How Not to Get Malaria

Tropical destinations are extremely appealing to anyone adventurous but unfortunately, malaria is rife in many of these areas. Malaria is caused by parasites transmitted via bites from mosquitoes.

Before you head off on your adventures, you should check a reliable and up-to-date source such as the Centers for Disease Control (CDC) website to see what the risk of malaria is in the location you’re heading to. The CDC website tells you which type of malaria prophylaxis is recommended for each particular destination. Then you’ll need to attend a travel clinic or see your GP for an antimalarial prescription.

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According to the World Health Organization (WHO), in 2017 there were approximately 219 million malaria cases in 87 countries and an estimated 435,000 malaria deaths. So it isn’t worth contemplating traveling without protecting yourself.

1. Symptoms

Malaria is an acute febrile illness and symptoms usually appear 10 to 15 days after the infective mosquito bite. The first symptoms are mild (fever, headache, and chills) making it sometimes initially hard to recognize as malaria. If not treated within 24 hours, anyone infected by the P. falciparum malaria parasite strain of malaria can become severely ill, and often this leads to death.

The WHO says certain population groups are at higher risk of malaria than others, which includes travelers, as well as infants, under 5s, pregnant women, people with HIV/AIDS and non-immune migrants.

The Good News

There are a few reasons to be optimistic about the future of controlling malaria. During the past 150 years, approximately half of the countries in the world have eradicated malaria.

Although it’s not commercially available yet, there are currently trials underway in Malawi for a malaria vaccination known as RTS, which so far has shown to be the only vaccine that can significantly reduce malaria in children (two children die per minute from malaria).

2. Pre-planning

Malaria medications are called ‘malaria prophylaxis’ because you start taking them before you arrive at the destination in order to reduce your chances of getting malaria. How soon before your travels you need to start taking it, depends on the type of malaria prophylaxis. For example, with some, you start taking them a few days before arrival and with others, an entire week before you get there.

You’ll need to see a GP or go to a travel clinic for their professional advice and a prescription. They’ll take into account how long you’ll be spending in the destination and if you’ve ever had an adverse reaction to antimalarials or other drugs and your medical history. Sometimes you’ll be given a choice of antimalarials, which is when you’ll need to weigh up the price, effectiveness and any possible side-effects.

Side Effects

Some antimalarials such as Primaquine and Tafenoquine can cause anemia in some people. And Lariam used to be a very common antimalarial (it was given to US troops in Vietnam during the war) but it can have severe side-effects that can include paranoia and hallucinations. Even so, many travelers are willing to take the risk of using it because it’s much cheaper than alternatives, such as Malarone. Malarone has far fewer side effects but costs several times more, which often turns people off it.

In any case, always consult a medical practitioner to get advice and a prescription and don’t wait to do it when you arrive because you might contract malaria in those vital days before the antimalarials start to kick in.

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3. Bite Avoidance

While taking the following steps isn’t enough to completely safeguard you from getting malaria – and no antimalarial is 100% effective – you can also take some practical steps to minimize the risk of being bitten by mosquitoes. (After all, there are plenty of other nasty mosquito-borne illnesses around that you’d want to avoid, such as dengue fever and chikungunya).

Mosquito Nets are a Must

According to the charity, The Against Malaria Foundation, sleeping under a mosquito net treated with long-lasting insecticide (it kills bugs on contact) is instrumental in reducing the number of people contracting, and dying from, malaria.

Mosquitoes typically bite between 10pm and 2am, so during these hours, you need to be particularly vigilant. This means sleeping under a mosquito net.

You can buy mosquito nets treated with permethrin or another kind of insecticide from popular camping/outdoor shops such as REI in the United States, Millets in the United Kingdom, Macpac in Australia and New Zealand or Atmosphere in Canada, plus many more outdoor retailers both online and in most cities.

Mosquito Net Tips

Pyramid-shaped nets are a good choice because they require fewer hooks to hang them up. You can bring thumb tacks (drawing pins) with you to attach them to walls in places where there aren’t hooks for hanging your net, and you can even find versions that go over your hammock. Often the ones provided by hotels and hostels are battered from use and contain holes, so don’t rely on them.

Make sure the edges of the net are always sealed (tucked under the mattress) and there are no gaps, as mosquitos have been known to crawl across floors looking for a fold they can creep under.

Always wash your hands after handling the net because the insecticide is serious stuff and can cause mild poisoning, particularly if you accidentally poke your eye or touch your mouth after using. It is tricky to clean your hands when you’re already sealed inside a net, so stash some wet-wipes and/or hand gel in your bed.

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If You’re not Sleeping Between 10am and 2am…

If you’re going to be out and about during peak malaria-carrying mosquito activity because you’re doing a night safari, heading to a bar or any other reason, cover any exposed areas of skin with a strong mosquito repellent containing DEET (if it doesn’t contain DEET it won’t cut it; nor will natural alternatives). If you can, wear a long-sleeved top and pants that cover your ankles too.

Bonus Tips

Even if you have a flyscreen, mozzies can always find a way in. You can double up on using mosquito nets and mosquito prophylactics by also using a plug-in mosquito killer such as this one. The liquid ones are less messy than the tablets because they don’t need refilling every day, and the smoke from mosquito coils is thought to be bad for your lungs.

4. Antimalarials

It’s important to remember to take your antimalarials every day and keep taking them for the full duration of the period you were prescribed for. The duration often includes days after you’ve left the region, as well as before.

It’s important to keep taking them even when you’re no longer around mosquitoes because you could be carrying the virus but not yet showing any symptoms.

5. Malaria Affected Destinations [Map]

Generally speaking, most malaria-affected countries are located in parts of Central and South America, Africa, the Middle East, Eastern Mediterranean, Western Pacific and, Asia. However, malaria has been eradicated in some countries in these regions.

Furthermore, malaria outbreaks can vary from year to year depending on rainfall, flooding and other factors, which is why it’s essential to get expert advice.

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This map broadly shows the regions where malaria is found

If you follow this advice, which is based on guidelines given by the WHO, Centers for Disease Control, and various malaria charities, you’ll decrease your chances of contracting malaria.

In the event of fever during or after your return from travel in areas with malaria, seek professional medical advice as soon as possible.