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Guidelines for malaria prevention in South Asia

Written by Helen Marshall, pharmacist

Visitors to all parts of the Indian subcontinent, except for the high mountains, are at risk of contracting malaria, both in rural areas and in some cities. Plasmodium vivax is the most prevalent form of malaria parasite in this area, but Plasmodium falciparum is also present and is often resistant to chloroquine. Mixed infections with these parasites can occur.

People who have emigrated to the UK from South Asia should be aware that malaria has re-emerged in most areas of South Asia since the malaria eradication campaigns, and that they and their families should take the recommended preventive medicines when they are visiting friends and families in South Asia.

Chloroquine plus proguanil, along with avoiding mosquito bites, is the recommended regimen for travellers to this area, except in the Chittagong Hill Tracts in Bangladesh and Assam in India, where chloroquine resistance is high. In this area, mefloquine or doxycycline or Malarone are the recommended medicines.

Risk	Country	Preferable regimen	Alternative regimen
Risk high. Chloroquine resistance high	Bangladesh (only in Chittagong Hill Tracts; low risk in other areas) India (Assam only)	Mefloquine OR doxycycline OR Malarone	.
Risk variable. Chloroquine resistance usually moderate	Bhutan (southern districts only) India (low risk in some areas - see below, high risk in Assam) Nepal (below 1500m, especially Terai districts; no risk in Kathmandu) Pakistan (below 2000m) Sri Lanka (north of Vavuniya; low risk in other areas)	Chloroquine plus proguanil	Mefloquine OR doxycycline OR Malarone
Risk low.	Bangladesh (but risk high in Chittagong Hill Tracts) India (Kerala [southern states], Tamil Nadu, Karnataka, Southern Andhra Pradesh [including Hyderabad and Mumbai], Rajasthan [including Jaipur], Uttar Pradesh [including Aggra], Haryana, Uttaranchal, Himachal Pradesh, Jammu, Kashmir, Punjab, Delhi; variable risk in other areas; high risk in Assam) Sri Lanka (but variable risk north of Vavuniya)	Avoid mosquito bites, but remember low risk exists if fever develops	.

Always see your pharmacist for more detailed information about the risks of malaria in each country you are visiting. Your pharmacist will be able to tell you which medicines are recommended.

Remember to tell your pharmacist:

if you are pregnant, planning a pregnancy or breastfeeding
if you suffer from any diseases or conditions
if you are taking any regular medications
if a child is travelling with you.

This information will help the pharmacist recommend the most appropriate regimen for you.

Remember to leave yourself enough time before you leave to obtain your medicines. All the malaria prevention medicines must be started before you travel. Mefloquine needs to be started two-and-a-half weeks before travel, chloroquine and proguanil should be started a week before, and Malarone and doxycycline one to two days before travelling.

Chloroquine (Avloclor or Nivaquine) and proguanil (Paludrine) can be bought from pharmacies, but may have to be ordered in if you are going for a long trip. Mefloquine (Lariam), doxycycline (eg Vibramycin) and Malarone all require a prescription from your doctor.

For these reasons always see your pharmacist at least three weeks before you plan to travel, to find out which (if any) medicines are recommended, when you need to start taking them, and whether you need a prescription to obtain them.

Remember to take your medicines regularly while you are away, and continue taking them for four further weeks after leaving the malarious area, with the exception of Malarone, which only needs to be continued for one week after leaving.

Always suspect malaria and seek urgent medical advice if you develop a fever or flu-like illness whilst you are away (even if you are taking preventive medicines) or up to a year after you return, in particular in the first three months.

Last updated 16.03.2007

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.

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