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Malaria – prevention

Key points

  • Malaria is a serious disease but can be prevented.
  • You get malaria through being bitten by an infected mosquito.
  • The best way to prevent malaria is to take steps to ensure you don’t get bitten.
  • There are a number of antimalarial medicines that you can take to help prevent the disease.

Malaria is a preventable disease, but it can be serious and potentially life-threatening. You get it from the bite of a type of female mosquito, which infects you with a parasite called Plasmodium.

About malaria

Malaria is an infection that can cause serious illness and may be life-threatening. You get malaria from the bite of a type of infected female mosquito called Anopheles. They carry a parasite called Plasmodium, which goes to your liver and then infects your red blood cells.

The Anopheles mosquitoes that carry malaria usually bite at dusk and during the night. If you’re bitten by a mosquito that is carrying malaria, you will usually develop symptoms between seven and 18 days later. However, in some people the symptoms may not develop for up to a year.

Symptoms of malaria include:

  • a fever, sweating and chills
  • a headache
  • aching muscles
  • diarrhoea
  • a cough
  • feeling generally unwell

The symptoms of malaria can get worse very quickly and therefore it’s important to get immediate treatment. If malaria isn’t treated, you may develop more serious health problems, such as fits, difficulty breathing and loss of consciousness. If you have been to a country where there is malaria and develop any symptoms or feel at all unwell, get medical advice straight away.

There are four main types of Plasmodium parasite that infect humans. These are Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae. Of these, Plasmodium falciparum is the most severe form and is responsible for most deaths from malaria.

Which countries have malaria?

The mosquitoes that carry malaria are found in more than 100 different countries. This includes countries in Africa, Asia, Central and South America, and parts of the Middle East. Malaria is very common in these countries. As many as 250 million people across the world get malaria every year and up to one million die from the disease. It’s mainly children living in Africa who die from malaria.

Illustration showing the distribution of malaria throughout the world

You can’t get malaria in the UK but about 1,500 people are treated for the infection every year in the UK. These people will have been infected while travelling or living in a country where malaria is found.

Immunity to malaria

If you live in an area where there is malaria, you may gradually build up some immunity to the disease. This is because you’re continuously exposed to it. However, any immunity you may have built up when living in a country with malaria quickly goes away once you leave it.

If you usually live in a country where there is no malaria, such as the UK, you’re very unlikely to be immune to it. Therefore, if you’re travelling to a country where malaria is present, it’s important that you take steps to prevent it. You can help to protect yourself against the disease by following the ABCD of malaria prevention.

  • Awareness of risk – find out if the country you’re visiting has malaria.
  • Bite avoidance – take steps to reduce your risk of getting bitten by mosquitoes.
  • Chemoprophylaxis – this means taking medicines to prevent malaria if appropriate.
  • Diagnosis – see a doctor straight away if you have any symptoms while you’re abroad or within a year of returning from a malaria zone.

Preventing bites

The key to preventing malaria is to protect yourself against being bitten by mosquitoes. There are some factors that increase your risk of being bitten. The main ones are listed below.

  • Visiting a country that is warm and wet. Mosquitoes are common in places where the temperature is between 20ºC and 30ºC and there is a lot of moisture in the air (high humidity).
  • Going on a long trip. The longer you stay in an area where there are lots of mosquitoes, the more likely you are to get bitten.
  • Staying in a rural area or village rather than a town or city.
  • It being the rainy season. Mosquitoes breed more at this time so there are more around.
  • Staying somewhere that doesn’t have air conditioning and that can keep out mosquitoes.
  • Being outside between dusk and dawn. This is the time when this type of mosquito is most active.

You can reduce your risk of being bitten by ensuring you’re well prepared and taking a number of precautions. The main ones are listed below.

