Do I need to be worried about malaria in South Africa?

Malaria in South Africa

From 2010 to 2018, South Africa has experienced varying degrees of success in reducing the malaria burden.

South Africa has made significant progress in controlling malaria, reducing malaria incidence from 11.1 to 2.1 total cases per 1,000 population at risk.

In 2010/2011, the incidence rate for local and unclassified cases only (excluding imported) was 0.87 cases per 1,000 population at risk.

Overall, malaria cases reduced from approximately 14,000 in 2014 to 5,800 in 2016 and increased to 30,000 during an epidemic in 2017 in Limpopo.

The country has achieved high coverage against set targets with effective malaria control interventions in the areas of case management, vector control, surveillance, epidemic preparedness and response (EPR) and health promotion.

Areas of risk

In South Africa, malaria is mainly transmitted along the border areas. 

Some parts of South Africa’s nine provinces (Limpopo, Mpumalanga and KwaZulu-Natal) include malaria areas.  Malaria transmission in South Africa is seasonal, with malaria cases rising in October, peaking in January and February, and waning towards May, according to the Department of Health.

In Limpopo Province, Vhembe and Mopani districts experience the highest burden of disease, while the remaining three districts (Waterberg, Sekhukhune and Capricorn) experience very low local transmission.

In Mpumalanga Province, transmission is highest in the Bushbuckridge and Nkomazi municipalities of Ehlanzeni District, Mpumalanga’s only endemic district.

As compared to the other endemic provinces, KwaZulu Natal districts (Zululand, Umkhanyakude and King Cetshwayo) have reported the lowest burden of malaria cases for the years 2013-2018. Gauteng Province reported the highest number of imported cases for this period.

Source: Department of Health

Prevention and cure

The A, B, C, D of malaria is a simple mnemonic:

A: Awareness

Malaria transmission occurs in Central and South America, sub-Saharan Africa, the Indian subcontinent, Southeast Asia, the Middle East and Oceania. It is transmitted by the bite of an infected female Anopheles mosquito and causes fever, chills, headache, muscle aches and a general ill feeling.

B: Bite prevention

Travellers should take protective measures to reduce contact with mosquitoes between dusk and dawn when Anopheles mosquitoes feed. Use insect repellents with up to 50% DEET, wear long sleeves, and sleep under mosquito nets and ceiling fans. Vital Protection®, a human friendly insecticide, can safeguard the user from mosquito bites.

C: Chemoprophylaxis

Travellers are urged consult their GP or travel doctor before departure to discuss appropriate chemoprophylaxis in the form of oral antimalarial tablets. Pregnant women and children have a higher risk of contracting malaria, so it is recommended that they do not enter a malaria area.

D: Drug treatment

Travellers who experience symptoms of malaria should present promptly on return if illness is suspected.

Early diagnosis of malaria by means of a blood test is essential to prevent complications. If caught early malaria can be treated with oral tablets, but severe cases may need to be hospitalised for

intravenous therapy

Common Myths

It is better not to take any prophylaxis, as it masks the symptoms and makes diagnosis difficult

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 can to multiply at phenomenal rates, and malaria can quickly progress quickly, and lead to severe complications and death.

There is this new deadly strain of malaria

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 cannot be cured

Malaria can indeed be cured with the appropriate drugs. Due to drug resistance to certain drugs, it is important to use the recommended drugs for the specific area.

Also, because most common drugs only deal with the blood and not the liver stages of the disease, the two malaria species that have dormant liver stages (vivax and ovale) may relapse. If the parasite species is not identified correctly, or if there were two species present in the blood, of which one was missed, malaria can recur, sometimes many months later. However, once the species has been correctly identified, the liver stage can be successfully treated with primaquine.

Only take prophylaxis while in a malaria area

The drugs available 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 four weeks after leaving a malaria area. Atovaquone-proguanil is an exception in that it acts primarily on the tissue stage and therefore one needs only to continue the course for seven days after leaving the area.

The drugs are worse than the disease

Antimalarials, like any other drug, do have side effects in 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.

If I take an antimalarial, there will be nothing left to treat me if I do get malaria

There are numerous different drugs and drug regimens 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.

I will be visiting the area outside of the malaria season, so I do not need prophylaxis

Although transmission decreases during the “off” season, infected mosquitoes may still be active in the offseason, just in lower concentrations. One still needs to take protective measures against mosquito bites, but not necessarily chemoprophylaxis.

Drinking Gin and Tonic or Rum will prevent mosquitoes from biting me, and will safeguard me against contracting malaria

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.

I wasn’t bitten, can I stop taking my prophylaxis?

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.


  • Department of Health: Republic of South Africa
  • The South African National Travel Health Network
  • Department of Health: Republic of South Africa: Malaria Elimination Strategic Plan for South Africa 2019-2023
  • The South African National Travel Health Network (SaNTHNeT)

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