http://www.cdc.gov/travel/regionalmalaria/safrica.htm#malariarisk
Malaria Information for Travelers to Countries in Southern Africa 
 
On This Page 
 
NOTE: Please check the Outbreaks section for important updates on this region.
Transmission and Symptoms 
Malaria Risk by Country 
Prevention 
Antimalarial Drugs Purchased Overseas 
Protect Yourself from Mosquito Bites 
Additional Malaria Information 
More Travel Health Information 
Complete List of Countries in This Region 
 
Countries included in this region. 
 
Transmission and Symptoms 
  
Malaria is a serious disease that is transmitted to humans by the bite of an infected 
female Anopheles mosquito. Symptoms may include fever and flu-like illness, 
including chills, headache, muscle aches, and fatigue. Malaria may cause anemia and jaundice. 
Plasmodium falciparum infections, if not immediately treated, may cause kidney failure, coma, and death. 
Malaria can often be prevented by using antimalarial drugs and by using personal protection measures to 
prevent mosquito bites. However, in spite of all protective measures, travelers may still develop malaria.
Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. 
Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, 
any fever should be promptly evaluated.
Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or 
flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), 
you should seek immediate medical attention and should tell the physician your travel history.
 
Malaria Risk by Country 
  
Botswana: Risk north of 21° latitude south in the northern districts of Central, Chobe, Ngamiland, 
North East, and Okavango. Lesotho: No risk. Namibia: Risk in the provinces of Kunene, Ohangwena, 
Okavango, Caprivi, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa. 
South Africa: Risk in the low altitude areas of the Mpumalanga Province, Northern Province, 
and northeastern KwaZulu-Natal as far south as the Tugela (Thukela) River. 
Risk in Kruger National Park. St. Helena (U.K.): No risk. Swaziland: Risk in all lowlands. 
Zimbabwe: Risk in all areas, except no risk in cities of Harare and Bulawayo.
 
