The Travelers Guide to Malaria Prevention, Treatment, and Tablets in Africa

by wheretheroadforks

While traveling through a malaria zone, you need to take a few additional precautions, that you don’t have to worry about in malaria-free regions. In this guide, I outline the three most popular malaria prevention medications, doxycycline, atovaquone/proguanil (Malarone), and mefloquine (Lariam). I discuss the pros and cons of each medication. I also share tips to help you avoid mosquito bites in the first place. Finally, I discuss what to do if you think you have malaria. This guide mainly focuses on travel in Africa but much of the information applies to all malaria zones.

a mosquito biting someone

What is Malaria?

Malaria is a potentially deadly disease caused by the Plasmodium parasite. Transmission most commonly occurs through the bite of an infected mosquito. Once the parasites enter your body, they rapidly multiply in your liver and begin attacking the red blood cells. After you are bitten by an infected mosquito it usually takes between one and two weeks for symptoms to begin showing.

Where Can You Catch Malaria?

Malaria exists in over 100 countries around the world including much of Africa, Asia, and Central and South America. Malaria can also be found in parts of the Carribean, Middle East, and some Pacific Islands.

You are at the highest risk of catching malaria while traveling in warm, tropical regions. the risk is lower in higher elevation locations above 1400 meters (4500 feet). Travel in cities generally carries a lower risk than rural areas. Dry areas like deserts typically don’t have malaria. 

In Africa, malaria is present pretty much everywhere south of the Sahara with a few exceptions. For example, there are a few non-malaria zones in higher elevation parts of East Africa in Kenya and Ethiopia. Some parts of subtropical southern Africa are also free of malaria. For example, much of South Africa and Namibia. Desert areas such as the Sahara and the Horn of Africa also do not have Malaria.

Beautiful Lake Malawi. Unfortunately, malaria is common here.

Malaria is particularly common for travelers in Africa. Particularly around the lakes. Pretty much every traveler that I have met who has spent a decent amount of time traveling in Africa has caught malaria at some point. I have never met a traveler who had caught malaria outside of Africa. 

Malaria Prophylaxis

These are pills that you take periodically to protect yourself from malaria in case you are exposed to the virus. The three most popular medications are Atovaquone/Proguanil (Malarone), mefloquine (Lariam), and doxycycline. Each has benefits and drawbacks.

These medications are particularly hard on the liver so you should take them as prescribed and only use them if you are sure that malaria is a risk where you are traveling.

blister packs of malaria tablets

Blister packs of pills

Atovaquone/Proguanil (Malarone)

Pros

  • Few side effects- If you’re sensitive to medications, Malarone has the fewest side effects of the three. Common side effects include nausea, vomiting, diarrhea, and headache.
  • Highly effective- Malarone protects you against most strains of malaria. 
  • Good for last-minute travelers- You only have to start the medication one to two days before travel. Other medication require that you take them for one to two weeks before they become effective.
  • Good for shorter trips- You only have to continue the medication for 7 days after you leave the malaria zone. Some medications require that you continue for up to a month.
  • You can start and stop use as you enter and leave malaria zones- This is possible because you only have to start taking the pill 2 days before you enter a malaria zone and stop 7 days after leaving. 

Cons

  • Expensive- 24 tablets cost about $180 in the United States. For longer trips, you may want to consider the other options as the cost will add up to several hundred dollars depending on where you buy the pills. Of course, the price is lower in many countries. 
  • Not effective against all strains of malaria- This is mostly due to drug resistance. You must research the specific strain of malaria that exists in the region that you will be traveling in.
  • Not ideal for long term travel- Some countries limit the number of pills that can be prescribed due to health concerns. If you’re traveling longer than 3 months, you may wish to choose another prophylaxis.
  • Availability- You can’t buy Malarone everywhere. It’s just not sold in some countries. The generic drug is called Atovaquone/Proguanil. It is becoming more widely available. 

Malarone Dosage

Malarone should be taken starting 1-2 days before entering a malaria zone and continued for 7 days after leaving. You take one tablet per day with food at the same time each day.

Some countries health agencies recommend that Malarone should not be taken for periods longer than three months at a time. Some countries don’t have strict limits. l have read reports of people taking it for up to 12 months without problems.

Mefloquine (Lariam)

Pros

  • Only taken once per week- Some people find this more convenient than taking a pill every day. 
  • Affordable- Cost-wise, Lariam falls between Malarone and doxycycline.
  • Easily available- You can replenish your supply of pills pretty much anywhere.
  • Can be taken long term- 

Cons

  • Side effects- Mefloquine has been known to cause some serious psychological side effects including hallucinations and suicidal thoughts. Some effects may even be permanent. In fact, side the side effects are so bad that the US military has pretty much stopped issuing Mefloquine to soldiers. for more info, check out this interesting article from Military Times.
  • Not effective everywhere- This is due to drug resistance. You must check into the specific type of malaria that exists in the region where you will be traveling.
  • Not ideal for last-minute travelers- You must take mefloquine for 2 weeks before you enter a malaria zone
  • Not ideal for short trips- You have to take mefloquine for 4 weeks after you exit the malaria zone. 
Lariam Dosage

Lariam must be taken for 1-2 weeks before entering a malaria zone and continued for 4 weeks after leaving the malaria zone. One tablet must be taken on the same day each week with food.

