SANParks.org Forums

Malaria and your safari of a lifetime

(The name malaria comes from the Italian mala aria, meaning bad air.)

While the risk of malaria is low in both Kruger National Park and Mapungubwe National Park, the risk is there, so if you go to either park you should know what to do.
Seasons with more rainfall and higher temperatures will have more malaria transmission than colder, drier seasons. However even during cooler months or periods of less rainfall you can be at risk!
The threat of malaria should not affect your decision to enjoy and experience the Kruger Park, but is just something one should be aware of and take precautions to be exposed to.
A 24-hour malaria hotline is available on +27 (0)82 234 1800 to give detailed explanation on risk and advice on precautionary measures.

What is malaria?

Malaria is always a serious disease and may be a deadly illness! In fact over a million people worldwide die from malaria each year.
Malaria is caused by a parasitic germ (the Plasmodium family) that lives in Anopheles mosquitoes, and passed to people through bites. While all species of malaria parasites can make a person feel very ill, Plasmodium falciparum causes severe, potentially fatal malaria.
Most types of mosquito do not carry the malaria plasmodium and if one is bitten it does not mean one will contract malaria. Only mosquitoes of the anopheles genus carry the plasmodium, and then only if they have previously fed on an infected host. As the presence of people with the plasmodium in their bloodstream in the park is greatly reduced compared to past times, risk is once more reduced. One reason for these reductions is that the accommodation units in the parks are sprayed periodically throughout the year. Now that international campaigns see treatment taking place in adjacent countries such as Mozambique and Swaziland, malaria occurrence has been further reduced.

What you should always do
This is just a little guide, most people can just take simple precautions, but not every body is the same, so visit your doctor and ask his/her advice! Especially pregnant woman should do so, your baby is at risk!
Also keep in mind that children under 5 kilos can not take antimalarials, so the only protection they have is mosquito repellant soaps and spray... And if they are somewhat heavier the side effects listed at the end of this post are not really pleasant...

What can you do against malaria?
Persons who travel to areas where P. falciparum malaria is present should be extra careful to take their antimalarial drug and to prevent mosquito bites.
Malaria is transmitted by the bite of an infected mosquito, these mosquitoes usually bite between dusk and dawn, in the night. To avoid being bitten, remain indoors in a screened or air-conditioned area during the peak biting period. If out-of-doors, wear long-sleeved shirts, long pants, and hats. Apply insect repellent (bug spray) to exposed skin.
For the prevention of malaria an insect repellent with DEET (N, N-diethyl-m-toluamide) is the repellent of choice. Many DEET products give long-lasting protection against the mosquitoes that transmit malaria (the anopheline mosquitoes).
A new repellent is now available that contains 7% picaridin (KBR 3023). Picaridin may be used if a DEET-containing repellent is not acceptable to the user. However, there is much less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria. Also, since the percent of picaridin is low, this repellent may only protect against bites for 1-4 hours.
Taking precautions is effective, but not 100%!

Know the Symptoms
Despite these protective measures, you may become infected with malaria. Malaria symptoms can include:
- fever
- chills
- headache
- flu-like symptoms
- muscle aches
- fatigue
- low blood cell counts (anemia)
- yellowing of the skin and whites of the eye (jaundice)
If not promptly treated, infection with Plasmodium falciparum, the most harmful malaria parasite, may cause coma, kidney failure, and death.

You may have heard that taking antimalarial drugs masks the actual malaria. This is not strictly true, but it is harder to diagnose as for instance the parasite count is lower. So if you have malaria-like symptoms have you medic look twice. The malaria itself will not be as severe, and recovery is quicker.

Malaria is always a serious disease and may be a deadly illness. Travelers who become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after returning home (for up to 1 year) should seek immediate medical attention and should tell the physician their travel history.

Taking antimalarials
Take your antimalarial drug exactly on schedule. Missing or delaying doses may increase your risk of getting malaria.
For the best protection against malaria, it is important to continue taking your drug as recommended after leaving the malaria-risk area (4 weeks for mefloquine, doxycycline, or chloroquine, 7 days for atovaquone/proguanil or primaquine). Otherwise, you can develop malaria.
Halofantrine (also called Halfan) is/was widely used to treat malaria. It's recommended that you do not take Halfan because of serious heart-related side effects, including deaths.

