Malaria is a serious and sometimes fatal disease which is widespread in many tropical and subtropical countries. It is caught by being bitten by an infected mosquito that is carrying the malaria parasites in its saliva.

The malaria parasite is a microscopic organism called a Plasmodium and it belongs to the group of tiny organisms known as protozoans. There are four types of plasmodium: P. falciparum (the most dangerous), P. vivax, P. ovale and P. malariae. The species of mosquito that carries the malaria parasites is the Anopheles mosquito.

These parasites enter the host's bloodstream when bitten by an infected mosquito and then migrate to the liver where they multiply before returning back into the bloodstream to invade the red blood cells.

The parasites continue to multiply inside the red cells until they burst releasing large numbers of free parasites into the blood plasma causing the characteristic fever associated with the disease. This phase of the disease occurs in cycles of approximately 48 hours.

The free parasites are then able to infect any mosquito that feeds on the host's blood during this phase. The cycle then continues as the parasites multiply inside the mosquito and eventually invade its salivary glands. (see the plasmodium life cycle below).

Malaria occurs in over 100 countries and more than 40% of the people in the world are at risk. Large areas of Central and South America, Hispaniola (Haiti and the Dominican Republic), Africa, the Middle East, the Indian subcontinent, Southeast Asia, and Oceania are considered malaria-risk areas.

Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhoea may also occur. Malaria may cause anaemia and jaundice (yellow colouring of the skin and eyes) because of the loss of red blood cells. Infection with one type of malaria, P. falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death.

For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 8 days or up to 1 year later. Two kinds of malaria, P. vivax and P. ovale, can relapse; some parasites can rest in the liver for several months up to 4 years after a person is bitten by an infected mosquito . When these parasites come out of hibernation and begin invading red blood cells, the person will become sick.

Any traveller who becomes ill with a fever or flu-like illness while travelling and up to one year after returning home should immediately seek professional medical care. You should tell your GP that you have been travelling in a malaria-risk area.

Malaria can be cured with prescription drugs. The type of drugs and length of treatment depend on which kind of malaria is diagnosed, where the patient was infected, the age of the patient, and how severely ill the patient was at start of treatment.

Anybody travelling to an area where malaria is endemic is at risk of catching the disease. Lately there has been an increase in the cases of malaria reported in the UK - in 1993 there were 1922 reported cases in the UK, including five deaths. All caught the disease abroad and almost all cases could have been prevented.

Be aware of the fact that adventure travellers are usually more exposed to malaria than ordinary travellers due to the nature of their activities and the fact that they travel to the more remote locations.

The Prevention and Treatment of Malaria

Malaria is a preventable infection that can be fatal if left untreated. You cannot be vaccinated against malaria, but you can protect yourself. Click on the image (right) to view a video presentation showing the dangers of Malaria, how easily it can spread, and it's effects on humans.

Avoidance of Bites

Mosquitoes cause much inconvenience because of local reactions to the bites themselves and from the infections they transmit. Mosquito bites spread other diseases such as yellow fever, dengue fever and Japanese B encephalitis.

Mosquitoes bite at any time of day but the anopheles bites in the night with most activity at dawn and dusk. If you are out at night wear long-sleeved clothing and long trousers.

Mosquitoes may bite through thin clothing, so spray an insecticide or repellent on them. Insect repellents should also be used on exposed skin.

Spraying insecticides in the room, burning pyrethroid coils and heating insecticide impregnated tablets all help to control mosquitoes. If you are sleeping in an unscreened room a mosquito net (which should be impregnated with insecticide) is a sensible precaution. If sleeping out of doors it is essential. Portable, lightweight nets are available.

NOTE: Things like Garlic, Vitamin B and ultrasound devices do not prevent mosquito bites.

Taking Anti-Malaria Tablets

It should be noted that no prophylactic regimen is 100% effective and advice on malaria prophylaxis changes frequently. There are currently five prophylactic regimens used (A,B,C,D & E), due to the differing resistance that exists by the malaria parasites to the various drugs used. (See the above map of Malaria Endemic Areas).

The tablets you require depend on the country to which you are travelling (see the table page). Start taking the tablets before travel take them absolutely regularly during your stay, preferably with or after a meal and continue to take them after you have returned. This is extremely important to cover the incubation period of the disease.

Prompt Treatment

If you develop a fever between one week after first exposure and up to two years after your return, you should seek medical attention and inform the doctor that you have been in a malarious area.

Anyone with suspected malaria should be treated under medical supervision as soon as possible. If malaria is diagnosed then treatment is a matter of urgency. Treatment should not normally be carried out by unqualified persons.


The drug treatment of malaria depends on the type and severity of the attack. Typically, Quinine Sulphate tablets are used and the normal adult dosage is 600mg every twelve hours which can also be given by intravenous infusion if the illness is severe.

