Malaria and the traveller

Malaria remains a significant health risk to millions of people living in endemic areas of the world. An increase in drugresistant parasites combined with an increase in international travel, has seen a concordant increase in the number of cases of malaria imported by travellers into the industrialised world annually. Malaria in travellers can nearly always be prevented by the application of personal protective measures and by taking appropriate chemoprophylaxis. The vast majority of cases of malaria in travellers are contracted as a result of noncompliance with taking antimalarial agents, or inappropriate prescribing. When assessing an individual need for malaria chemoprophylaxis, a number of factors must be taken into account, including a detailed travel history, past medical history, contraindications to specific medications, and the drug resistance pattern of the parasite in the destination. It is imperative that the traveller actually be at risk of malaria before a prophylactic agent is prescribed; these medications are not innocuous and adverse events should be avoided if possible. The traveller should be involved in the decision-making process regarding antimalarial medication, they need to be aware of the potentially fatal nature of the disease, the importance of complying with their chosen regimen, and the symptoms of malaria so they can act promptly should their prophylaxis fail. There are a number of alternative chemoprophylaxis regimens available to travellers that are discussed here.