A side effect from many antimalarials is that it can cancel the pill, something to keep in mind too, or you might have a very dear memento of your visit to the park!

Travelers to areas with malaria risk should take one of the following antimalarial drugs (listed alphabetically):

- atovaquone/proguanil
- doxycycline
- mefloquine
- primaquine (in special circumstances).

If you do still have questions you can probably find the answers in this topic, and if not, just ask there. Remember though that in order to get malaria you have to be bitten by a specific mosquito, and that mosquito has to have bitten someone with malaria. So happily go on your safari, but do it safely.
Deet, Peacefull sleep and such can be bought at most campshops.



This medical info from the American CDC, or Centers for Disease Control and Prevention may be interesting:

Atovaquone/proguanil (brand name: Malarone)
Atovaquone/proguanil is a combination of two drugs, atovaquone plus proguanil, in one tablet. It is available as the brand name, Malarone.
The adult dosage is 1 adult tablet (250 atovaquone/100 mg proguanil) once a day.
Take the first dose of atovaquone/proguanil 1 to 2 days before travel to the malaria-risk area.
Take your dose once a day during travel in the malaria-risk area.
Take your dose once a day for 7 days after leaving the malaria-risk area.
Take your dose at the same time each day and take the pill with food or milk.

Side Effects and Warnings
The most common side effects reported by travelers taking atovaquone/proguanil are stomach pain, nausea, vomiting, and headache. Most people taking this drug do not have side effects serious enough to stop taking it, if you cannot tolerate atovaquone/proguanil, see your health care provider for a different antimalarial drug.

Doxycycline (many brand names and generic drugs are available)
Doxycycline is related to the antibiotic tetracycline.
The adult dosage is 100mg once a day.
Take the first dose 1 or 2 days before arrival in the malaria-risk area.
Take your dose once a day, at the same time each day, while in the risk area.
Take your dose once a day for 4 weeks after leaving the risk area.

Side Effects and Warnings
One of the most common side effects reported by travelers taking doxycycline include sun sensitivity (sunburning faster than normal). To prevent sunburn, avoid midday sun, wear a high SPF sunblock, long-sleeved shirts, long pants, and a hat.
Doxycycline may cause nausea and stomach pain. Take the drug on a full stomach with a full glass of liquid. Do not lie down for 1 hour after taking the drug to prevent reflux of the drug (backing up into the esophagus).
Women may develop a vaginal yeast infection on doxycycline. Treat vaginal discharge or itching with either an over-the-counter yeast medication or ask your health care provider for a prescription pill or cream.
Most people taking this drug do not have side effects serious enough to stop taking it; if you cannot tolerate doxycycline, see your health care provider. Other antimalarial drugs are available.

Mefloquine (brand name Lariam and generic)
The adult dosage is 250 mg (one tablet) once a week.
Take the first dose 1 week before arrival in the malaria-risk area.
Take your dose once a week, on the same day of the week, while in the risk area.
Take your dose once a week for 4 weeks after leaving the risk area.
Take the drug on a full stomach with a full glass of liquid.

Side Effects and Warnings
The most common side effects reported by travelers taking mefloquine include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances. Mefloquine has rarely been reported to cause serious side effects, such as seizures, depression, and psychosis. These serious side effects are more frequent with the higher doses used to treat malaria; fewer occurred at the weekly doses used to prevent malaria.
Mefloquine is eliminated slowly by the body and thus may stay in the body for a while even after the drug is discontinued. Therefore, side effects caused by mefloquine may persist weeks to months after the drug has been stopped.
Most travelers taking mefloquine do not have side effects serious enough to stop taking the drug.

The following travelers should not take mefloquine and should ask their health care provider for a different antimalarial drug:
persons with active depression or a recent history of depression
persons with a history of psychosis, generalized anxiety disorder, schizophrenia, or other major psychiatric disorder
persons with a history of seizures (does not include the type of seizure caused by high fever in childhood)
persons allergic to mefloquine
Mefloquine is not recommended for persons with cardiac conduction abnormalities (for example, an irregular heartbeat).

Primaquine
In special situations when other antimalarial drugs cannot be taken and in consultation with malaria experts, primaquine may be used to prevent malaria while the traveler is in the malaria-risk area (primary prophylaxis).

