Malaria Prophylaxis for Sub-Saharan Africa Travel

Introduction to Malaria Prophylaxis

The Centers for Disease Control and Prevention recommends that all travelers to Sub-Saharan Africa should have adequate protection against mosquito bites and chemoprophylaxis because the risk is high throughout the area and chloroquine-resistant falciparum malaria is common 1
The World Health Organization states that Sub-Saharan Africa has the highest malaria transmission intensity globally, with most imported malaria cases and deaths acquired from this region 2, 1

The British Medical Association suggests that first-line options for Sub-Saharan Africa include atovaquone-proguanil, mefloquine, and doxycycline, with specific dosing regimens for each 3, 4
The American Society of Tropical Medicine and Hygiene recommends that chloroquine alone is NOT adequate for Sub-Saharan Africa due to widespread resistance, with efficacy described as "limited" in this region 3, 5

The National Institute for Health and Care Excellence advises using DEET-containing insect repellents on exposed skin, sleeping under permethrin-impregnated bed nets, wearing long-sleeved clothing and long trousers after sunset, staying in well-screened, air-conditioned rooms, and using pyrethroid-containing flying-insect spray in living areas during evening hours 2, 3, 6

The European Centre for Disease Prevention and Control warns that mefloquine neuropsychiatric effects occur in 0.01% severely, with 70% occurring in the first three doses; avoid in those with seizure history or psychiatric disorders 3, 6, 7
The World Health Organization states that doxycycline photosensitivity can be severe—avoid excessive sun exposure 3, 5

The Centers for Disease Control and Prevention recommends chloroquine alone for chloroquine-sensitive areas and mefloquine for chloroquine-resistant areas after the first trimester for pregnant women 8
The Centers for Disease Control and Prevention recommends primaquine terminal prophylaxis for prolonged exposure to endemic areas, with mandatory G6PD testing required before use 8

The Centers for Disease Control and Prevention notes that more than 80% of US malaria cases are acquired in Africa, with 71.7% of patients having taken no prophylaxis, highlighting the importance of prophylaxis in high-risk areas like Sub-Saharan Africa 8

The Centers for Disease Control and Prevention recommends primaquine terminal prophylaxis for prolonged exposure to endemic areas, such as missionaries or Peace Corps volunteers, to prevent relapsing malaria [*P. vivax* and *P. ovale*] [8]