Prevention 
  
All travelers to malaria-risk areas in Southern Africa, including infants, children, and former 
residents of Southern Africa, should take one of the following antimalarial drugs (listed alphabetically):
atovaquone/proguanil, 
doxycycline, 
mefloquine, 
primaquine (in special circumstances). 
Note: Chloroquine is NOT an effective antimalarial drug in Southern Africa and should not be taken 
to prevent malaria in this region.
Most antimalarial drugs are well-tolerated; most travelers do not need to stop taking their drug 
because of side effects. However, if you are particularly concerned about side effects, discuss 
the possibility of starting your drug early (3-4 weeks in advance of your trip) with your health 
care provider. If you cannot tolerate the drug, ask your doctor to change your medication.
Atovaquone/proguanil (brand name: MalaroneTM) 
Atovaquone/proguanil is a fixed combination of two drugs, atovaquone and proguanil. In the United States, 
it is available as the brand name, MalaroneTM.
Directions for Use 
The adult dosage is 1 adult tablet (250mg atovaquone/100mg proguanil) once a day. 
Take the first dose of atovaquone/proguanil 1 to 2 days before travel to the malaria-risk area. 
Take atovaquone/proguanil once a day during travel in the malaria-risk area. 
Take atovaquone/proguanil once a day for 7 days after leaving the malaria-risk area. 
Take the dose at the same time each day with food or milk. 
Atovaquone/proguanil Side Effects and Warnings 
The most common side effects reported by travelers taking atovaquone/proguanil are abdominal pain, nausea, 
vomiting, and headache. Most travelers taking atovaquone/proguanil do not have side effects serious enough 
to stop taking the drug. Other antimalarial drugs are available if you cannot tolerate atovaquone/proguanil; 
see your health care provider.
Contraindications 
The following travelers should NOT take atovaquone/proguanil for prophylaxis (other antimalarial drugs are 
available; see your health care provider) (updated December 22, 2006):
children weighing less than 5 kilograms (11 pounds); 
pregnant women; 
women breast-feeding infants weighing less than 5 kilograms (11 pounds); 
patients with severe renal impairment; 
patients allergic to atovaquone or proguanil. 
Doxycycline (many brand names and generics are available)
Doxycycline is related to the antibiotic tetracycline.
Directions for Use 
The adult dosage is 100 mg once a day. 
Take the first dose of doxycycline 1 or 2 days before arrival in the malaria-risk area. 
Take doxycycline once a day, at the same time each day, while in the malaria-risk area. 
Take doxycycline once a day for 4 weeks after leaving the malaria-risk area. 
Doxycycline Side Effects and Warnings
The most common side effects reported by travelers taking doxycycline include sun sensitivity 
(sunburning faster than normal). To prevent sunburn, avoid midday sun, wear a high SPF sunblock, 
wear long-sleeved shirts, long pants, and a hat. Doxycycline may cause nausea and stomach pain. 
Always take the drug on a full stomach with a full glass of liquid. Do not lie down for 1 hour 
after taking the drug to prevent reflux of the drug (backing up into the esophagus).
Women who use doxycycline may develop a vaginal yeast infection. You may either take an over-the-counter
yeast medication or have a prescription pill from your health care provider for use if vaginal itching or 
discharge develops.
Most travelers taking doxycycline do not have side effects serious enough to stop taking the drug. 
(Other antimalarial drugs are available if you cannot tolerate doxycycline; see your health care provider.)
Contraindications
The following travelers should NOT take doxycycline (other antimalarial drugs are available; see your
health care provider):
pregnant women; 
children under the age of 8 years; 
persons allergic to doxycycline or other tetracyclines. 
Mefloquine (brand name: LariamTM and generic) 
Directions for Use
The adult dosage is 250 mg salt (one tablet) once a week. 
Take the first dose of mefloquine 1 week before arrival in the malaria-risk area. 
Take mefloquine once a week, on the same day each week, while in the malaria-risk area. 
Take mefloquine once a week for 4 weeks after leaving the malaria-risk area. 
Mefloquine should be taken on a full stomach, for example, after a meal. 
Mefloquine Side Effects and Warnings
The most common side effects reported by travelers taking mefloquine include headache, nausea, 
dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances.
Mefloquine has rarely been reported to cause serious side effects, such as seizures, depression, 
and psychosis. These serious side effects are more frequent with the higher doses used to 
treat malaria; fewer occurred at the weekly doses used to prevent malaria. Most travelers 
taking mefloquine do not have side effects serious enough to stop taking the drug. 
(Other antimalarial drugs are available if you cannot tolerate mefloquine; see your health care provider.)
Contraindications
Some travelers should NOT take mefloquine (other antimalarial drugs are available; see your health care provider):
persons with active depression or a recent history of depression; 
persons with a history of psychosis, generalized anxiety disorder, schizophrenia, or other major psychiatric disorder; 
persons with a history of seizures (does not include the typical seizure caused by high fever in childhood); 
persons allergic to mefloquine; 
Mefloquine is not recommended for persons with cardiac conduction abnormalities (irregular heartbeat). 
Primaquine (primary prophylaxis)
In certain circumstances, when other antimalarial drugs cannot be used and in consultation with malaria experts, 
primaquine may be used to prevent malaria while the traveler is in the malaria-risk area (primary prophylaxis).
Directions for Use
Note: Travelers must be tested for G6PD deficiency (glucose-6-phosphate dehydrogenase) and have a 
documented G6PD level in the normal range before primaquine use. Primaquine can cause a fatal hemolysis 
(bursting of the red blood cells) in G6PD deficient persons.
The adult dosage is 52.6mg salt (30mg base primaquine)/once a day. 
Take the drug 1-2 days before travel to the malaria-risk area. 
Take the drug once a day, at the same time each day, while in the malaria-risk area. 
Take the drug 7 days after leaving the malaria-risk area. 
Primaquine Side Effects
The most common side effects reported by travelers taking primaquine include abdominal cramps, nausea, and vomiting.
Contraindications
Some travelers should not take primaquine (other antimalarial drugs are available; see your health care provider):
persons with G6PD deficiency; 
pregnant women (the fetus may be G6PD deficient, even if the mother is in the normal range); 
women breast-feeding infants unless the infant has a documented normal G6PD level; 
persons allergic to primaquine. 
 
 Antimalarial Drugs Purchased Overseas 
  
You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured 
according to United States standards and may not be effective. 
They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs 
that are not safe to use. Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. 
CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, 
including deaths. You should avoid using antimalarial drugs that are not recommended unless you 
have been diagnosed with life-threatening malaria and no other options are immediately available.
 
