The best prevention is personal protection against the mosquito. Malaria mosquitoes generally bite after dark, wear long sleeves and trousers in the afternoon and evening; stay in-doors if possible. Use insect repellent on exposed skin.

1. Avoid being bitten by mosquitoes

The best prevention is personal protection against the mosquito. Malaria mosquitoes generally bite after dark. Wear long sleeves and trousers in the afternoon and evening; stay in-doors if possible. Use insect repellent on exposed skin. Sleep under a bednet or in a netted tent or hut or in a house or caravan with screens. Close windows and doors at night. Spray insecticide aerosol and/or burn mosquito coil at night.

2. Take prophylaxis in malaria risk areas

Get good advice before you plan your holiday. The appropriate prophylaxis for a given malaria area depends on several factors including:

• The parasite's resistance to drugs in this area.
• The safety of the drug.
• The efficacy of the drug.
• The degree of malaria risk in the area.(See map of risk areas in south Africa)
• The risk of resistance to (or reducing the efficacy of) the drug, in the future, due to inappropriate use.

Take the pills same day each week when weekly, or at the same time of the day if daily.  Continue prophylaxis for 4 weeks after your return. Complete the course.

(a) Mefloquine

Mefloquine (Lariam®) has been taken by people up to 12 months without side effects, is highly effective and has a simple weekly dosage. However, it has a number of contra-indications and requires a doctor's prescription. It also has been known to have rare but severe neurological side effects.
Start a week or two before, to check for possible side-effects and continue for 4 weeks after leaving the area. Mefloquine should be taken on a full stomach.

(b) Doxycycline

This is a highly effective antimalarial. It should be started 1-2 days before entering the malaria area and taken daily while there and daily for four weeks after leaving the malaria area. Take after a meal with plenty of fluid and avoid excessive sun exposure. A doctor's prescription is required.

(c) Atovaquone / Proguanil combination (Malanil®)

This combination is highly effective and is generally well tolerated. It should be started 1-2 days before entering the malaria area and taken daily while there and daily for seven days after leaving the malaria area. Paediatric tablets are also available for children weighing 11 kgs or more. A doctor's prescription is required.

3. Carry your own malaria test

Test yourself immediately on first malaria symptoms.  There are several good rapid tests available now . Don't leave home without one.

4. Carry your own alternative medication

When travelling in Africa, make sure you have everything with you.

When you get malaria head for the nearest doctor. Show your test and ask to be treated.

If you have contracted malaria in spite of prophylaxis you will need Lumafantrine-artemether or quinine. Sulfadoxine-Pyrimethamine (Fansidar«) may suffice. But be aware that Sulfadoxine-Pyrimethamine resistance exists. Refuse chloroquine treatment.

5. Carry a do-it-yourself treatment

For the worst-case scenario, take along some Lumafantrine-artemether. If you get stuck and cannot get to a doctor, treat yourself.  This is for emergency situations only.Always seek medical help if at all possible.

6. Cancel / postpone your holiday if necessary

If you are pregnant or have small children, avoid a holiday in a high-risk malaria area / season.

Updated: 19 November 2020