🦟 Men's Health

Malaria Prophylaxis for Travellers

Protecting Nigerians returning from abroad and non-immune visitors to Nigeria against malaria

Malaria chemoprophylaxis — taking preventive medication to avoid malaria — is relevant for two groups in the Nigerian context: non-immune travellers (expatriates, diaspora Nigerians who have been abroad for years, and visitors to Nigeria) coming into malaria-endemic areas; and Nigerians travelling to very high-risk areas outside Nigeria where strains may differ. Nigerians living in endemic areas have partial immunity that reduces the risk of severe malaria — but this immunity wanes rapidly (within months) after leaving Nigeria. A diaspora Nigerian who has lived in the UK for 2 years visiting Lagos for Christmas is at significant risk.

Signs and Symptoms

✓ Malaria in a non-immune or partly immune traveller may present atypically

✓ Classic symptoms: fever, rigors, headache, muscle aches, nausea, vomiting

✓ Severe malaria: confusion, jaundice, difficulty breathing, seizures, dark urine (blackwater fever)

✓ Fever within 3 months of return from an endemic area = malaria until proven otherwise — this is a medical emergency

Risk Factors

Non-immune traveller (never lived in endemic area)
Diaspora Nigerian with waned immunity — absent from Nigeria for >6–12 months
Visiting during the rainy season (April–October in most of Nigeria) — peak transmission
Rural or agricultural areas — higher mosquito density
Not taking prophylaxis or taking it incorrectly
Pregnancy — malaria is more severe in pregnancy

When to Seek Help

Emergency — within 24 hoursFever in a traveller within 3 months of returning from a malaria-endemic area — malaria blood film or RDT urgently. In the UK/US/EU, this means going to A&E immediately — imported malaria is a leading cause of preventable death in non-endemic countries

Pre-travelBook a travel health appointment 4–6 weeks before visiting Nigeria or any endemic area — to choose and start the right prophylaxis

During travelFever with rigors during the visit to Nigeria — attend a health facility for testing immediately. Do not assume it is flu

Tests & Diagnosis

🧪 Malaria RDT and blood film

At the destination if febrile. On return if fever develops within 3 months

🧪 Full blood count

Anaemia and thrombocytopenia are common in malaria

🧪 Blood glucose

Hypoglycaemia is a serious complication of severe malaria and quinine therapy

🧪 Renal and liver function

Severe malaria can cause multi-organ failure — baseline and monitoring during treatment

Treatment Options

Atovaquone-proguanil (Malarone) — the first choice

Daily tablet, starting 1–2 days before travel, during, and 7 days after return. Excellent efficacy (>95%), few side effects, and convenient. Can be used for any duration. Available in UK, US, and major Nigerian pharmacies. Cost is the main limitation. Take with food (fat increases absorption)

Doxycycline — the affordable alternative

100 mg daily, starting 1–2 days before, during, and 4 weeks after travel. Inexpensive and widely available. Side effects: photosensitivity (use sunscreen), GI upset (take with food and water), oesophageal irritation (do not lie down after taking). Not for children under 8 or pregnant women

Mefloquine (Lariam) — for longer stays

Weekly tablet, starting 2–3 weeks before travel, during, and 4 weeks after. Less popular due to psychiatric side effects (vivid dreams, anxiety, psychosis — rare but serious). Avoid in those with psychiatric history, seizure disorder, or cardiac conduction defects. Must be started early to identify side effects before travel

Primaquine — for areas with Plasmodium vivax

Used for areas with P. vivax (common in East Africa and Asia, less so West Africa). Must check G6PD status before use — causes haemolysis in G6PD deficiency. Can be used as causal prophylaxis for P. falciparum

Personal protective measures — reduce mosquito bites

DEET 20–50% repellent — apply to exposed skin from dusk to dawn (Anopheles bites at night). Permethrin-treated clothing and bed nets. Sleep under a long-lasting insecticidal net (LLIN). Air-conditioned rooms reduce mosquito exposure. Light-coloured, full-length clothing in evenings

Standby emergency treatment (SBET)

For travellers to remote areas far from medical care — carry a course of artemether-lumefantrine (Coartem) for self-treatment if unable to access testing and fever develops. Use only when medical care is unavailable within 24 hours. Artemether-lumefantrine is the WHO-recommended first-line treatment for uncomplicated P. falciparum malaria

Prophylaxis failure and breakthrough malaria

No prophylaxis is 100% effective. Fever during or after prophylaxis use requires immediate malaria testing — breakthrough malaria can occur. Artemether-lumefantrine is the treatment of choice even in someone who was on prophylaxis (different mechanism of action)

Frequently Asked Questions

Do Nigerians living in Nigeria need malaria prophylaxis?

No — Nigerians living continuously in endemic areas have partial immunity from ongoing exposure. Routine chemoprophylaxis for the general Nigerian population is not recommended. Exceptions: pregnant women (who take IPTp with sulfadoxine-pyrimethamine) and infants in their first year of life. The malaria vaccine (RTS,S/Mosquirix) is being piloted for young children in some African countries.

My immunity will protect me when I visit Nigeria from the UK — right?

Partially — but this is a dangerous assumption. Immunity wanes rapidly after leaving endemic areas. After 6–12 months in the UK, your protection against severe malaria is significantly reduced. Many diaspora Nigerians visiting home for Christmas have died from falciparum malaria they dismissed as 'ordinary fever'. If you have been abroad for more than 6 months, take prophylaxis seriously.

Can I take Nigerian ACTs (Coartem) as prophylaxis?

No — artemisinin combination therapies (like Coartem) are TREATMENT drugs, not prophylaxis drugs. Using them as prophylaxis promotes resistance, does not provide continuous protection, and is not recommended. Use only the approved prophylaxis drugs: atovaquone-proguanil, doxycycline, or mefloquine.

Is there a malaria vaccine?

Yes — RTS,S (Mosquirix) and R21/Matrix-M have been approved by WHO and are being rolled out in sub-Saharan Africa for children under 5. Ghana, Kenya, and Malawi have introduced it. Nigeria has pilot programmes. The vaccines are for young children in endemic areas — they are not appropriate as travel prophylaxis for adults. Check the current WHO guidance on malaria vaccine deployment in Nigeria.