 Protect Yourself from Mosquito Bites 
  
Malaria is transmitted by the bite of an infected mosquito; these mosquitoes usually bite between dusk and dawn. 
To avoid being bitten, remain indoors in a screened or air-conditioned area during the peak biting period. 
If out-of-doors, wear long-sleeved shirts, long pants, and hats. Apply insect repellent (bug spray) to exposed skin.
Choosing an Insect Repellent
For the prevention of malaria, CDC recommends an insect repellent with DEET (N, N-diethyl-m-toluamide) as the 
repellent of choice. Many DEET products give long-lasting protection against the mosquitoes that transmit 
malaria (the anopheline mosquitoes).
A new repellent is now available in the United States that contains 7% picaridin (KBR 3023). 
Picaridin may be used if a DEET-containing repellent is not acceptable to the user. However, there is much 
less information available on how effective picaridin is at protecting against all of the types of mosquitoes 
that transmit malaria. Also, since the percent of picaridin is low, this repellent may only protect 
against bites for 1-4 hours.
At this time, use of other repellents is not recommended for the prevention of malaria because there is 
insufficient data on how well they protect against the mosquitoes that transmit malaria.
Precautions When Using Any Repellent
Read and follow the directions and precautions on the product label. 
Use only when outdoors and thoroughly wash off the repellent from the skin with soap and water after coming indoors. 
Do not breathe in, swallow, or get repellent into the eyes or mouth. If using a spray product, apply to your face 
by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth. 
Never use repellents on wounds or broken skin. 
Pregnant women should use insect repellent as recommended for other adults. Wash off with soap and water after 
coming indoors. 
Repellents may be used on infants older than 2 months of age. 
Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's 
hands or around their eyes and mouth. 
Using Repellents With DEET
Do not get repellent containing DEET into the mouth. DEET is toxic if swallowed. 
Higher concentrations of DEET may have a longer repellent effect; however, concentrations over 50% provide no 
added protection. 
Timed-release DEET products, which are micro-encapsulated, may have a longer repellent effect than liquid 
DEET products. Re-apply as necessary, following the label directions. 
Using Repellents With Picaridin
Spray enough picaridin repellent to slightly moisten skin. 
Reapply repellents with picaridin (7% picaridin is the only product currently available in the United States) 
every 3 to 4 hours. Do not apply more than 3 times a day. 
Picaridin repellent causes moderate eye irritation. Avoid contact with eyes. If in eyes, wash with water for 
15 to 20 minutes. 
Other Recommended Anti-mosquito Measures
Travelers should take a flying insect spray on their trip to help clear rooms of mosquitoes. The product should 
contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes. 
Travelers not staying in well-screened or air-conditioned rooms should sleep under bed nets (mosquito nets), 
preferably nets treated with the insecticide permethrin. Permethrin both repels and kills mosquitoes as well as 
other biting insects and ticks. In the United States, permethrin is available as a spray or a liquid 
(e.g. PermanoneTM). Pre-treated nets, permethrin or another insecticide deltamethrin, are available overseas. 
For information on ordering insecticide-treated bed nets: www.travmed.com, phone 1-800-872-8633, fax: 413-584-6656; 
or www.travelhealthhelp.com, phone 1-866-621-6260. 
Protect infants (especially infants under 2 months of age not wearing insect repellent) by using a carrier 
draped with mosquito netting with an elastic edge for a tight fit. 
Clothing, shoes, and camping gear, can also be treated with permethrin. Treated clothing can be repeatedly 
washed and still repel insects. Some commercial products (clothing) are now available in the United States 
that have been pretreated with permethrin. 
 
 
  
Additional Malaria Information 
  
Frequently Asked Questions 
Guidelines for diagnosis and treatment (for clinicians) 
Preventing Malaria in the Pregnant Woman (Information for the Public) 
Preventing Malaria in the Pregnant Woman (Information for Health Care Providers) 
Preventing Malaria in Infants and Children (Information for the Public) 
Preventing Malaria in Infants and Children (Information for Health Care Providers) 
Prescription Drugs for Preventing Malaria (Information for the Public) 
Prescription Drugs for Preventing Malaria (Information for Health Care Providers) 
For information about other travel health risks, precautions, and vaccination recommendations, 
please see Health Information for Travelers to Southern Africa.