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Malaria in South Africa

About Malaria

Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. Each year 350-500 million cases of malaria occur worldwide, and over one million people die, most of them young children in sub-Saharan Africa.

This sometimes fatal disease can be prevented and cured. Bednets, insecticides, and antimalarial drugs are effective tools to fight malaria in areas where it is transmitted. Travelers to a malaria-risk area should avoid mosquito bites and take a preventive antimalarial drug.

Usually, people get malaria by being bitten by an infected female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person.

When a mosquito bites, a small amount of blood is taken in which contains the microscopic malaria parasites. The parasite grows and matures in the mosquito’s gut for a week or more, then travels to the mosquito’s salivary glands. When the mosquito next takes a blood meal, these parasites mix with the saliva and are injected into the bite.

Once in the blood, the parasites travel to the liver and enter liver cells to grow and multiply. During this "incubation period", the infected person has no symptoms. After as few as 8 days or as long as several months, the parasites leave the liver cells and enter red blood cells. Once in the cells, they continue to grow and multiply. After they mature, the infected red blood cells rupture, freeing the parasites to attack and enter other red blood cells. Toxins released when the red cells burst are what cause the typical fever, chills, and flu-like malaria symptoms.

If a mosquito bites this infected person and ingests certain types of malaria parasites ("gametocytes"), the cycle of transmission continues.

Malaria in South Africa

Malaria is endemic in the Lowveld of Mpumalanga and in Limpopo and in KwaZulu Natal, malaria is endemic on the Maputaland coast. So if you are travelling to the far north of South Africa, please consult a heath-care professional for the latest advice on malaria prophylaxis as it changes regularly. In intermediate risk areas (Kosi Bay, Sodwana Bay, Mkuze Game Reserve and St Lucia Lake (not the town of St Lucia and the river mouth), the use of anti-malarial drugs is advisable only for high risk people from October to May.

Anti Malaria Dugs

Drugs and dosage for chemoprophylaxis



Pros and Cons

Adverse Effects



Atovaquone (250 mg) plus Proguanil (100 mg) (Malarone®) 1 tab. daily


11-20kg: ¼ tab. daily
21-30kg: ½ tab. daily
31-40kg: ¾ tab. daily
>40kg: 1 tablet daily
Daily dosing; only have to continue for 7 days after exposure; not in pregnancy and lactation Nausea, vomiting, abdominal pain, diarrhea, increased liver enzyme levels; rarely seizures, rash, mouth
(Tablet with 150mg base)
300 mg base once weekly 5mg/kg base weekly;
maximum 300 mg
Long-term safety known; chloroquine resistance reported from most parts of the world; not for persons with epilepsy, psoriasis Pruritis, nausea, headache, skin eruptions, nail and mucous membrane discoloration, partial hair loss, photophobia, nerve deafness,
myopathy, blood dyscrasias, psychosis and seizures

200 mg daily

< 2 yrs: 50 mg/day;
2-6 yrs:
100 mg/d
7-9 yrs:
150 mg/day;
>9 yrs: 200 mg/d

Used in combination

Doxycycline (100mg) 100mg once daily 1.5mg base/kg once daily
(max. 100 mg)
<25kg or <8 yr: Not given
25-35kg or 8-10 yr: 50mg
36-50kg or 11-13 yr: 75mg
>50kg or >14 yr: 100mg
Daily dosing required; not in pregnancy and lactation Abdominal discomfort, vaginal candidiasis, photosensitivity, worsening of renal function tests in renal diseases, allergic reactions, blood dyscrasias, esophageal ulceration
Mefloquine (Tablet with 250mg base, 274mg salt) 250 mg base once weekly <15 kgs: 5mg of salt/kg;
15-19 kg: ¼ tab/wk;
20-30 kg: ½ tab/wk;
31-45 kg: ¾ tab/wk;
>45 kg: 1 tab/wk
Weekly dosing; occasional reports of
severe intolerance; not in first trimester of pregnancy, breast feeding, high altitudes or deep sea diving,  patients with epilepsy, psychosis, heart blocks, receiving ß blockers
Dizziness, headache, sleep disorders, nightmares, nausea, vomiting, diarrhea, seizures, abnormal coordination, confusion, hallucinations, forgetfulness, emotional problems including anxiety, aggression, agitation, depression, mood changes, panic attacks, psychotic or paranoid
reactions, restlessness, ?suicidal ideation and suicide



And while they describe the side effects, warnings and contra-indications of the malaria prophalaxis, they don’t mention that these drugs will, in a lot of cases, make you feel horrible. A better approach is don’t get bitten. That’s not so difficult. There are plenty of people who live in malaria areas, and since you can’t take these drugs for a sustained period of time, not getting bitten is their only defense. And they manage. To protect yourself, always use mosquito repellent (even during the day) wear light, long sleeved shirts, long pants and shoes and socks at night, and sleep under a net or in a mosquito-proof room. Even if you are taking oral malaria prophylactic, you can still get malaria if you are bitten by an infected anopheles mosquito, so a good repellent is your easiest and most effective precaution.

Malaria Symtoms

* fever
* chills
* headache
* flu-like symptoms
* muscle aches
* fatigue
* low blood cell counts (anemia)
* yellowing of the skin and whites of the eye (jaundice)

When Symptoms Appear, Seek Immediate Medical Attention. 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. The sooner malaria is treated the easier it is to treat.