  • Wear loose-fitting clothes with long sleeves, long trousers and socks if you’re out at dusk or at night. Tucking your trousers into your socks will make it more difficult for mosquitoes to bite you. You can also buy clothes that have been treated with insect repellent.
  • Apply an insect repellent containing diethyltoluamide (DEET) to your skin and clothes. Stronger preparations last for longer and need to be put on less often. For example 50 percent DEET will last for up to 12 hours on your skin; 20 percent DEET will last for up to three hours. If you’re allergic to DEET, you can use repellents that contain lemon eucalyptus or chemicals called icaridin and IR3535 (3-ethylaminopropinate). However, these aren’t as effective as DEET. Don’t use oil of citronella as it’s not thought to be effective. See our frequently asked questions for more information.
  • Use a mosquito net over your bed. Make sure that it’s impregnated with an insecticide and doesn’t have any holes in it. Ideally the net should to be long enough to reach the floor but if not, tuck it in under the mattress.
  • Spray your room with an insecticide before you go to bed.
  • Use an electrical device that vaporises an insect repellent tablet in your room at night.
  • Cover doors and windows with fine mesh netting.
  • Use air conditioning or a fan in your room, as mosquitoes are less active in cooler temperatures.

Medicines to prevent malaria

There are a number of different medicines that can help to prevent malaria. It’s important to remember that these aren’t completely effective so you also need to follow the advice for preventing mosquito bites. Your GP will prescribe you a medicine based on a number of things. These include:

  • your general health
  • whether you’re taking any other medicines
  • where you’re travelling to
  • what you will be doing
  • how long you will be in a malaria zone

It’s important to see your GP or a travel health clinic well in advance of when you travel – six to eight weeks if possible. This is because depending on what medicine you’re prescribed, you may need to start taking it several weeks before you go abroad. You will need to take the medicines before you travel, while you’re away and when you come back. The length of time and how often you need to take the medicines will vary. It’s very important to finish the course of medicines prescribed for you.

It’s important to be aware that no medicine for preventing malaria is totally effective. However, you can reduce your risk of getting the disease if you take the most appropriate one for you as instructed.

In the past, a medicine called chloroquine was often used to prevent malaria. This is because it has very few side-effects and can safely be taken by most people including children and pregnant women. However, malaria caused by Plasmodium falciparum in most parts of the world is now resistant to chloroquine. Therefore, you will probably be prescribed an alternative. Some of the common medicines are described here.

Doxycycline

You may be prescribed doxycycline if you’re travelling at short notice. This is because you only need to start taking it one to two days before going to an area where there is malaria. You will need to take it for four weeks after returning. This is to ensure that any parasite that may be left in your body is killed.

Side-effects of doxycycline can include feeling sick, vomiting and diarrhoea. Children under 12 and pregnant or breastfeeding women shouldn't take doxycycline.

Doxycycline increases your skin’s sensitivity to the sun. Therefore, it’s very important that you take extra care to protect yourself from the sun by using a high factor sunscreen or covering up with clothing.

Proguanil with atovaquone

You also only need to start taking these medicines one to two days before you go to a malaria area. You must continue taking them for a week after coming back. The side-effects can include headaches, feeling sick, vomiting and diarrhoea.

Mefloquine

You only need to take mefloquine weekly, not daily, so it may be preferable if you’re going away for a long time. However, you will need to start taking it two to three weeks before travelling. This is to ensure you don’t have any severe side-effects, which can include sickness, diarrhoea, headache, dizziness and disturbed sleep. You need to continue taking it for four weeks after you come back. You won’t be prescribed mefloquine if you have epilepsy or certain mental health conditions. Don’t try to become pregnant while taking mefloquine or for three months after you stop taking it.

You may be prescribed other combinations of these medicines, for example chloroquine and proguanil. This will vary according to your general health, where you’re going and whether malaria in that area is resistant to any medicines.

Emergency standby treatment

If you’re travelling to a remote place where you won’t have easy access to medical help, your GP may prescribe emergency standby treatment for you. This isn’t used instead of the usual medicines to prevent malaria and you should already be taking these. It’s recommended for use if you think you may have developed malaria despite taking preventative medicines and can’t get to a doctor. Ask your GP for more information.

Malaria and pregnancy

You’re at an increased risk of developing severe malaria if you’re pregnant. Therefore, you shouldn’t travel to an area where there is malaria unless it’s absolutely necessary.

If you do have to travel, it’s particularly important that you take all the measures to protect yourself from mosquito bites. You also need to take medicines to prevent malaria exactly as prescribed. Being pregnant means you’re more likely to get bitten, so protecting yourself is very important. If you can, stay indoors between dusk and dawn. Seek urgent medical attention if you think you develop any of the symptoms of malaria while pregnant. Ask your GP or travel health clinic for more information.


Reviewed by Polly Kerr, Bupa Health Information Team, February 2014.

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For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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