Note: Travelers must be tested for G6PD deficiency (glucose-6-phosphate dehydrogenase) and have a documented G6PD level in the normal range before primaquine use. Primaquine can cause an hemolysis (bursting of the red blood cells) in G6PD deficient persons, which can be fatal.
The adult dosage is 2 tablets (30 mg base primaquine) once a day.
Take the first dose 1-2 days before travel to the malaria-risk area.
Take the dose once a day, at the same time each day, while in the risk area.
Take the primaquine once a day for 7 days after leaving the risk area.

Side Effects and Warnings
The most common side effects reported by travelers taking primaquine include stomach cramps, nausea, and vomiting. The following travelers should not take primaquine and should ask their health care provider for a different drug:
- persons with G6PD deficiency
- persons who have not had a blood test for G6PD deficiency
- pregnant women (the fetus may be G6PD deficient, even if the mother's blood test is in the normal range) women breast-feeding infants unless the infant has a documented normal G6PD level
- persons allergic to primaquine
Do not share primaquine with others; they may be G6PD deficient and suffer bursting of their red blood cells, which can be fatal.

Chloroquine phosphate (brand name Aralen and generics)
The adult dose is 500 mg chloroquine phosphate once a week.
Take the first dose of chloroquine 1 week before arrival in the malaria-risk area.
Take your dose once a week, on the same day of the week, while in the risk area.
Take your dose once a week for 4 weeks after leaving the risk area.
Chloroquine should be taken on a full stomach to lessen the risk of nausea and stomach upset.

Side Effects and Warnings
The most common side effects reported by travelers taking chloroquine include nausea and vomiting, headache, dizziness, blurred vision, and itching. Chloroquine may worsen the symptoms of psoriasis. Most travelers taking chloroquine do not have side effects serious enough to stop taking the drug. Other antimalarial drugs are available; see your health care provider.
Note: In malaria-risk areas where chloroquine is the recommended drug but chloroquine cannot be taken, atovaquone/proguanil, doxycycline, mefloquine, or primaquine can be used as your antimalarial drug.

Hydroxychloroquine sulfate (brand name: Plaquenil)
Hydroxychloroquine sulfate is an alternative to chloroquine phosphate, although less evidence exists on its effectiveness as an antimalarial drug.
The adult dosage is 400 mg once a week.
Take the first dose 1 week before arrival in the malaria-risk area.
Take your dose once a week, on the same day of the week, while in the risk area.
Take the dose once a week for 4 weeks after leaving the risk area.
Take hydroxychloroquine sulfate on a full stomach to lessen nausea and stomach upset.

Side Effects and Warnings
Nausea and vomiting, headache, dizziness, blurred vision, difficulty sleeping, and itching have been reported with hydroxychloroquine sulfate use. Minor side effects usually do not require stopping the drug. Hydroxychloroquine sulfate may worsen the symptoms of psoriasis. Other antimalarial drugs are available; see your health care provider.

Note: In malaria-risk areas where hydroxychloroquine sulfate is the recommended drug but hydroxychloroquine sulfate cannot be taken, atovaquone/proguanil, doxycycline, mefloquine, or primaquine can be used as your antimalarial drug.

Thanks for this excellent link! Its very helpful malaria info.

Can I add to the symptoms? Joint aches. Especially in the wrists. Not just muscle aches.

As for the headache. It is one straight from hell!!

Oh no, that sounds ominous!

It is a headache that makes your head feel it is rattling with any movement, and your bones ache deeply.......horrid illness!

The headache sounds like tickbite fever headache!

Yes kite -- and it also starts or gets worse late afternoon / evening.

If in doubt -- get a blood test

Hey DQ Not sure if you would like to add a quick addendum to the thread but I feel it is relevent The Atovaquone and Proguanil tablets are not marketed in SA as Malarone but rather as Malanil. There is also a Malanil Paediatric version available working up to 40 kgs and is an excellent choice for kids. Obviously doctors do need to be consulted before deciding but despite its relatively high price it has become the drug of choice for many people especially families looking for a largely side effect free drug that only has to be taken for one week after leaving a malaria infected area. Kids under 6 are by far the most vulnerable and whenever we are heading into high risk spots, we always use malanil in conjunction with sprays, sensible clothing and where possible mozzie nets too.The World Health Organization has a wealth of collated information on malaria on their website for people looking for comprehensive breakdown of the disease http://www.who.int/malaria/en/

Agree and pregnant women too. And I still dumbfounded by how many take the risk.

