Malaria, Prophylaxis
Description General Measures Medicine Treatment ICD-10 codes: Z29.1 DESCRIPTION In South Africa, malaria chemoprophylaxis should be used, together with preventive measures against mosquito bites, from September to May in moderate-risk malaria-endemic areas. Risk areas in South Africa are shown in the map included in the National Guidelines for the Prevention of Malaria (2018) found at
Description
General Measures
Medicine Treatment
ICD-10 codes: Z29.1
DESCRIPTION
In South Africa, malaria chemoprophylaxis should be used, together with preventive measures against mosquito bites, from September to May in moderate-risk malaria-endemic areas. Risk areas in South Africa are shown in the map included in the National Guidelines for the Prevention of Malaria (2018) found at: https://www.nicd.ac.za/wpcontent/uploads/2019/03/National-Guidelines-for-prevention-of-Malaria_updated08012019-1.pdf
Malaria chemoprophylaxis is recommended for persons intending to travel to malaria-endemic areas within and outside of South Africa. There are moderate- and high-risk areas in neighbouring countries. Chemoprophylaxis must be started before entering the malaria area, and continued for a period of time after exiting the malaria area.
GENERAL MEASURES
Always use preventative measures, in addition to pharmacological therapy, against mosquito bites between dusk and dawn:
- Use di-ethyl 3-methylbenzamid (DEET) insecticide impregnated mosquito nets, insecticide coils or pads.
- Apply insect repellent to exposed skin and clothing. Aim for 30% DEET. Don’t get on lips, eyes, breaks in skin.
- Wear long sleeves, long trousers and socks, if outside, as mosquitoes are most active at this time.
- Visit endemic areas only during the dry season.
MEDICINE TREATMENT
Prophylaxis
CAUTION
Immunocompromised patients, pregnant women and children <8 years of age should avoid visiting malaria-endemic areas, as they are more prone to the serious complications of malaria.
However, if this cannot be avoided, malaria chemoprophylaxis should be considered (as recommended by the National Guidelines for the Prevention of Malaria (2018) found at: https://www.nicd.ac.za/wp-content/uploads/2019/03/National-Guidelines-for-preventionof-Malaria_updated-08012019-1.pdf
However, as only doxycycline is provided in the public sector, alternative options for pregnant women and children <8 years of age need to be purchased in the private sector.
Non-pregnant adults:
- Doxycycline oral, 100 mg daily.
- Take from 2 days prior to entering endemic area until 4 weeks after exiting the endemic area.
LoE:IIIb4
Children ≥8 years of age:
- Doxycycline oral, 2 mg/kg/dose daily.
- Take from 2 days prior to entering endemic area until 4 weeks after exiting the endemic area.
LoE:IVb5
Note:
Doxycycline is contra-indicated in pregnant women, and in children <8 years of age.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.1_20 January 2025
Chapter 10: Infections and Related Conditions_10.7 Malaria_10.7.3 Malaria, prophylaxis