Doxycycline

Pros

  • Affordable- This is probably the cheapest malaria prophylaxis. I paid only a few dollars for a 4 month supply at a pharmacy in Ethiopia. 
  • Easily available- Doxycycline is a common antibiotic. It is sold in pretty much everywhere. I bought some in a tiny pharmacy in the Omo Valley of Ethiopia.
  • Effective- Doxycycline is effective against pretty much all strains of malaria. It works almost everywhere. 
  • Can be taken long term- I have read reports of travelers taking doxycycline for periods of up to two years. That’s probably not ideal but people have done it without any negative effects.
  • Good for last minute travelers– You only need to begin taking doxycycline 1-2 days before you enter a malaria zone.
  • Can protect you against infections other than malaria- Doxycycline is an antibiotic. 

Cons

  • There are a few side effects- For example, some people experience a greater sensitivity to sunlight. Some experience crazy dreams. Personally, I had strange dreams about once every week or 2 and didn’t notice any increased sensitivity to the sun. Other side effects include vomiting and diarrhea.
  • Not ideal for short trips- You must continue taking doxycycline for 4 weeks after you exit the malaria zone.
  • Not an option for some travelers- Pregnant women and children shouldn’t take doxycycline. 
Doxycycline Dosage

Doxycycline is an antibiotic that must be taken starting 2 days before you enter a malaria zone and continued for 4 weeks after you leave the malaria zone. You take one 100 milligram pill per day. You must take the pill with food at roughly the same time every day for the greatest efficacy.

For more help, check out this excellent guide to choosing a malaria prevention drug from the CDC.

My Thoughts on Malaria Tablets

Because the side effects can be so severe for some people and the fact that all of these medications are hard on the liver, malaria prophylaxis should only be used if they are absolutely necessary. These are fairly strong medications. Also, remember that they are not 100% effective.

In my travels, I have only taken doxycycline while in malaria zones Africa because the risk is so high there. I have traveled through other malaria zones in India, Southeast Asia, and Central and South America, but decided to skip the malaria medications and just take the necessary precautions to avoid bites. I’ll discuss those in the following section

Something else to consider when taking malaria tablets is the fact that your body is not operating at 100%. Even if you are not experiencing any side effects, your body will be weaker because of the strong medications that you are putting into it. Because of this, it is important to take extra care of your health. Make sure you are eating a healthy and balanced diet. Don’t skip meals. Be sure to get 8 hours of sleep per night. When you are weak you are more susceptible to other sickness and disease. Stay healthy.

For more general health tips, check out my guide How to Stay Healthy While Traveling: Tips for Diet, Exercise, Sleep, and Avoiding Sickness.  

a mosquito biting

How to Avoid Mosquito Bites

The best way to prevent malaria is to simply avoid being exposed in the first place. To avoid being bitten by mosquitoes, you should:

  • Use bug repellent with DEET- I like Repel 100 Insect Repellent. It contains 98.11% DEET and lasts for up to 10 hours per application. The 4-ounce bottle can be taken on the airplane and lasts for months of regular use. I hate putting chemicals on my skin but it is better than the alternative in this case.
  • Cover up when the mosquitoes are at their worst- Put on a long sleeve shirt, long pants, and socks at night to cover as much skin as possible. If the mosquitoes can’t get to your skin, they can’t bite.
  • Travel with your own mosquito net- I like the Dimples Excel Mosquito Net because it only needs one mount and is less of a hassle to set up than others I have tried. It also packs up pretty small.
  • Use your mosquito net properly- Make sure you kill or remove all mosquitoes from your net before you fall asleep. Also, check the net for holes and patch them if possible before sleeping. I travel with a sewing kit which I can use to quickly sew up holes in old, torn mosquito nets.
  • Wear light-colored clothing- Some research suggests that mosquitoes are less attracted to light-colored clothing. I don’t believe that this has been absolutely confirmed, but it’s worth a try. 

Should I Visit a Doctor for a Malaria Consultation Before My Trip?

Probably yes. The only reason not to have a malaria consultation before travel is due to the cost and time.  A consultation at a travel clinic in the United States costs between $50 and $100. This does not include malaria tablets.