I have, from time to time, been making fairly comprehensive contributions to malaria and its prevention on other threads on the SANParks forum, so I am not going to give extensive details on everything discussed above today, but would indeed like to add comments where appropriate:



Firstly, this statement covers the malaria risk areas amongst the SANParks reserves, but these are not the only malaria risk areas in Southern Africa (I am concentrating on this part of the world because this is the areas that we are dealing most with here on the forums): for example, several areas of Kwazulu-Natal have malarial risk (although mostly low- and medium-risk); parts of Swaziland and some northern parts of Botswana are also seasonal-risk areas, as is Kruger and Mapungubwe; and some countries, like Mozambique, are high-risk areas all year round; while some areas bordering and near Kruger Park and Mapungubwe also contain malaria-infection potential, although generally of a low-risk nature all year round. NOTE: For detailed areas of malaria risk in Southern Africa (and of course anywhere in the world), please consult a competent and up-to-date malaria-risk map!

Secondly, defining a low-risk malarial area depends on the number of reported cases of malaria found in that area. The high-risk season for malaria in both Kruger and Mapungubwe (end of September until end of May) is considered relatively low-risk as compared to all-year-round high-risk areas like Mozambique, most of Tropical Africa, Malawi, and so on. As stated, the risk is lower than many other countries with malaria risk, but it is not wise to ignore that risk.

Thirdly, risk of contracting malaria may rise in some susceptible people, depending on, for example, age, health, how often you get bitten, and when you get bitten.




Because the unborn foetus and young children are particularly at risk of morbidity and mortality from contracted malaria, the first recommendation for pregnant women and young children is NOT to enter a malaria-risk area unless it is absolutely necessary. If the latter, then every suitable non-drug, plus chemoprophylactic (antimalaria medication), measure must be used to prevent contracting malaria; and only after thorough and competent professional advice has been received.




It is the female anopheles mosquito that may transmit malaria, and she mostly bites between dusk and dawn, with peak biting periods usually closer to midnight, and again in the early hours of the morning prior to dawn. These mosquitoes usually enter human dwellings from around 5 p.m. - 10 p.m., and again in the early hours of the morning, and biting begins anywhere from dusk until dawn. Try to avoid going outside at these times and stay inside a suitably protected dwelling (e.g. intact mosquito nets on the doors and windows, anti-mosquito mats, use of citronella products, and so on).




Antimalarial drugs - taken correctly - do significantly reduce the risk of contracting malaria, although they do not prevent the disease a hundred-percent of the time! Hence the necessity of using non-drug measures despite being on chemoprophylaxis. If you are one of the unlucky ones to still contract malaria despite taking antimalarial drugs and suitable non-drug measures, the initial diagnosis of the disease may be more difficult to determine. However, as time goes on, the disease may still progress, until it may indeed become as severe and as dangerous as someone who has not taken any precautions. The advantage in taking antimalarial drugs is that recovery is often quicker when malaria is diagnosed, as the parasite count may be lower than in someone who didn't take these precautions. ALWAYS take all drugs correctly, diligently, and finish the courses as required.




Most people who contract Falciparum malaria (generally the most deadly form of the disease) notice malaria symptoms within a few days to a couple of months after entering a malarial area. Chemoprophylaxis, as discussed above, may delay presentation of these symptoms. However, it is indeed safest to adequately test for malaria up to six months, and even one year, after entering a malarial area and presenting with flu-like and other malaria symptoms. People who are in a malaria-risk area (and especially an all-year-round high-risk area) for extended periods of time (weeks, months, or years) should consult a competent medical professional as to what is the best antimalarial measures to use under these circumstances.




Please note that there are only a few places in the world where chloroquine as a preventative antimalarial drug is still recommended, as many places have developed significant chloroquine-resistance; in other words, taking chloroquine will, in all likelihood, have a reduced potential for preventing malaria infection in these places. Because of this, the World Health Organisation and the South African Department of Health do not anymore recommend that chloroquine be used first-line to prevent malaria in malaria-risk areas in Southern Africa, and indeed Africa, and also many other parts of the world. (Again, consult an up-to-date malaria risk-areas map, as well as appropriate preventative information for each area.) Please, therefore, be very wary of using chloroquine as an antimalarial preventative in chloroquine-resistant areas. It has been argued that chloroquine will still provide some protection against acquiring malaria in chloroquine-resistant malarial areas, but there are several other antimalarials that will give significantly better results in this regard, and so are recommended first-line by competent sources. The article above suggests mefloquine, doxycycline, and a proguanil/atovaquone combination, and these are indeed first-line recommended antimalarials in chloroquine-resistant areas like Southern Africa. Always make sure you consult a competent, knowledgeable medical professional for obtaining the antimalarial most suited to your needs because (potential) side-effects, contra-indications, concomitant medical treatment, and other appropriate factors, may mean that you are better off with one of these rather than the others.



