Do I Need Anti-Malaria Tablets?

anti malaria tablets

Malaria is a tricky one. You can’t be vaccinated against it, but it can be cured. Yes, almost one million people die from it every year, but those who do, don’t have access to treatment. There are many ways to try and prevent malaria, but are these anti-malaria tablets really needed? Doctors will tell you, ‘Yes, yes, yes, you must’, but many travelers beg to differ.

So, if your trip is in a remote area of a country where medication is not available, it is best to have yours. Malaria is more common in these areas due to dense forest, exposed to waste products, and more importantly, poor drainage

If you’re a hypochondriac, then yes, buy some anti-malaria tablets. Spare your fellow travelers the agony.

Types of Malaria

Malaria is caused by Plasmodium parasites, transmitted from human to human through bites of a mosquito.

There are four types of these bad boys:

  • Plasmodium falciparum (most deadly)
  • Plasmodium vivax
  • Also, Plasmodium malaria
  • And Plasmodium ovale

The first two are the most common, unluckily. But not all mosquitoes can carry the parasite, only certain female mosquitoes can who bite mainly at night, especially at dusk and dawn.

Anti-Malaria Tablets For Prevention

Do everything you can to not get bitten, within reason. Go nuts with insect repellents, spray them on your skin, on your clothes, everywhere. But don’t inhale them. Wear long sleeves and long pants at night. Burn pyrethroid or insecticide coils and candles. Also, use a mosquito net when you sleep if there are potential ambush zones in your room/tent/hut. But you don’t have to go crazy by changing your travel plans.

Most doctors will advise you to take some sort of anti-malaria drug like the anti-malaria tablet if you plan to travel to Africa, Latin America, the Middle East, India or South East Asia. There are a few different types, none 100% proof, all with potential side-effects.

Drug Regimen Length
Chloroquine 2 tablets weekly Start 1 week before travel, finish 4 weeks after return
Proguanil 1 tablets daily Start 1 week before travel, finish 4 weeks after return
Mefloquine 1 tablet weekly Start 2.5 weeks before travel, finish 4 weeks after return
Doxycycline 1 tablet daily Start 2 days before travel, finish 4 weeks after return
Malarone 1 tablet daily Start 2 days before travel, finish 1 week after the return

Some Side Effects of Ati-Malaria Tablet Usage

Chloroquine was the most widely used anti-malarial, until recently when parasitic strains became drug-resistant. It is also the least expensive, best tested and safest of all the drugs. So, it can be used in conjunction with Proguanil in areas of drug resistance. But Mefloquine, Doxycycline, and Malarone are recommended if visiting an area known for drug resistance.

All of these drugs can give you higher sensitivity to the sun, nausea, diarrhea, or a dull headache. Nausea especially can occur when you don’t take the malaria tablet with or after food.

Slight hair loss and mouth ulcers have been occasionally reported with the use of Proguanil. Mefloquine has been found to cause vivid dreams and nightmares among some users. Doxycycline can cause abnormal tooth enamel, depression of bone growth and photosensitivity, so it’s not recommended for young children or pregnant women.

If you’re not used to taking medication or vitamins daily, then sticking to a new regimen might be hard. The drugs are not really effective against infection if you forget a few days, but they will help you get better as most antimalarials are also used for treatment.

I’ve read a number of travelers have been infected, even when they’ve been on a recommended regimen. So just because you’re on the drugs, doesn’t mean you can forget about all other preventative measures.

Malaria Symptoms

Symptoms of malaria and their severity range. The classic symptom of malaria is the occurrence of sudden coldness and shaking chills, followed by fever and sweating lasting four to six hours, recurring every 1-3 days. Other symptoms include continuous fever, flu-like illness, shivering, headache, muscle aches, tiredness, nausea, vomiting, diarrhea, anemia, and jaundice. Basically, anything that traveling can cause anyway.

Most people tend to show these signs between 10 days and 4 weeks after being infected, but some parasites can stay in the liver for months, even up to 4 years after being bitten. The most severe malaria usually arises 6 to 14 days after infection.

