Families, particularly those with very young children, have to choose their travel destinations carefully and be particularly mindful of the risk of malaria.

Dr Albie de Frey, Owner of The Travel Doctor, says it is best not to travel to malarial areas with children under the age of five. “If you have to travel, it is best to do so in the cooler, dry season, provided the area has seasonal malaria (not year-round as in many tropical destinations in Africa). In South Africa, that means visiting the Lowveld during the dry, cooler winter months. This is reflected in the malaria prophylaxis recommendations for the Kruger National Park, where year-round mosquito bite precautions should be observed but malaria chemoprophylaxis (pills to prevent malaria) are only advised from September to May,” he says.

De Frey says clients should be advised that, when travelling to an area where malaria is endemic, they should consult a travel clinic well in advance of their departure to discuss practical mosquito bite avoidance, insect repellents, malaria prophylaxis and, importantly, how to recognise the early signs and symptoms of possible malaria, even when all the precautions have been taken. “We do not have accurate data for malaria in travellers in South Africa, but anecdotally I have dealt with several children with malaria contracted anywhere between Mpumalanga and the far north of Benin. Each and every case was a harrowing experience that I do not wish on any parent,” he adds.

If your clients prefer to err on the side of caution, they should seek malaria-free areas like the Eastern and Western Cape, Gauteng and Northwest, rather the more risky areas of northern Limpopo, Mpumalanga and northern KZN. Outside SA, Mozambique, Zambia, Swaziland and Zimbabwe are all considered high risk, according to the December 2018 malaria map of the National Institute for Communicable Diseases (www.nicd.ac.za).

So, where should families go? Nhlanhla Ngwenya, Communications Co-ordinator for Tourism KwaZulu-Natal, says the northern reaches of KZN carry a ‘low-risk’ malaria warning, meaning that preventative drugs are not normally recommended but anti-bite measures are still important.

Because the map showing malaria risk in Southern Africa is changing and evolving with the movement of people and rainfall variations, and because the consequences of malaria are so extreme, especially in children, the best advice agents can give is for the family to consult a reputable travel clinic before booking.

Tips for malaria prevention

Dr Albie de Frey of The Travel Doctor advises families with young children visiting malarial areas as follows:

  • Don’t get bitten: This is more difficult with small, mobile children.
  • Cover up: During the day, in hot areas, parents may struggle to get children to wear long sleeves and trousers, so exposed areas must be covered with insect repellent.
  • Keep them out: Mosquitoes hunt mostly between 23h00 and 02h00. Let children sleep under a properly fitted, insect-repellent-impregnated mosquito net. Mosquito screened windows and doors as well as air-conditioning in well-sealed rooms are helpful, as is a fan directed over the bed. It’s not advisable to camp with small children in a malaria endemic area and it is much more difficult to make a tent or caravan mosquito-proof.
  • Seek early treatment: Malaria must be diagnosed and effectively treated within 48 hours of the onset of symptoms; vital for babies and children.
  • Take ‘the pill’: Malaria prophylaxis is important for any travel to an endemic area.
  • Know the symptoms: Any flu-like illness in an adult or child who is in or has been to a malaria endemic area is malaria until proven otherwise. Symptoms include fever, malaise, headache, muscle and joint pain – even diarrhoea. Parents might notice something is wrong with their children (who aren’t always able to describe their symptoms accurately). Once malaria has become established in a child, it progresses much more rapidly (within hours) than in an adult. All children with malaria should be admitted to hospital on diagnosis.