Malaria – where the risk is, and how to avoid it

Malaria in South Africa is confined to the low-lying north-east of the country: the border areas of Limpopo and Mpumalanga — including the Kruger National Park — and the far north-east of KwaZulu-Natal. The rest of the country, including all the major cities, is not a malaria area.

Transmission is seasonal, broadly from the start of the rains in spring through to autumn, with the highest risk in the late summer months. Neighbouring Mozambique, Zimbabwe and parts of Botswana carry higher and more year-round risk, which matters for anyone travelling on.

The mosquito that transmits malaria bites between dusk and dawn, which is what makes the precautions below effective and specific.

1. 1Use an insect repellent containing DEET or picaridin on exposed skin from late afternoon onwards, and reapply as directed.
2. 2Wear long sleeves and long trousers after dark, in light colours.
3. 3Sleep under an insecticide-treated net if the room is not sealed and air-conditioned.
4. 4Use a plug-in insecticide or a mosquito coil in the room at night.
5. 5Keep windows and doors screened, and closed after dark.
6. 6Apply sunscreen first and repellent over it, not the other way round.

For travel into a risk area during the transmission season, preventive medication is usually recommended alongside bite avoidance rather than instead of it. Which one suits you depends on the destination, your other medicines, pregnancy and how long you are going for.

• Prophylaxis must be started before travel, taken throughout, and continued for the full period after leaving — stopping on the way home is a common and dangerous mistake.
• No preventive tablet is completely effective, which is why bite avoidance still matters.
• Pregnant women and small children are at much higher risk of severe malaria. Ideally avoid travel to risk areas; if that is not possible, get specific advice well beforehand.
• Speak to a travel clinic or pharmacist a few weeks before travelling, not the day before.

Early malaria looks exactly like flu: fever, chills, sweating, headache, muscle aches, tiredness, sometimes nausea, vomiting or diarrhoea. There is nothing distinctive about it, which is the whole problem.

It can progress from mild to life-threatening within a day, particularly in children, pregnant women and anyone without previous exposure. A rapid test takes minutes and is available at clinics in and around risk areas.

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