Malaria Around the World

Here is a list of countries where malaria is present:

Region Countries with Risk of Malaria

Sub Saharan Africa

Low Risk – Avoid mosquito bites

  • Cape Verde
  • Mauritius – Except a few rural areas where chloroquine is appropriate.
Variable Risk – Chloroquine plus Proguanil recommended

  • Botswana – Only in the northern half of the country – November to June
  • Mauritania – All year round in the south. November to June in the north
  • Zimbabwe – Areas below 1,200 meters – November to June. All year long in the Zambezi Valley where Doxycycline, Mefloquine or Malarone are preferable. A risk is negligible in Harare and Bulawayo
Very High Risk – Doxycycline or Mefloquine or Malarone recommended

  • Angola
  • Benin
  • Burkina Faso
  • Burundi
  • Cameroon
  • Central African Republic
  • Chad
  • Comoros
  • Congo
  • Djibouti
  • Equatorial Guinea
  • Eritrea
  • Gabon
  • Gambia
  • Ghana
  • Guinea
  • Guinea Bissau
  • Ivory Coast
  • Kenya
  • Liberia
  • Madagascar
  • Malawi
  • Mali
  • Mozambique
  • Niger
  • Nigeria
  • Principe
  • Rwanda
  • Sao Tome
  • Senegal
  • Sierra Leone
  • Somalia
  • Sudan
  • Swaziland
  • Tanzania
  • Togo
  • Uganda
  • Zaire
  • Zambia
  • Ethiopia – Areas below 2,200 meters. No risk in Addis Ababa
  • Namibia – The northern third of the country – November to June. All year long around the Kavango and Kunene rivers
  • South Africa – Northeast, low altitude areas of Mpumalanga and Northern Provinces, Northeast KwaZulu-Natal as far south as the Tugela river. Risk present in Kruger National Park
  • Zimbabwe – The Zambezi Valley

North Africa, the Middle East, and Greater Asia

Very Low Risk – Avoid mosquito bites

  • Algeria – Virtually no risk
  • Egypt – Main tourist areas are malaria free
  • Georgia – Some southeastern villages July to October
  • India – No risk in parts of mountain states of the north
  • Kyrgystan – Some southern and western areas
  • Libya
  • The Maldives – no risk
  • Morocco – A few rural areas only limited risk
  • Turkey – Most tourist areas
  • Uzbekistan – Sporadic cases in the extreme south-east only
Low Risk – Chloroquine recommended

  • Armenia – The whole country June to October
  • Azerbaijan – Southern border area June to October
  • Egypt – El Faiyum region only, June to October
  • Iraq – Basrah and rural north, May to November
  • Syria – Northern border, May to October
  • Turkey The plain around Adana, Side & south-east Anatolia, March to November
  • Turkmenistan – The south-east only, June to October
Variable Risk – Chloroquine plus Proguanil recommended

  • Afghanistan – Areas below 2,000 meters, May to November
  • Bangladesh – The whole country except the Chittagong Hill Tracts. No risk in Dhaka City
  • Bhutan – Southern districts only
  • India – All areas below 2,000 meters, including Goa
  • Iran
  • Nepal – Areas below 1,500 meters, especially Terai districts. No risk in Kathmandu
  • Oman – Remote rural areas only
  • Pakistan – Areas below 2,000 meters
  • Saudi Arabia – The whole country except northern, eastern and central provinces, Asir plateau, and western border cities where there is little risk. No risk in Mecca
  • Sri Lanka – No risk in Colombo
  • Tajikistan – Southern border areas, June to October
  • Yemen – No risk in Sana’a city
High Risk – Doxycycline or Mefloquine or Malarone recommended

