Stay safe from malaria
By Glynis Horning
February 2025
This potentially deadly illness is still a risk in parts of Southern Africa.
Malaria is one of the deadliest infectious diseases globally. According to the World Health Organization (WHO), malaria was responsible for an estimated 608,000 deaths in 2022, with the majority of these deaths occurring in Africa. In terms of global mortality rates, malaria ranks among the top infectious diseases, along with tuberculosis, HIV and influenza.
According to its most recent update (2024), in the last few years South Africa has had between 6 000 and 14 000 notified cases a year, often imported from outside South Africa, Mozambique accounts for the majority of imported cases
Within the country, malaria transmission has been limited to the north-eastern part, mainly in the low altitude (below 1 000m) areas of Limpopo, Mpumalanga and northern KwaZulu-Natal. the NICD notes. “All of South Africa’s neighbouring countries, with the exception of Lesotho, have malaria transmission.” The highest risk of contracting malaria occurs at the end of the rain season, typically around March, April, coinciding with the Easter holidays.
To help you keep safe, follow these simple tips:
Cover up
Preventing bites by the malaria-carrying Anopheles mosquito is “always indicated, irrespective of the use of tablets to avoid malaria”, says Dr Albie de Frey of Travel Doctor. Don’t go outdoors between dusk and dawn in risk areas, cover up (long pants and sleeves, socks and closed shoes), and apply a DEET containing insect repellent to all exposed areas.
Dose up
There is no vaccine available for travellers and no malaria prophylactic tablet is 100% effective in preventing malaria. However, it is still crucial to take one of those available – they offer around 90% protection, says De Frey, and malaria is a serious disease that kills rapidly.
The main choice is between doxycycline (which has many trade names), taken once a day after meals; a combination of atovaquone and proguanil (Malanil®/Mozitec®/Malateq®/Hetovanil®), also taken once a day and mefloquine (Lariam®) taken once a week. Of note, mefloquine is the drug of choice for pregnant women, but no longer freely available in South Africa. It is available from The Travel Doctor as a Section 21 medication. Mefloquine and doxycycline must be taken for four weeks after leaving the malaria area, atovaquone/proguanil can be stopped after seven days, says De Frey.
He adds that they all have some minor side effects – “much less serious than malaria” – and the final choice depends on personal preference “and the traveller’s chronic disease and medication profile”. Your medical professional or a travel doctor can prescribe the one best suited to you.
Special cases (pregnant women and children)
Mefloquine (Lariam®) is the only prophylactic that is safe to use in pregnancy, provided the person has no other contra-indications to the use of mefloquine. Although pregnant women should not travel to malaria areas, travel is sometimes unavoidable due to personal circumstances. Children should also not travel to malaria risk areas and children under the age of five years are at particular risk of complicated malaria. If travel is unavoidable they MUST take malaria prophylaxis. Children can take Mefloquine (Lariam®) or paediatric atovaquone/proguanil (Hetovanil ® 62.5/25mg) depending on their weight.
Step up
Know the signs of malaria, and that they can manifest even if you have taken all precautions. These include cold shivers, high fever, sweating, headache, nausea, vomiting and diarrhoea, muscle pain, weakness and finally jaundice, bleeding, convulsions and coma (‘cerebral malaria’). “Seek expert medical care within the first 24 hours of symptom onset!” says Dr De Frey.
Check up
Malaria is often misdiagnosed as flu (or COVID!) with fatal results, so if you have been to a malaria-risk area at any stage, tell your health practitioner and insist on being tested.
“If you are close to good medical care you should be tested by a laboratory,” says De Frey. “If you are going to travel remotely, you may want to take a malaria rapid test kit along, but then you and your travel companions must get trained on when and how to use it – and phone for knowledgeable medical assistance when you do use the kit.” Kits are available from The Travel Doctor and Clicks pharmacy can order kits on request, says Clicks pharmacist Waheed Abdurahman.
A single negative malaria test never excludes malaria, De Frey says – “repeat the test within hours if the person is no better or gets worse”.
Hurry up
If you are diagnosed with malaria, it needs to be treated as a medical emergency. Early treatment is key – the anti-malarial drug artemether-lumefantrine (Coartem®) is highly effective for uncomplicated malaria, provided treatment is started within three days of symptom onset.
Complicated cases – including pregnant women and children – should be treated with intravenous artesunate “The Travel Doctor advises that pregnant women and children under 5 should best avoid high risk malaria areas altogether,” says De Frey. Follow your doctor’s advice.
Speak to a Travel Doctor Clinic
