active around floor level, so spray under your socks and on your lower legs. If you prefer to avoid synthetic chemicals then natural alternatives based on pyrethrum flowers or lemon grass (citronella) may also be effective.

3. If possible you should avoid low lying areas at night, especially those where there are areas of stagnant fresh water in close proximity to high human population densities.

4. You should avoid leaving lights on unnecessarily. Mosquitoes and other insects are attracted to bright lights and so you should avoid using them whenever practically possible. The most obvious thing is to avoid leaving the lights in your room on whilst you go to dinner in the evening, especially not with the windows open as well.

5. Always sleep under a good mosquito net. The only exception to this is on safari, when the tent itself can act as the insect protection. Always spend time checking the integrity of your mosquito net before it gets dark, making any necessary repairs yourself or insisting that the lodge staff do so immediately. In our experience even the best lodges sometimes fail to provide fully secure nets. Make this your priority and make sure that you are carrying with you suitable repair materials in your medical kit.

In most rooms this means checking the mosquito net for holes and making sure that when it is down all the edges reach the ground and join together as they should. We always travel with a large roll of gaffer tape, a ball of string and a sewing kit for this purpose. In most tented safari camps protection is provided not by a mosquito net but by the tent itself, in which case we check over the whole tent, searching out areas where insects might be able to penetrate. The most common areas are around the pipe connections in the bathroom, at zipper junctions or around doors. Solving such issues can require some ingenuity, but will be worth it for the sake of a good night's sleep. No matter how much we complain to lodge owners about these issues, we continue to encounter them in maybe 4 out of 5 locations. On the other hand, many people would consider this as getting towards the phobic end of insect paranoia.

6. It is good practise to spray your net with Permethrin insect repellent, which you should carry in your medical kit. In practise regular mosquito nets rarely provide 100% protection, far greater effectiveness can be achieved by spraying the net with a suitable insecticide in order to kill the mosquito when it comes into contact with the net, thereby depriving it of the opportunity of searching for a gap. In theory all nets provided in lodges should already have been treated with Permethrin, but in reality who knows whether it actually was and whether it has been retreated regularly. It may be better to take the control and spray the net yourself.

7. Before going to dinner, spray your room with a strong insecticide. Most lodges provide aerosol sprays such as Silent Night, Peaceful Sleep or Doom as standard in each of the rooms. Check for this when you arrive and if there is not at least a half full canister then ask for one to be sent up from reception. If it is not the kind of lodge where you can make such demands, then get out and purchase one yourself from a local store. Before you spray, close all the windows and doors, spray and then leave. Do not stay in the room once you have sprayed, since theses chemicals can be pretty nasty if inhaled in high concentrations. Many lodges perform a turn down service, as part of which they spray your room. Our experience is that this service can be rather patchy and we would always prefer to take control of our own protection. On occasion turndown services can be very negative in this regard, with staff un-tucking the nets that you have so carefully arranged and turning bedside lights on in such as way that the nets fill with insects. It might be worth carrying with you a small pictorial sign saying "no turn-down service", although this is a level to which even we have not yet progressed!

8. You may also like to burn the mosquito coils that you have in your medical kit, both in your room and also around you whilst having dinner, although bear in mind that a certain amount of ventilation will be required to keep this comfortable.

9. You need to be careful on night time trips to the bathroom, as this always seems to be the moment that you get bitten. The only absolute solution to this is to take a suitable receptacle to bed with you, but for most people this is going a little bit too far. The more cautious amongst you will no doubt find your own solutions, ranging from getting dressed first, to carrying a can of spray along with you.

10. Another option is to sleep in a sealed and air-conditioned room. If you don't mind sleeping in air-conditioning then this can be quite a reasonable solution, although in our experience hotels which offer such facilities tend to be rather lax about other precautions such as spraying and providing adequate nets. Some of the worst mosquito nights we have ever had have been in the most upmarket air-conditioned rooms. But so long as all other steps are also taken, this can provide an additional level of defence.

Further information ...

For further advice refer to the following websites ...

US :
UK :

Disclaimer : Please note that all of the information on this page and elsewhere in the health section of our website is provided for information only. We suggest that you always refer to a health professional when seeking medical advice.
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