Avoiding Malaria When You Travel -
Or At Least Trying To

Avoiding malaria is one of the more controversial issues in travel health, and a lot of specialists have different opinions, especially on how to best do it. I'm not a doctor, just a backpacker, so my advice comes from thorough research - as yours should.

Malaria is common in sub-Saharan Africa; in large areas of the Middle East, South and South East Asia, Oceania, Haiti, Central and South America; and in parts of Mexico, North Africa and the Dominican Republic. Just draw a wide band along the equator and you're more or less in malaria territory.

It's been around since Antiquity, and was thought to come from bad air, or 'mal aria' near swamps.

There are three key things you should know about malaria.

First, there is no vaccine for it.

Second, nothing can protect you 100%.

And finally, it can appear months after you've been bitten so if symptoms - high fever accompanied by severe chills and muscle spasms - appear after you've returned home, head for the clinic and tell them you've been in a malaria-risk region. Left untreated, malaria can be fatal.

Malaria had to be eradicated to build the Panama Canal
Photo: CDC/Dr. Edwin P. Ewing, Jr.

Avoiding malaria is your first line of defence. The female anopheles mosquito, which carries malaria, tends to bite at night, from dusk to dawn.  

Here are the most common - and most effective - ways of avoiding malaria:

• wear long sleeves and long trousers
• use repellent (strong DEET solution - between 35%-50% depending on the expert) on any exposed skin
• spray your room with a pyrethroid-based insecticide spray
• use air conditioning or the fan if you have them
• always, always use a mosquito net or travel mosquito net (I use one of these and would never travel to infested zones without it)
• use mosquito coils in your room
• try to get back inside before dark

Warnings about DEET: DEET is a strong chemical so treat it with care: don't breathe or swallow it, keep it out of your eyes, put it on your hands and then spread it on your face. It may damage plastics (like sunglasses) and cause skin rashes or other reactions in a small number of people.

But the principal way of avoiding malaria is by taking antimalarial pills. But remember: they are not 100% effective, so you must do what you can to avoid bites. 

There's also a lot of debate around the drugs, with experts disagreeing with one another.

Antimalarial pills can save your life

You'll have to assess the risk of contracting malaria against the potential impact of the drugs and that's best done in the company of a medical practitioner well versed in tropical medicine.

A number of these drugs can cause anywhere from mild to severe side effects. Chloroquine can cause nausea, the antibiotic doxycycline makes it easier for you to get sunburned, and mefloquine can provoke severe psychological disturbances. I've taken mefloquine (Larium) without suffering any side effects but Tim, a fellow backpacker in Zimbabwe, began experiencing severe nightmares from mefloquine and had to go off the drug. There seems to be agreement that the drug with the least side effects is the newest one, Malarone. I've taken it for trips to both Panama and Senegal and haven't felt any side effects at all.

A word of caution: in some parts of the world ineffective or counterfeit drugs may be sold. Don't play with your life - buy your drugs before leaving home.

What pills you take will depend on where you're going. Malaria in certain areas has developed a resistance to common drugs like chloroquine, and even to the newer mefloquine so you'll have to make sure you take the drug that is appropriate to your destination.

Most of Central America and the Middle East, for example, tends to be suitable for chloroquine, but huge swathes of South America, Africa, South and Southeast Asia are resistant to it. So make sure you tell your doctor exactly where you're going (and for how long, because that also affects which drug you'll take). Come armed with some research if your doctor isn't a tropical medicine specialist.

Be aware that not all parts of a country are necessarily a malaria risk. Here again, experts disagree. Some say take the pills no matter where you go in the country, while others say do so only if you're going to malarial areas.

It's likely you'll face fewer risks in the cities. For example, you won't have to worry about malaria in Bangkok, but you will have to in the rural north and south. And Rio doesn't carry the same risks as the Amazon. Altitude also plays a part: malaria tends to occur at lower altitudes and anything above 1500m should be less worrisome.

If avoiding malaria hasn't worked

Even if you're careful you may still get malaria so best to know the symptoms: similar to flu, including fever, chills headache, aching muscles, tiredness, nausea and diarreha. It usually starts with the shivers, after which you get hotter and hotter until you sweat profusely.

If you develop these symptoms when you're in a malaria risk area, it is essential to get to a doctor. Otherwise you may be at risk of developing cerebral malaria, which can be fatal. A simple blood test, available throughout the developing world, will determine whether you're infected, and treatment is widely available.

Avoiding malaria is one thing, but there's also dengue fever, a painful disease that can take a long time to subside and makes your bones feel like they're breaking (this from a friend who caught it in Thailand). Like malaria there is no vaccine, and also like malaria, dengue requires avoiding bites by covering up and using repellent. It is found in similar climates, tropical and sub-tropical, with the difference that mosquitoes bite during the day.

The bad news: where malaria and dengue coexist, you'll have to take major precautions both day and night.