Remember: Prevention is better than cure and over two million people die from malaria every year. It is a very serious illness!

Side Effects of Anti-Malarials

Like all medicines, anti-malarials can sometimes cause side-effects:

Proguanil (Paludrine) can cause nausea and simple mouth ulcers.

Chloroquine (Nivaquine or Avloclor) can cause nausea, temporary blurred vision and rashes.

Patients with a history of psychiatric disturbances (including depression) should not take mefloquine as it may precipitate these conditions. It is now advised that mefloquine be started two and a half weeks before travel.

Doxycycline does carry some risk of photosensitisation i.e. can make you prone to sunburn.

Malarone is a relatively new treatment and is virtually free of side effects. It is licensed for use in stays of up to 28 days but there is now experience of it being taken safely for up to three months.

No other tablets are required with mefloquine or doxycycline or Malarone.

Drug Resistance

It is the plasmodia that cause malaria that develop resistance to anti-malarial drugs not the mosquitoes that transmit the disease.

Resistance to antimalarial drugs is proving to be a challenging problem in malaria control in most parts of the world. Since the early 60s the sensitivity of the parasites to chloroquine, the best and most widely used drug for treating malaria, has been on the decline.

Drug resistance is the ability of a parasite species to survive and multiply despite the administration of a drug in doses equal to or higher than those usually recommended but within the limit of tolerance.

Newer antimalarials have been developed in an effort to tackle this problem, but all these drugs are either expensive or have undesirable side effects.

The discovery of chloroquine revolutionalised the treatment of malaria, pushing quinine to the sidelines.

However, after a variable length of time, the parasites, especially the falciparum species, have started showing resistance to these new drugs.

Resistance is most commonly seen in P. falciparum whereas only sporadic cases of resistance have been reported in P. vivax malaria.

Resistance to chloroquine is most prevalent, while resistance to most other antimalarials has also been reported.

Resistance to chloroquine began from two epi-centres; Colombia (South America) and Thailand (South East Asia) in the early 1960s. Since then, resistance has been spreading world wide.

Recently, cases of mefloquine resistance have been reported from areas of Thailand bordering with Burma and Cambodia (see map above). Travellers to Thailand are therefore advised to avoid using mefloquine when travelling to these risk areas.

Because mefloquine is structurally similar to chloroquine, cross resistance is possible due to the prolonged half life of mefloquine.

The information supplied is derived from a number of reliable sources and is compared and compiled into the alphabetical lists found on this web site.

Countries requiring malaria prophylaxis should be regarded as being at risk all year round and you should also assume that the whole country is at risk unless otherwise indicated. The malaria regimen is the recommended regimen for a country. Use of the incorrect regimen may not provide adequate cover.

When there are two different regimens for the same country, they are area specific. Read the text to find out which regimen is suitable for the area you require.

Where regimen 1 is indicated there is Chloroquine resistance in that region and it is very likely to be the Falciparum malaria which is the most serious form of the disease. In this instance it is vitally important that travellers take adequate prophylaxis.

Remember:- No prophylaxis is 100% effective but not taking anti-malarials where they are indicated will put you at greater risk should you get the disease. Remember - Malaria is a killer!

Dose for
Chemoprophylaxis

Chloroquine

Proguanil

2 tablets weekly

2 tablets daily

150mg (base)

100mg

Mefloquine

Doxycycline

Malarone
(atovaquone & proguanil)

1 tablet weekly

1 tablet/capsule daily

1 tablet daily

250mg (228 in USA)

100mg

250mg atovaquone &
100mg proguanil

• Cape Verde - Remember, low risk if fever develops.
• Mauritius - Except a few rural areas where chloroquine prophylaxis is appropriate.

• Botswana - Only in the northern half of the country - November to June.
• Mauritania - All year round in the south. November to June in the north.
• Zimbabwe - Areas below 1,200 metres - November to June. All year long in the Zambezi Valley where Doxycycline, Mefloquine or Malarone are preferable. Risk is negligible in Harare and Bulawayo.

• Ethiopia - Areas below 2,200 metres. No risk in Addis Ababa
• Namibia - The northern third of the country - November to June. All year long around the Kavango and Kunene rivers.
• South Africa - North east, low altitude areas of Mpumalanga and Northern Provinces, Northeast KwaZulu-Natal as far south as the Tugela river. Risk present in Kruger National Park.
• Zimbabwe - The Zambezi Valley.

Doxycycline
OR
Mefloquine
OR
Malarone

Chloroquine
PLUS
Proguanil - (limited protection)

• Algeria - Virtually no risk
• Egypt - Main tourist areas are malaria free.
• Georgia - Some south eastern villages July to October.
• Kyrgystan - Some southern and western areas.
• Libya
• Morocco - A few rural areas only limited risk.
• Turkey - Most tourist areas.
• Uzbekistan - Sporadic cases in extreme south east only.