Disclaimer: My recommendations here - though based on some experience and some drug, and other, knowledge - are not absolute, and further consultation with suitable health-care professionals is suggested before a final decision is taken on whether to enter a malarial area, what prophylaxis to use, and any general factors and limitations that need to be taken into account. Furthermore, I only advise based on what information is given by the person(s) entering the malarial area, but I have no control on the information given to me, and so such information could possibly be incomplete or misleading. Moreover, people vary subjectively as to how they metabolise, and react to, drugs and other substances, which further accentuates that my suggestions here are only general suggestions, and therefore not to be taken as pertaining to every person alike.

So many types of anti-malarials - how do I know which one is best? I'm leaning towards Atovaquone/proguanil/Malanil because you have to take them for untill only 7 days after your visit. All the others have to be taken for 4 weeks after the visit. What's the difference?

It has less side effects than the others and is probably the most effective at the moment. But even taken into account taking it for only a week afterwards it still costs about three/four times as much.

On the last trip my Doxycycline tablets cost me £6.50, my SO's Malarone (Malanil) cost £72.50, even though I had 21 more tablets that he did.

I'm one of a tiny minority who can't take Malarone due to debilitating stomach upsets. He can't take Doxy because it increases the sensitivity to sun and he'd just burn.

Which goes to show there are other are other factors to consider. You need to talk to your General Practitioner to discuss the pros and cons of each one.

Contra-Indications for all the medications need to be taken into account also.

People with SLE have the chance of a severe reaction and have a flair-up of the symptoms, people with Ulcers/Gastro proplems, Kidney and Liver Function Impairment, People on Anti-coagulants are limited to what they are allowed, people with Psychological problems are limited due to the side effects (such as but not limited to temper tantrims etc), people are limited to certain meds because they have DVT, have history of strokes and cardiomyopathy, respiratory problems. The list is not complete and subject to more reports from doctors to manufacturers as to what is been of concern, so a full medical history should be given to your doctor when discussing which medication you can have. I am limited to Doxycycline only.

These matters will need to be discussed with your doctor. MIMS Book have a very large variaty info on Contra-Indication.

Even if you have a malaria test after you leave the malaria area, it could give you a false negative (would be best to wait a few days and re-test) or a false positive (both of which you can buy a malaria test kit at a local pharmacy), the self test can be tried twice to see if the readings are correct or conflict, thus you would need to have a full blood work assessment request. This a doctor would need to refer you for. In South Africa, most of your Malaria patients that are evacuated from a High Risk Malaria area that have a possible Cerebral Malaria or F. Malaria as otherwise known (prognosis is low if treatment is not initiated in time, however it also depends on your immune system and how long you have in a malaria area. People that have been exposed for a few months to a few years may show negative tests, however they can show after a long period of time, they could present with symptoms) are treated in Johannesburg, or in the area where there are doctors that are well versed in Malaria treatment (not saying that the local doctors in Nelspruit are not well versed), however your 3 Air Ambulance companies are based in Johannesburg, thus Johannesburg is where they go to.

Doxycycline will cost you around R70.00 (approx. US$10.00) in SA. Dont know about protocols abroad, however in SA under new CDC, a Prescription is needed for any anti-malaria medication as they have been changed to Schedule 3 and Schedule 4 medication. I am not sure of others though.

Another possible indication of malaria is dark urine, however that all depends on what fluids and food you have consumed that could throw that could also cause the dark urine.

Any Forum guys and gals going now on, dont forget your yellow ribbon to show us you there, and please take care and take your medication.

the information in regards to the medical evacuation process and types of malaria information is based on actual situations that have occured over my 8yrs of working in the field. However no legal liability can be imposed on myself as just my input and should be seen as a caution and info only.

The Contra-Indications are not limited to just those and are numerous, thus a doctor needs a full medical history in regards to all the medication one are on