Travelers guide to malaria situation in south africa 2010

This guide has been prepared by the Malaria Research Programme, of the Medical Research Council in South Africa. We are a malaria research group located in Durban, Kwazulu-Natal, along the Indian Ocean.
Disclaimer: The information is provided to inform you about the malaria situation in South Africa. We do not offer clinical advice in this guide and you should always consult your travel doctor for travel related medical advice specific to your needs. (Updated May 2010)
Download the guide as a pdf

Malaria Risk

Malaria risk for visitors travelling to South Africa during June and July 2010 should be low (Blumberg, 2010). We have provided a map of major cities in South Africa and the risk of malaria transmission in these cities (Map 1).

2010 Risk Map South Africa
Map 1. Major Cities in South Africa and Malaria Risk

Is there Malaria in South Africa?

Will I see mosquitoes while I’m in South Africa?

 

Malaria risk zones South Africa

Map 2. Malaria Risk areas in South Africa

Remember the “ABC” of Malaria prevention

Awareness – be aware of the risk
Bite prevention – avoid being bitten by mosquitoes, take the necessary precautions
Chemoprophylaxis – use prophylaxis to protect yourself against malaria
Diagnosis - insist on diagnostic tests if fever develops a week or more after exposure to malaria
Effective – malaria treatments are available and it is important to get the appropriate treatment specific to your circumstances

A: Awareness of malaria risk: what is my risk of getting malaria in South Africa?

Table 1: Summary of malaria risk periods and recommended precautions

Type of Malaria Risk Area

Time of year

Recommendation (from Department of Health Travel Health Information Booklet, 2007) 

Low risk when malaria transmission is low

End of May to end of September – cold dry months

No chemoprophylaxis recommended.
Take precautions against mosquito bites.

High risk when malaria transmission is high

October to May – wet summer months.
Throughout the year for high risk people

Chemoprophylaxis and precautionary measures against mosquito bites are recommended throughout the year.
High risk people should avoid high risk malaria areas if at all possible. People at high risk are elderly people, babies and children under 5 years, pregnant women, splenectomised patients and immuno-compromised people

What is my risk of getting malaria in countries neighbouring South Africa?

According to the World Health Organisation, the malaria situation in countries neighbouring South Africa is listed below (WHO, 2010).

Table 2: Malaria risk in countries neighbouring South Africa

Country

Malaria Risk and Duration

Angola

Throughout the year in the whole country

Botswana

From November to May-June in the northern parts of the country: Boteti, Chobe, Ngamiland, Okavango, Tutume districts/ subdistricts

Malawi

Throughout the year in the whole country

Mozambique

Throughout the year in the whole country

Namibia

From November to June in the following regions: Ohangwena, Omaheke, Omusati, Oshana, Oshikoto and Otjozondjupa. Risk throughout the year exists along the Kunene river and in Caprivi and Kavango regions.

Swaziland

Throughout the year in all low veld areas (mainly Big Bend, Mhlume, Simunye and Tshaneni)

Zambia

Throughout the year in the whole country, including Lusaka

Zimbabwe

From  November through June in areas below 1200 m and throughout the year in the Zambezi valley. In Bulawayo and Harare, the risk is negligible

B: Avoid mosquito bites: what precautions can I take when entering a malaria endemic area?

These are some of the precautionary measures you can take to avoid being bitten by mosquitoes:

C: Compliance with Chemoprophylaxis, when indicated: what should I do about chemoprophylaxis?

D: Early Detection of malaria

E: Effective treatment

Malaria treatment in South Africa

References

Department of Health (2009) Guidelines for the treatment of malaria in South Africa. Click here
http://www.doh.gov.za/docs/factsheets/guidelines/malaria/treatment/2009guidelines-a.pdf

Department of Health (2009) Guidelines for the Prevention of malaria in South Africa http://www.doh.gov.za/docs/factsheets/guidelines/prevention_malaria09.pdf

Department of Health (2007) Travel Health Information Booklet for Travellers within South Africa

Baker, L. (2009) Malaria Prophylaxis: make the right choice for travelers with special  circumstances. South Afr J Epidemiol Infect. 24 (4).
http://www.sajei.co.za/index.php/SAJEI/article/view/193/212

Blumberg, L. (2010) The 2010 FIFA World Cup: Communicable disease risks and advice for visitors to South Africa. Journal of Travel Medicine.17 (3). 150-152
http://dx.doi.org/10.1111/j.1708-8305.2010.00413.x

World Health Organisation. International Travel Health (2010) http://www.who.int/ith/ITH2010countrylist.pdf

Resources

Common Myths

This is incorrect. Prophylactic drugs suppress parasite development, and therefore, even if not totally effective (due to partial drug resistance or non-compliance), symptoms tend to take longer to appear, may be less severe at first and development of complications is retarded. In the complete absence of drugs, parasites are able to multiply at phenomenal rates, and malaria can quickly get out of hand, and lead to severe complications and death.

Cerebral malaria is not a new strain; it is a complication of untreated P.falciparum malaria. Early diagnosis and appropriate treatment should ensure that no one gets cerebral malaria.

Malaria can indeed be cured with the appropriate drugs. Due to drug resistance to certain drugs, it may take several attempts with different (combinations of) drugs to effect a complete cure.

The drugs that we have to prevent malaria are known as blood schizontocides, which means that they work on the parasite once it enters the red blood cells. This does not occur until 10-14 days after being bitten by an infected mosquito. If the drug is stopped before the parasites reach the blood cells, there will not be enough in the blood to kill the parasites and the prophylaxis will fail. It is therefore extremely important to continue taking prophylaxis for 4 weeks after leaving a malaria area.

Antimalarials, like any other drug, do have side effects on some people, and in varying degrees. However only 15-20% of people experience side effects, and these are usually tolerable, with severe adverse reactions being rare. Malaria is potentially fatal and causes severe illness and discomfort which could land you in hospital and out of action for weeks.

There are numerous different drugs and drug regimes available for the fast and effective treatment of malaria. The use of one chemoprophylactic, does not exclude the future use of another antimalarial should the need arise.  

Although transmission decreases during the “off” season, infective mosquitoes may still be active in the off season, just in lower concentrations. One still needs to take protective measures.

There is no scientific evidence that either will protect you against mosquito bites. Malaria is a potentially fatal disease that requires proper preventative measures to be implemented.

The female Anopheles mosquito is not known as 'the silent killer' for nothing. She does not buzz around your head at night, irritating you. You may not be aware of her presence at all. The reaction to her bite may also not be as pronounced as it is with other bloodsucking insects and you may be unaware of having been bitten.