• Armenia - The whole country June to October.
• Azerbaijan - Southern border area June to October.
• Egypt - El Faiyum region only, June to October.
• Iraq - Basrah and rural north, May to November.
• Syria - Northern border, May to October.
• Turkey The plain around Adana, Side & south east Anatolia, March to November.
• Turkmenistan - The south east only, June to October.

• Afghanistan - Areas below 2,000 metres, May to November.
• Iran
• Oman - Remote rural areas only.
• Saudi Arabia - The whole country except northern, eastern and central provinces, Asir plateau, and western border cities where there is very little risk. No risk in Mecca.
• Tajikistan - Southern border areas, June to October.
• Yemen - No risk in Sana'a city.

• Maldives - no risk
• India - No risk in parts of mountain states of the north.

• Bangladesh - The whole country except Chittagong Hill Tracts. No risk in Dhaka City.
• Bhutan - Southern districts only.
• India - All areas below 2,000 metres, including Goa.
• Nepal - Areas below 1,500 metres, especially Terai districts. No risk in Kathmandu.
• Pakistan - Areas below 2,000 metres.
• Sri Lanka - No risk in Colombo.

• Bangladesh - Chittagong Hill Tract Districts only.
• India - Assam region.

Doxycycline
OR
Mefloquine
OR
Malarone

• Bali - Part of Indonesia
• China - Main tourist areas.
• Hong Kong
• Indonesia - Jakarta, main cites and tourist resorts including Java.
• Malaysia - Most areas including Kuala Lumpur and Penang.
• North Korea - A few southern areas have limited risk.
• Philippines - Low risk in main cities, Cebu, Bohol & Catanduanes. No risk in Manilla.
• South Korea - Limited risk in the extreme northwest.
• Sarawak - (Borneo) except deep forest areas.
• Thailand - Bangkok and main tourist areas including Pattaya, Phuket, Krabi, Hua Hin, Koh Samui, Kanchanaburi, Damnoen Sadouak, Ayutthaya, Sukhothai, Khon Kaen & Chiang Mai.

• Indonesia - Areas other than Bali and low risk cities, or Irian Jaya and Lombok where the risk is high and chloroquine resistance is present.
• Philippines - Rural areas below 600 metres.
• Malaysia and Sarawak (Borneo) - Deep forest regions of penninsular Malaysia and Sarawak.

• Borneo - Sabah
• Cambodia - Most of the country except Phnom Penh where there is no risk.
• China - Yunnan and Hainan provences only. All other remote areas use chloroquine.
• East Timor
• Irian Jaya & Lombok
• Laos - except Vientiane where there is no risk.
• Myanmar - (formerly Burma).
• Sabah - Part of Malaysia (Borneo)
• Vietnam - Most rural areas, no risk in cities, Red River delta area and the coastal plain north of Nha Trang.

Doxycycline
OR
Mefloquine
OR
Malarone

Risk great.
Chloroquine resistance prevalent. Some mefloquine resistance reported

• Cambodia - Western provences.
• Thailand - Near borders with Cambodia & Myanmar. Koh Chang.
• Myanmar - Eastern part of Shan state.

• Papua New Guinea - below 1,800 metres.
• Solomon Islands
• Vanuatu

Doxycycline
OR
Mefloquine
OR
Malarone

• Brazil - Except the Amazon basin region, Mato Grosso & Maranhao.

• Argentina - Rural areas along northern borders only.
• Belize - Rural areas except Belize district.
• Costa Rica - Rural areas below 500m.
• Dominican Republic
• El Salvador - Only Santa Ana province in the West.
• Guatamala - Areas below 1,500 metres.
• Haiti - The whole country.
• Honduras - The whole country.
• Mexico - Some rural areas rarely stayed in by tourists.
• Nicaragua - The whole country.
• Panama - West of the canal.
• Paraguay - Some rural areas.

• Bolivia - Rural areas below 2,500 metres
• Ecuador - Areas below 1,500 metres. No malaria in Galapagos Islands nor in Guayaquil.
• Panama - East of the canal.
• Peru - Rural areas below 1,500 metres.
• Venezuela - Rural areas other than the coast. Caracas is free of malaria.

• Brazil - Amazon basin region, Mato Grosso & Maranhao only. Very low risk and no chemoprophylazis required elsewhere.
• Colombia - Most areas below 800m
• Ecuador - Esmeraldas Province.
• French Guiana - Especially border areas.
• Guyana - All interior regions.
• Surinam - Except Paramaribo and coast.
• Amazon basin areas of Bolivia, Venezuela and Peru

Doxycycline
OR
Mefloquine
OR
Malarone