Doxycycline is cheap but Malarone costs about $180 per month. These costs add up depending on how long you are traveling. If you are on a tight budget or just looking to save money you can wait until you are at your destination to buy your malaria tablets. Know that if you do this, you may not be able to choose which medication you want. Not all varieties are available in every country.

I decided to wait until I arrived in Africa to buy my malaria pills. I flew into Addis Ababa which is not a malaria zone because the city is at elevation. After extensive research, I decided to use doxycycline because of the cost and the fact that it has relatively few side effects. It is also easy to get as it has many uses outside of malaria prevention.

I bought my doxycycline in Ethiopia. I walked into a small pharmacy in Jinka, a small town in the Omo Valley, and asked for doxycycline. The pharmacist offered me 2 options: doxycycline made in India or doxycycline made in Ethiopia. I bought the Ethiopian one because it was slightly cheaper. The cost was only a few dollars for a 4 month supply of pills. The pills came sealed in blister packs and kept me malaria free for the duration of my trip.

Common Symptoms of Malaria

The most common early symptoms of malaria are:

  • Fever
  • Headache
  • Scratchy or dry throat
  • Fatigue or drowsiness
  • Nausea or vomiting
  • Flue like symptoms

Types of Malaria

Not all malaria is the same. There are 5 varieties that humans can catch. 4 of which are transmitted by the mosquito and one is transmitted by animals. Depending on where you are traveling, Malarone or Lariam may not be an option for prevention because of drug resistance. Doxycycline can be used as a prophylaxis for all types of malaria in all regions.

What to Do If You Think You Have Malaria

If you begin to feel any of the above-listed symptoms while traveling through a malaria zone, you should err on the side of caution and go directly to the nearest clinic for a malaria test. The test is quick and only costs a few dollars. It’s better to be safe than sorry.

When you are tested, the nurse will simply prick your finger and put a drop of blood on a paper test strip. You will instantly know if you have the disease and you can begin treatment right away. Malaria is very common in Africa so every clinic, even in the smallest towns, should have tests and treatment available. They see this stuff on a daily basis and know what they are dealing with but the earlier you catch it, the better.

If you are traveling somewhere very remote where you will be unable to access a clinic, it is possible to buy the medication for treatment at a pharmacy or clinic and take it if you think you are getting malaria. This should only be done in an emergency if you are unable to make it to a clinic in time.

It is not good to take the medications unnecessarily because they are strong and hard on the body. Different treatments exist for different types of malaria so you’ll want to make sure you are carrying the proper medications for the region you are traveling in.

What You Should Do If You Catch Malaria

The earlier you catch it and get treatment, the easier the whole ordeal will be on you and your health. If left untreated, malaria can cause permanent damage to your body including liver damage and even psychological damage. Eventually, depending on the type, malaria can kill you if left untreated. If you believe you have malaria, go to a clinic for treatment immediately.

The good news is that if you catch it early, you should be back in good health in two weeks or less depending on the type of malaria that you caught. In some cases, you can even recover after just a few days.

My friend caught a mild strain early and was able to continue traveling during treatment. He just took his pills when the doctor told him and we continued our journey without missing a day. He experienced a mild fever and was a bit disoriented one night but was feeling back to normal just 3 days after the diagnosis. During treatment, it is best to get plenty of rest and eat well just as you would for any other sickness.

Travel Insurance

While traveling in a malaria zone it is a good idea to have travel insurance. If you do catch malaria, you could end up in the hospital temporarily and be sick in bed for some time after recovering. Travel insurance will help to cover your hospital bills or if you missed a flight during the time that you were sick. I like World Nomads. I have used them for all of my trips and have had good luck with them. For more information and a free quote, check out my travel insurance page.

Final Thoughts: Malaria Prevention, Treatment, and Tablets

This goes without saying, but I’m not a medical professional. I did, however, extensively research malaria before my travels to Africa and while researching for this article. This is just a rough guide to get you started and set you in the right direction as far as choosing a medication and preventing the disease.

Before you set off on your trip, you should do specific research on the region you are traveling to determine if malaria exists there and if prophylaxis is recommended or needed. If you need tablets, make sure that the type that you choose will work to prevent the strains of malaria that are present in the region that you are traveling. Drug resistance makes some pills useless. 

Before my trip to Africa, the thought of catching malaria terrified me. I thought it was pretty much a death sentence. Through my research and experience, I have learned that it is a manageable disease. Millions of people have to put up with malaria throughout their lives.

Also, know that millions of people catch malaria each year and hundreds of thousands of people still die of the disease including tourists. This is a real threat that must be taken into consideration when you travel. Hopefully in the future with the advancement of modern medicine and technology humanity can eradicate malaria or develop a vaccine to protect us from the disease. Until then, stay healthy and safe travels!

Have you caught malaria while traveling? Share your experience in the comments below!

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1 comment

NP November 15, 2018 - 3:50 am

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