It's something you talk to a travel specialist or a tropical disease specialist, not your GP. Where you are going decides what drugs you need, protection that works in one part of the world won't necessarily work in another.

I have been infected while on chloroquin in Africa--I knew it was only partially effective but I was allergic to what I should have been taking.

All anti-malaria drugs need to be taken before you enter the area and for some time after you leave--my mother came down with malaria something like a couple of weeks after we returned home because she didn't keep on with the drugs long enough.

The cases I have seen (including my own) haven't been all that bad but it certainly can be more serious--the last time my malaria flared up the doc I went to (GP but he worked with Doctors without Borders and had plenty of clinical experience with it.) wasn't sure it was really malaria because given the time since onset (I had mistaken it for allergies at first. Unfortunately, one symptom is stupidity.) he thought I would have been in the hospital. (I had driven myself to his office. Out of the question during a cycle but between them it wasn't a problem.)

I have heard of strains that can kill in 24 hours, though. Don't take chances!



P.S. I don't know if chloroquin is still used at all. If it is, get it in a western country, not Africa. It's incredibly vile tasting, you want coated tablets or else capsules, not the cheap version that's simply tableted.

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Malarone is better, but about $7 per daily pill plus you have to take it for a few days before and after.

The other drugs can have major side effects...my wife's headache was so bad that she had to go to the doctor.

I would take the drugs, but risk of infection is not as big of a deal as you would think. Many people work on these areas for years with no problem.

Artesonate is probably the most widely used anti-malarial medication in Africa nowadays. It is likely a prescription drug officially, but you can buy Chinese ripoffs from hawkers at traffic lights in most major African cities.

Works like a charm and hasn't killed me yet. Costs around 25c for a 6-day course (more if you look foreign and the vendor thinks he can rip you off).

Only place chloroquin is still used is in parts of Central America (lowlands of Guatemala). It is vile tasting but you only take it weekly. I tried to hide the taste by mixing it up with apple sauce for my 2 year old daughter and 14 year later, she still will not touch apple sauce!

Prices in Guatemala are a fraction of the cost found in the US so it comes down to a bitter taste or a bitter bill.

Many US insurance companies now cover Malarone. If yours doesn't, check prices at Canadian pharmacies ...I think I've paid $4-$5 a pill through them.

YMMV, and I'm not a medical doctor, but in my experience the degree of precautions recommended decreases with how well your doctor is familiar with malaria. Here in Singapore, which has both top-notch health care and extensive first-hand knowledge of tropical diseases, most doctors recommend against malaria meds unless you're going to spend several weeks in rural areas in the wet season. The effective drugs have pretty unpleasant side effects, and quite a few people I know who live in highly malarial areas (eg. rural Zambia) also adopt B747-437B's approach -- live your life normally and cure it if you get ill.

The fact that Zambia has about a 20%-25% HIV infection rate and the leading cause of death isnt AIDS, but rather malaria, might indicate that isnt necessarily great advice.

I've used a variety of different malaria medications, and my understanding of the most popular options is (warning, I'm not a doctor!):

1. Chloroquine. Cheap, easy, few side effects, but only works in a very few areas (in most regions the malaria is resistant).

2. Larium. This is relatively cheap, but can lead to extremely disturbing psychotic side effects (extremely bloody dreams, hallucinations, etc). These side effects are far more common than the CDC claims -- from my experience I'd say something like 25% of people experience them. Those with a history of depression are particularly at risk.

3. Doxycycline. Cheap and widely used. Side effects are photosensitivity (you will sunburn so fast with it).

4. Malarone. Very expensive, but probably the best for short trips. Very limited side effects, and you don't have to take it as long before/after as some of the other drugs.

I've found that most primary care docs are not very familiar with travel medicine; chances are they'll look up stuff when you ask. I've gotten incorrect/out of date info (Lariam for a mefloquine resistant region, for example). At least here you'll be talking to people with experience.

I've seen people with psychological side-effects from Lariam. Not fun, especially since it stays in your system for over a week. Is there any reason to take this over Malarone (other than price and laziness)?

It has daily dosing, but is that really a problem?

Stay away from LARIUM if you can. It gave me tremendous psycho-dreams, with very vivid colors. It's the only time I have ever had an anxiety attack....and that, while flying in a small prop over the Masai Mara and sitting at the exit door.

Many of the people we met in Africa were on larium. Since you start it x number of days before your arrival in the affected area, everyone seemed to be on a different schedule. So, at breakfast each morning, the discussion would eventually turn to "OK....who took their larium yesterday....and what kind of dreams did you have."

One of the tourists was an MD, and she started getting anxiety attacks so badly that when we got back into a city (Nairobi? or Jo'burg) she actually went to see a doc to get some sedatives.

There are many sites and blogs that document the side effects!

I find it odd that people are quibbling about the essentially trivial costs of visiting the proper MD and taking even the most expensive meds. Really, is this going to increase the cost of the trip by >5%?

Personally I don't see any reason other than price and laziness to take Larium rather than Malarone. But the price difference can be substantial ($5/day) if you're going to be there for a while. I realize this is a small fraction of the cost of most trips, but if you're going to live in Africa or visit there for research for 6 months or something it gets to be a big expense (and an unnecessary one if you are lucky enough to not have severe side effects from Larium or doxycycline).

I believe there is also some concern about potential harmful consequences of taking Malarone for more than 3 months at a stretch. I'm not sure what these are, but that's what I've heard.

I help set up community malaria clinics in rural & remote India where the incidence of malaria can be above 50% in the local population (asymptomatic).

If you've been living in Indian cities, for the most part you will not have seen the effects of malaria. Your experience should not keep you from doing the right thing. You are only in Africa for the length of a safari. Take the best medicine available to you (hopefully it's malarone). If you are not there long term, you shouldn't worry about the cost or any long term side effects. You should worry about a killer called malaria. Even if you get treated, you are hammering your body with this parasite. Some people take months to get really better. That's like going on a safari by foot with no gun. You might survive, you might have a good time, but why take the risk? You don't hear of a million people every year getting eaten by lions or stampeded by elephants, so obviously the risk from malaria is far, far greater.

I took Lariam when I visited a friend who lives way out in rural Zambia. (FWIW, my doc in Singapore thought it was unnecessary, but gave in when I insisted.) Once I arrived, the local expats found it funny that I was taking it for a week-long trip, as none of them were and they'd been there years. Occasionally they got infected, but they shook it off with the same nonchalance that people in the West use to talk about the flu, which also kills millions of people in a bad year.

At the end of the day, malaria kills people with no access to proper medical care, which regrettably includes about 90% of Zambians. But if you're wealthy enough to be able to afford a return plane ticket and travel insurance, your odds of dying of malaria are very low, as long as you keep an eye out for symptoms and get it treated fast.

I agree with jpatokal that the main reason why malaria is such a killer is not that it is extremely dangerous, but because the areas that have been too poor to eradicate the disease are areas where people can't afford the pills to cure it. That said, I had a friend who spent a year in Burkina Fasa who almost died because he came down with malaria & dysentary at the same time, and was too sick for some days to get himself on a bus to get to a doctor to get the medication he needed.

For OP, to answer some of your original question, I would go to a REI or outdoors camping store and they will sell mosquito nets and sprays for your clothing (permethrin I think, rather than deet).