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Malaria

What is Malaria?

Malaria is an infectious disease which is caused by single-celled parasites of the genus Plasmodium. The (plasmodium) parasite is transmitted to humans by mosquitoes. Approximately 8-10 days after the bite the first symptoms may occur, such as fever, chills, muscle aches and headaches. Often these symptoms are preceded by a flu-like feeling.

Malaria is a dangerous disease and it is wise to protect yourself properly. The malaria mosquitoes are particularly active at sunset until sunrise. In this period it is advisable to wear clothing that covers your skin and applying mosquito repellent lotion. If possible, make use of a mosquito net (set-up the mosquito net even before the sun sets closed around your bed). If you are taking anti-malaria tablets, you can still be stung by a mosquito. However, when taking malaria tablets note that the symptoms are not as severe as if you are not taking malaria tablets.

On the map below you can see in which areas malaria mosquitoes are most active. Occasionally, however, a case of malaria in an area not as a risk area is seen (for example, when mosquitoes 'travelled' from a malaria area).

South Africa Specialist assumes no responsibility for information below. For the most up to date information, we refer you to your local Hospital. For information on vaccinations and malaria, we recommend contacting your GP. For more information about general health, click here.

Malaria Symptoms

Malaria may occur with severe attacks of chills and fever as well as flu-like symptoms with headache without apparent fever. It usually starts as a fever, chills, muscle aches and headaches. These complaints come as the infection is not treated when you are back home a few days. This may include vomiting, diarrhoea, cough and jaundice (yellow skin and whites of the eyes) may occur.

It is very important to know that the disease can spread very quickly and then several complications occur, sometimes within 24 hours! Fever or "flu" that lasts longer than two days must be regarded as malaria until proven otherwise. If you suspect a malaria attack, have your blood examined by a doctor or in a hospital for malaria parasites. Proper treatment can be given. Malaria is in principle curable!

Malaria areas South Africa

There is malaria in South Africa, and only in the eastern part of South Africa, including the Kruger Park, especially from September to May. See the map for the malaria areas in South Africa. It is recommended that Lariam, Malarone, or doxycycline is used in this area in the same period.

The west is an area where there is malaria, but malaria tablets are not recommended. Anti-mosquito measures are important in both parts of South Africa, in all seasons. Durban is located just outside the malaria area.

The map gives an overview of malaria in South Africa. You should always personally advise on measures against malaria, because the choice of the antimalarial agent depends on your personal circumstances, including your health, your stay in South Africa and other factors.

For current information from the SA Government click here.

Malaria prevention

Malaria can be prevented by taking the following measures:

1. To protect yourself against mosquito bites.
2. Impregnated mosquito net and use Deet (minimum 30%).
3. After sunset wear covering clothing (long pants, long sleeves, shoes and socks). Especially cover your feet and ankles because mosquitoes often fly just above the ground.
4. Through the use of anti-malarial agents (malaria prophylaxis)
5. Consult a doctor as soon as possible if you think you have symptoms of malaria.

Malaria tablets

What malaria medication is best for you is dependent on your destination and how long you travel. There are different ones for different types of malaria in different areas, and in some areas the mosquitoes are weather resistant to some antimalarial drugs.

For questions about malaria in combination with pregnancy, please contact:

The different malaria tablets

Paludrine (proguanil hydrochloride)

Paludrine is an agent currently used in areas where mosquitoes are not yet resistant against. The most common side effects, if they occur, are mild nausea, diarrhoea, abdominal pain, chest tightness, vomiting, headache and similar. Paludrine can be used during pregnancy and lactation.

Nivaquine: (chloroquine)

Nivaquine suppresses Malaria tertian and therefore does not prevent it, making it even after returning could still stab the head. The most common side effects are (although mild), issues such as hair loss, dizziness, rashes and also attributed to regular use of Nivaquine. You may not use it if you have psoriasis. You should basically take the weekly dose of chloroquine on the day of departure to the malaria area and the next day once a week and then about once a week, the weekly dose. Continue to 4 weeks after leaving the malaria-area. Tablets should be taken during or after meals. It can be used by pregnant women and children, although pregnant women are still advised not to travel to malaria areas. The effects of the treatment if you once have malaria as it could be a risk for both mother and unborn child.

