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Malaria is a life-threatening disease caused by a parasite (in South Africa, Plasmodium falciparum) that is transmitted through the bite of infected mosquitoes. In the human body, the parasites multiply in the liver and then infect the red blood cells.


Malaria is common in many parts of the world and is one of the six major causes of death from communicable diseases. 90% of the world’s annual malaria deaths occur in Africa. Between 2015-2019 South Africa had between about 10 000 and 30 000 cases of malaria per year. Here, we will discuss the symptoms, diagnosis, and treatment of malaria in South Africa.

Malaria Distribution in South Africa

Malaria in South Africa is primarily found in three provinces, namely Mpumalanga, Limpopo, and KwaZulu-Natal. These provinces are in the northeastern part of South Africa and share borders with countries where malaria is endemic, such as Mozambique, Zimbabwe, and Swaziland. Within these provinces, malaria transmission occurs mainly in rural areas and is more prevalent during the summer months from September to May. The risk of malaria transmission in urban areas of South Africa is generally low. However, travellers to rural or remote areas of these provinces should take precautions to avoid mosquito bites and malaria infection. It is important to note that the risk of malaria transmission can change depending on various factors, such as seasonal changes, weather conditions, and mosquito control efforts. Therefore, it is always advisable to check with local health authorities or travel clinics for updated information on the risk of malaria in specific areas of South Africa.

South African Malaria Risk Map December 2018


Malaria diagnosis typically involves clinical assessment, laboratory testing, and evaluation of the patient’s medical history and travel history.

Clinical assessment involves evaluating the patient’s symptoms which usually appear around a week after being bitten by an infected mosquito. Some of the common symptoms of malaria include:

  • High fever
  • Chills and sweats
  • Headache
  • Nausea and vomiting
  • Muscle aches and pains
  • Fatigue

A physical examination may also show an enlarged spleen or liver.

Laboratory testing is the most reliable method of diagnosing malaria. Blood tests are used to detect the presence of the malaria parasite in the patient’s blood. The main blood tests available include:

  1. Rapid diagnostic tests (RDTs). These are simple and inexpensive tests that can provide results within 15 to 20 minutes. They work by detecting specific proteins produced by the malaria parasite in the patient’s blood. 
  2. Thick and thin blood smears are more complex tests that involve staining a blood sample and examining it under a microscope to detect the presence of the parasite.
  1. Polymerase chain reaction (PCR) tests. These are molecular tests that detect the DNA of the malaria parasite in the patient’s blood. They are more sensitive than other tests and can detect the parasite even at low levels. However, they are more expensive and require specialised equipment and trained personnel.


The treatment for malaria involves antimalarial medication, which is usually taken for several days. The type of medication and the length of treatment will depend on the severity of the infection and the species of the parasite that is causing the infection. In some cases, hospitalisation may be necessary, especially for severe malaria cases.

If left untreated, malaria can lead to complications such as anaemia, kidney failure, and coma. In severe cases, it can even be fatal.


Malaria prevention, also known as malaria prophylaxis, has been implemented to reduce the risk of malaria infection. Malaria prophylaxis involves several processes:

Antimalarial medication:

Antimalarial medication is the most effective way to prevent malaria. The type of medication prescribed will depend on the area you are travelling to, your medical history, and other factors. Some commonly prescribed antimalarial medications include doxycycline, atovaquone/proguanil, and mefloquine. These medications must be taken before, during, and after travel to the malaria-endemic area. It is important to complete the full course of medication, even if you feel fine.

Mosquito control measures:

Preventing mosquito bites is an essential aspect of malaria prophylaxis. You can use insect repellents that contain DEET or picaridin to reduce the risk of mosquito bites. It is also recommended to wear long-sleeved clothing and trousers during the evening and night when mosquitoes are most active. You can also use mosquito nets, especially if you stay in an area without screened windows and doors.

Environmental control:

Eliminating or reducing the breeding of mosquitoes in the environment is another important measure to prevent malaria. This can be done by eliminating stagnant water around your home or accommodation. Mosquitoes lay their eggs in stagnant water, and reducing their breeding sites can help to reduce the mosquito population.


Education is an essential aspect of malaria prophylaxis. Knowing the signs and symptoms of malaria and seeking medical attention promptly if you suspect you have been infected can help prevent complications of malaria infection. It is also important to understand the preventive measures and to follow them closely.


Malaria is a serious disease that can be life-threatening if left untreated. If you have symptoms of malaria or have been in an area where malaria is common, it is important to see a doctor for a proper diagnosis and treatment. Malaria prophylaxis is essential for anyone travelling to a malaria-endemic area. This involves taking antimalarial medication, using mosquito control measures, environmental control, and education. It is always advisable to consult a healthcare professional or travel clinic before travelling to a malaria-endemic area to determine the appropriate malaria prophylaxis measures for you. With proper treatment and prevention, malaria can be effectively managed.