  • Bangladesh – Chittagong Hill Tract Districts only
  • India – Assam region

South East Asia

Very Low Risk – Avoid mosquito bites

  • Bali – Part of Indonesia
  • Borneo – except deep forest areas
  • China – Main tourist areas
  • Hong Kong
  • Indonesia – Jakarta, main cities and tourist resorts including Java
  • Malaysia – Most areas including Kuala Lumpur and Penang
  • North Korea – A few southern areas have limited risk
  • The Philippines – Low risk in main cities, Cebu, Bohol & Catanduanes, no risk in Manilla
  • South Korea – Limited risk in the extreme northwest
  • Thailand – Bangkok and main tourist areas including Pattaya, Phuket, Krabi, Hua Hin, Koh Samui, Kanchanaburi, Damnoen Sadouak, Ayutthaya, Sukhothai, Khon Kaen & Chiang Mai
Variable Risk – Chloroquine plus Proguanil recommended

  • Indonesia – Areas other than Bali and low-risk cities, or Irian Jaya and Lombok where the risk is high and chloroquine resistance is present
  • Philippines – Rural areas below 600 meters
  • Malaysia and Borneo – Deep forest regions of Peninsular Malaysia and Borneo
Substantial Risk – Doxycycline or Mefloquine or Malarone recommended

  • Borneo – Sabah
  • Cambodia – Most of the country except Phnom Penh where there is no risk
  • China – Yunnan and Hainan provinces only. All other remote areas use chloroquine
  • East Timor
  • Irian Jaya & Lombok
  • Laos – except Vientiane where there is no risk
  • Myanmar – (formerly Burma)
  • Sabah – Part of Malaysia (Borneo)
  • Vietnam – Most rural areas, no risk in cities, Red River delta area and the coastal plain north of Nha Trang
Very High Risk – Doxycycline or Malarone recommended

  • Cambodia – Western provinces
  • Thailand – Near borders with Cambodia & Myanmar. Koh Chang
  • Myanmar – Eastern part of Shan state

Oceania

High Risk – Doxycycline or Mefloquine or Malarone recommended

  • Papua New Guinea – below 1,800 meters
  • Solomon Islands
  • Vanuatu

Latin America

Very Low Risk – Avoid mosquito bites

  • Brazil – Except the Amazon basin region, Mato Grosso & Maranhao
Variable to Low Risk – Chloroquine recommended

  • Argentina – Rural areas along northern borders only
  • Belize – Rural areas except for Belize district
  • Costa Rica – Rural areas below 500m
  • Dominican Republic
  • El Salvador – Only Santa Ana province in the West
  • Guatemala – Areas below 1,500 meters
  • Haiti – The whole country
  • Honduras – The whole country
  • Mexico – Some rural areas rarely stayed in by tourists
  • Nicaragua – The whole country
  • Panama – West of the canal
  • Paraguay – Some rural areas
Variable to High Risk – Chloroquine plus Maloprim recommended

  • Bolivia – Rural areas below 2,500 meters
  • Ecuador – Areas below 1,500 meters. No malaria in Galapagos Islands nor in Guayaquil
  • Panama – East of the canal
  • Peru – Rural areas below 1,500 meters
  • Venezuela – Rural areas other than the coast. Caracas is free of malaria
High Risk – Chloroquine recommended

  • Brazil – Amazon basin region, Mato Grosso & Maranhao only. Very low risk and no chemoprophylaxis required elsewhere
  • Colombia – Most areas below 800m
  • Ecuador – Esmeraldas Province
  • French Guiana – Especially border areas
  • Guyana – All interior regions
  • Suriname – Except Paramaribo and coast
  • Amazon basin areas of Bolivia, Venezuela, and Peru

Not that I’m trying to deter you from traveling to countries where there is a risk of malaria, (come on, I’m in India at the moment) I’m just making you aware. For more info, see the Travel Doctor website, a great resource.

It’s your decision whether to buy antimalarials. They can be quite expensive if you’re traveling for an extended period, but they’re also usually a lot cheaper in areas affected by malaria, so you can buy some to start you off before you travel, and then buy the rest of your supply when you get there.

Definitely get some pills if you’re trekking, camping or volunteering outside, in particular, near swamps and other water holes where mosquitoes can breed.

Traveling can be unpredictable. When planning your trip you may want to consider individual disability insurance which provides financial support in the event of a disabling illness or injury.