When preparing for a safari to northern Botswana, including Chobe National Park, Moremi, Linyanti and the Okavango Delta, the Center for Disease Control (CDC) recommends numerous precautions including Hepatitis A and Hepatitis B and Typhoid. Also recommended are anti-Malarial drugs. From my experience, no one seems to my the immunizations shots, but the anti Malaria medications seem to create a fair amount of debate, so I thought I would relate some general information and my personal experience.
Let me be 100% clear, on all of my trips to the region I take my doctors recommended anti-malarial medications. Further, my 26 year old son also has taken his doctor prescribed treatments. Each of us have taken different medications so I can relate the experiences from two of the common medications. Let me also be 100% clear that regardless of the comments in this article, I recommend you visit http://wwwn.cdc.gov/travel/destinations/botswana.aspx to get the latest CDC recommendations.
With our case, one trip was in 2007 and one was in 2009. Both times we were driving during July (Southern Africa’s winter) with a group of about a dozen South African friends from Johannesburg up to Kasane for 12 days in Chobe. All of our fellow travelers were seasoned safari travelers, going several times per year to destinations such as Etosha, Pilanesberg and Sabi Sands. On both trips, our South African friends laughed at the fact that we were taking the medications. Comments included:
- “Don’t you worry about the side effects?”
- “The cure for malaria is much easier to tolerate than those chemicals you are taking”
- “You’ll never see mosquitoes in such a dry area in the winter”
- “All of the lodge rooms will have screens as well as mosquito nets over the beds if you’re really concerned”
To my knowledge, no one in our party either trip took medications except my son and me. I must admit, I saw numerous insects on each trip, but I did not actually see a mosquito. Contrary, to their retorts, one lodge did not have screens nor did it have mosquito nets for the beds! Regardless, I am still happy I took the meds a plan to each time I go to a malaria region.
Chobe National Park is a Malaria Region!
From the CDC website:
CDC site info:
Areas of Botswana with Malaria: North of 22°S in the northern provinces of Central, Chobe, Ghanzi, and Ngamiland, including safaris to the Okavango Delta area. None in the city of Gaborone.
If you will be visiting an area of Botswana with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:
- Taking a prescription antimalarial drug
- Using insect repellent and wearing long pants and sleeves to prevent mosquito bites
- Sleeping in air-conditioned or well-screened rooms or using bednets
All of the following antimalarial drugs are equal options for preventing malaria in Botswana: Atovaquone/proguanil, doxycycline, or mefloquine. For information that can help you and your doctor decide which of these drugs would be best for you.
My antimalarial experience
The medication I was prescribed was Mefloquine (brand Name Lariam™ and generic). Per my doctor, I was to take it once per week beginning one week prior to my trip and continuing for 4 weeks after my trip. My medical insurance provider, in their wisdom, allowed a total of 5 pills under the plan (I guess I was approved for a one night stay), so the additional 2 pills were out of my pocket. I can’t recall the cost, but it was reasonable.
Per my script, I took the first pill one week prior to departure. That day I had some mild dizziness, but not other side effects. For the rest of my pills, I took them one week apart at supper time. The evening I took the second and third pill, I had some very vivid and quite strange dreams but no other side effect. I guess my body became tolerant as I had no side effect for the remainder of my dosage.
My son’s antimalarial experience
My son’s doctor prescribed Atovaquone/proguanil (brand name: Malarone ™). None of his medication was covered under his insurance plan. The cost of his prevention was ~$75. His script called for:
- The adult dosage is 1 adult tablet (250 atovaquone/100 mg proguanil) once a day.
- Take the first dose of atovaquone/proguanil 1 to 2 days before travel to the malaria-risk area.
- Take your dose once a day during travel in the malaria-risk area.
- Take your dose once a day for 7 days after leaving the malaria-risk area.
- Take your dose at the same time each day and take the pill with food or milk.
He followed the script in detail. Strangely, he also suffered from vivid, almost hallucinogenic dreams. He had no other side effects.
In our case, the fear of side effects was much ado about nothing. The dreams were vivid, but not bad and almost fun. We enjoyed sharing our weird stories while in the bush the next morning.
More General Information about Malaria
Malaria, spread by the Anopheles mosquito, kills millions of people in tropical and sub-tropical Africa every year. As a visitor to these areas you are also at risk of getting this disease. With the right precautions you can minimize your chances of getting malaria.
Tips on how to avoid malaria:
- Find out if you are traveling to an area where malaria is endemic. There are very few countries in Africa that are malaria-free, especially in sub-Saharan Africa. The US Center for Disease Control keeps a current map of the malaria risk areas, check it here.
- If the answer to the above is yes, then visit your doctor or travel clinic at least 6 weeks before your departure and get a prescription for malaria pills (prophylactics). Ask your doctor to provide you with the correct dosage of medicine for both prevention and treatment of malaria. It’s unlikely that your health insurance will cover the prescription in the US.
Commonly prescribed malaria prophylactics and treatments include:
- Primaquine (sometimes post-travel)
- Start taking your malaria pills before you depart as instructed by your doctor – usually 1 week (sometimes longer). Make sure you take them exactly on schedule without missing doses. Children under 12 and women who are pregnant should consult their doctors before taking any anti-malarial medications.
Common side effects include photosensitivity when taking doxycycline and neuropsychiatric side effects when taking mefloquine.
Check with your doctor if you have any concerns or questions about this.
- Obviously the best way to avoid malaria is to avoid getting bitten by mosquitoes. The following tips will help you do just that. It’s difficult to avoid every single bite and still enjoy your safari or time at the beach, so take malaria prophylactics as well.
Tips for avoiding mosquito bites:
- Use a mosquito net at night, the most effective are those treated with an insect repellent. Bring one with you, they are very light and will easily fit in your luggage.
- Spray your room before you go to sleep with insect repellent. A brand called Doom is widely available and very effective in Southern Africa. Out lodge provided this. Mosquito coils are also highly effective and burn for up to eight hours. Place the coil beside or under your bed.
- Stay in rooms with screens on the windows, fans and/or air conditioning.
- Switch off all lights while you are sleeping since mosquitoes are attracted to light.
- Avoid wearing strong after-shave or perfume, the smell will attract mosquitoes.
- Wear long pants and long-sleeved clothing especially around dawn and dusk when the anopheles mosquitoes are most active.