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Do I Need Anti-Malaria Tablets?

by Globetrooper Lauren | 17 Responses
Do I Need 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 preventive pills really needed? Doctors will tell you, ‘Yes, yes, yes, you must’, but many travellers beg to differ.

If you’re a hypochondriac, then yes, buy some anti-malaria meds. Spare your fellow travellers 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
  • Plasmodium malariae
  • 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.

Malaria 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. 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 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 return

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. 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 anti-malarials are also used for treatment.

I’ve read a number of travellers 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, diarrhoea, anaemia and jaundice. Basically anything that travelling 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 metres – November to June. All year long in the Zambezi Valley where Doxycycline, Mefloquine or Malarone are preferable. 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 metres. 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 – North east, 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, Middle East and Greater Asia Very Low Risk – Avoid mosquito bites

  • Algeria – Virtually no risk
  • Egypt – Main tourist areas are malaria free
  • Georgia – Some south eastern villages July to October
  • India – No risk in parts of mountain states of the north
  • Kyrgystan – Some southern and western areas
  • Libya
  • Maldives – no risk
  • Morocco – A few rural areas only limited risk
  • Turkey – Most tourist areas
  • Uzbekistan – Sporadic cases in 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 metres, May to November
  • Bangladesh – The whole country except Chittagong Hill Tracts. No risk in Dhaka City
  • Bhutan – Southern districts only
  • India – All areas below 2,000 metres, including Goa
  • Iran
  • Nepal – Areas below 1,500 metres, especially Terai districts. No risk in Kathmandu
  • Oman – Remote rural areas only
  • Pakistan – Areas below 2,000 metres
  • Saudi Arabia – The whole country except northern, eastern and central provinces, Asir plateau, and western border cities where there is very 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 cites and tourist resorts including Java
  • Malaysia – Most areas including Kuala Lumpur and Penang
  • North Korea – A few southern areas have limited risk
  • 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 metres
  • Malaysia and Borneo – Deep forest regions of penninsular Malaysia and Borneo
Subtantial 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 provences 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 provences
  • 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 metres
  • 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 Belize district
  • Costa Rica – Rural areas below 500m
  • Dominican Republic
  • El Salvador – Only Santa Ana province in the West
  • Guatamala – Areas below 1,500 metres
  • 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 metres
  • Ecuador – Areas below 1,500 metres. No malaria in Galapagos Islands nor in Guayaquil
  • Panama – East of the canal
  • Peru – Rural areas below 1,500 metres
  • 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 chemoprophylazis 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 travelling to countries where there is 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 anti-malarials. They can be quite expensive if you’re travelling 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.

17 Responses to Do I Need Anti-Malaria Tablets?

  1. Enjoyed the blog post!

  2. I have been to the dominican republic a couple of weeks ago, but i didnt get bitten while i was away so do i really need to finish the course of malaria tablets?

    • Hey Vikky,

      Apparently you should, but if they’re making you feel ill at all, personally I wouldn’t. We’re not doctors though :)

  3. Chloroquine is easily drug resistant, Mefloquine, Doxycycline and Malarone are harmful for vision and hearing nurves. Now only compound drug from artemisinin is best drug for malaria, for example, compound dihydroartemisinin (artecom).

  4. is better to use a natural things like Artemisia Annua than tablets which are very expensive and there is a high risk you may damage your liver after long period taking them…

  5. You actually make it seem really easy with your presentation however I find this topic to be actually something that I think I might by no means understand. It sort of feels too complicated and extremely huge for me. I’m looking forward in your subsequent publish, I’ll attempt to get the grasp of it!

  6. I am not certain the place you’re getting your information, however great topic. I must spend a while finding out more or understanding more. Thank you for excellent info I was looking for this info for my mission.

  7. Will be travelling around the globe but almost all in malarial countries so Mexico, Cambodia, India, East Africa: so we are up against chloroquine resistant and non resistant mosquitos…so does anyone know of one anti malarial we could take or do we interleave two varieties and take two types at once? Have been scanning web sites but still confused: is there a wonder remedy for all the world?!

  8. Going to Haiti in the middle of Aug. with a group from Church. Is it easy to get it there? How much would a person be able to get in a bottle and do I need to go to a doctor to get in?

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  10. As a slight adjustment to your suggestion, don’t just sleep under any old net if you want to minimize your chances of contracting malaria; instead ensure that it is an insecticide-laced net.

    Studies have shown that using a net like this can reduce your chances of catching malaria by 20% straight off the bat. Check your own net therefore to ensure it does have insecticide added and how often you need to top this up.

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