Lariam (mefloquine)

Lariam to be attributed by travellers have strange side effects such as abnormal dreams, panic attacks and depression. However, most travellers have no problems or at least no more trouble than they are to other anti-malarial. Experts disagree on how large the risk of these side effects are and the results of studies vary from 1 in 10 000 to 1 in 140. Many travellers also become more accustomed to certain side effects after a while. It is certainly important that you yourself take your own decision on this (and / or in consultation with your doctor and travel doctor).

The most common side effects are mild nausea, diarrhoea, dizziness, sleep problems and lack of sense of balance (usually after a week or more it is about 70% of the symptoms is the first of three pills). People with epilepsy (severe) depression or other psychiatric disorders, with those beta blockers or have heart problems, this means in principle it cannot be used to prevent malaria (check with your doctor), for children under 15 kilos it is not recommended. You swallow it once a week. It is recommended for 3 weeks in advance to start at home, so you can see if you are sensitized or not. Thereafter you continue up to and including 4 weeks after leaving the malaria-area. Resistance to lariam happens every now and then.

When you go diving it is not recommended to use Lariam. This is because it can cause dizziness and problems with balance. For small children there are the Lariam capsules. Pregnancy and lactation: Lariam should not be used during the first three months of pregnancy. It is advised not to become pregnant for 3 months after using last intake of Lariam, feeding is also not recommended.

Malarone (combination of Atavaquon-proguanil)

This agent is for example in Denmark on the market since the late nineties, but still relatively new. Fairly pricey agent, especially since you have to take it every day: around 40 euros for 12 tablets. After a week or two, Lariam is cheaper and if you go away longer, obviously more of a difference. Studies have shown that Malarone is about 98% effective in malaria prevention, which equals to lariam or doxycycline.

Malarone has fewer side effects than other antimalarial drugs, headaches or stomach problems can occur. Malarone you should take each day at the same time with some food or milk. Start one day before departure and continue until 7 days after leaving malaria area. Pregnancy and breast-feeding: Malarone cannot be used during pregnancy, including lactation which is not recommended. Not recommended for those sensitive to atovaquone and proguanil.

22 pills Malanil (same as Malarone) are sold in South Africa for about 45 Rand per pill when you buy 22. Note that you need a prescription from the doctor (in SA) to buy the pills at the pharmacy.

Doxycycline:

This antibiotic is not yet registered in Europe as an antimalarial agent, but is widely prescribed for example in England and is easy to get locally. Doxycycline is used mainly in areas where resistance occurs against other malaria tablets (South East Asia). Doxycycline is very cheap (cheaper than lariam, let alone malarone).

In combination with the contraceptive pill Doxycycline can work well! In addition, some people suffer from hypersensitivity to the sun or upset GI. Start with taking it on the departure day and drink for up to 4 weeks after leaving the malarial area. Preferably test one week in advance to see if it does not bother you. Not suitable for children under 8 years. Doxycycline cannot be used during pregnancy and lactation. Not yet recommended to swallow without a doctor's supervision for more than three months.

Other resources

Fansidar: It is no longer prescribed to prevent malaria partly because of the severe side effects. It is  still used as a treatment to cure malaria. Maloprim: a reserve asset because of side effects. Halofantrine: because of side effects is not used much anymore. Quinine: is used as a treatment agent.

Promising new agents are fully examined and sometimes get local

Artemesia annua (sweet wormwood) natural product in many tropical countries to simply buy, it seems very few side effects, but it has not been tested enough to get through the western admission institutes (inter alia HINTS shelf life of the pills).
Qinghaosu also a natural product
Arteflene
artemether
artesunate

Malaria Test

There are several Malaria test kits on the market (among others Now Malaria and Mala Quick). However, the functioning of this is still relatively unknown.

Malaria area Botswana

When you visit the north or northeast of Botswana, you should consider malaria (among others in the Chobe National Park, Okavango Delta).

Malaria area Namibia

Also in parts of Namibia there is malaria, keep that in mind when you visit the north of the country. For example, if you are on safari in Etosha National Park and the Caprivi Strip (today Zambezi Region).