Malaria is a serious and potentially deadly disease. Before you travel, seek expert advice according to your itinerary (rural areas are especially risky) and on medication and side effects. At the time of writing, most of South India was considered a low to no risk area, apart from the Mangaluru (Mangalore) region, which was declared high risk in mid-2018.
Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms, such as headache, diarrhoea, cough or chills, may also occur. Diagnosis can only be properly made by taking a blood sample.
Two strategies should be combined to prevent malaria: mosquito avoidance and antimalarial medications. Most people who catch malaria are taking inadequate or no antimalarial medication.
Travellers are advised to prevent mosquito bites by taking these steps:
- Use a DEET-containing insect repellent on exposed skin. Wash this off at night, as long as you are sleeping under a mosquito net. Natural repellents such as citronella can be effective, but must be applied more frequently than products containing DEET.
- Sleep under a mosquito net impregnated with pyrethrin.
- Choose accommodation with proper screens and fans (if not air-conditioned).
- Impregnate clothing with pyrethrin in high-risk areas.
- Wear long sleeves and trousers in light colours.
- Use mosquito coils.
- Spray your room with insect repellent before going out for your evening meal.
There are a variety of medications available:
Chloroquine & Paludrine combination Limited effectiveness in many parts of South Asia. Common side effects include nausea (40% of people) and mouth ulcers.
Doxycycline (daily tablet) A broad-spectrum antibiotic that helps prevent a variety of tropical diseases, including leptospirosis, tick-borne disease and typhus. Potential side effects include photosensitivity (a tendency to sunburn), thrush (in women), indigestion, heartburn, nausea and interference with the contraceptive pill. More serious side effects include ulceration of the oesophagus – take your tablet with a meal and a large glass of water, and never lie down within half an hour of taking it. It must be taken for four weeks after leaving the risk area.
Lariam (mefloquine) This weekly tablet suits many people. Serious side effects are rare but include depression, anxiety, psychosis and seizures. Anyone with a history of depression, anxiety, other psychological disorders or epilepsy should not take Lariam. It is considered safe in the second and third trimesters of pregnancy. Tablets must be taken for four weeks after leaving the risk area.
Malarone A combination of atovaquone and proguanil. Side effects are uncommon and mild, most commonly nausea and headache. It is the best tablet for scuba divers and for those on short trips to high-risk areas. It must be taken for one week after leaving the risk area.