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| Guidelines for malaria prevention in sub-Saharan Africa |
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Written by Helen Marshall, pharmacist
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The risk of falciparum
malaria is very high in sub-Saharan Africa, except in the
extreme South, and much of the malaria is resistant to
chloroquine. Everyone visiting malarious parts of
sub-Saharan Africa should take appropriate preventive
medicines and use adequate protection to prevent mosquito
bites. It is essential to regard all fevers and flu-like
illnesses that occur up to a year after leaving Africa,
and particularly in the first three months, as possible
malaria, and to seek urgent medical advice, as almost all
fatal cases of malaria in UK travellers have been contracted
in Africa.
The forest zone of
West Africa has a high risk of falciparum malaria
throughout the year. Chloroquine-resistant parasites are
widespread but their distribution is still patchy.
Mefloquine or doxycycline or Malarone are the recommended
preventive medicines for this area.
Moving north
towards the Sahara, malaria transmission becomes seasonal
but remains intense, with most infections being contracted
during or shortly after the rainy season. Inland,
chloroquine resistance is patchy but widespread. Closer to
the Sahara the high-risk season becomes shorter. In
particular, most cases in the Gambia are contracted between
June and December. Mefloquine or doxycycline or Malarone
are the medicines of choice for the Gambia, and for most
of sub-Saharan Africa, because of the increasing
chloroquine resistance.
|
Risk | Country |
Preferable
regimen |
| Risk very high, or
locally very high. Chloroquine resistance
very widespread | Angola, Benin, Burkina Faso,
Burundi, Cameroon, Central African Republic,
Chad, Comoros, Congo, Democratic Republic of the Congo (formely Zaïre), Djibouti, Equatorial
Guinea, Eritrea, Gabon, Gambia, Ghana,
Guinea, Guinea-Bissau, Ivory Coast, Kenya,
Liberia, Madagascar, Malawi, Mali, Mozambique,
Niger, Nigeria, Principe, Rwanda, São Tomé,
Senegal, Sierra Leone, Somalia, Sudan,
Swaziland, Tanzania, Togo, Uganda, Zambia
Botswana (only in the northern half
of the country,
November-June)
Ethiopia (areas below 2000m; no risk
in Addis Ababa)
Mauritania (year round
in the south; July-October in the
north)
Namibia (all year along Kavongo and
Kunene rivers;
November-June in northern third)
South Africa (north
east, low altitude areas of Northern
Province and Mpumalanga, Kruger National
Park, and north-eastern
KwaZulu-Natal as far south as Tugela river.)
Zimbabwe (all year in Zambezi
valley; November-June in other areas below
1200m; risk negligible in
Harare and Bulawayo) | Mefloquine
OR doxycycline OR Malarone |
| Low risk | Cape Verde (some risk on São Tiago)
Mauritius | Avoid insect
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
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if you suffer from any
diseases or conditions
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if you
are taking any regular medications
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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.
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Last updated 16.03.2007
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