Malaria

What is malaria

Malaria is an infectious disease caused by a parasite inside mosquitoes which is transmitted into the blood by a mosquito bite to the skin. This condition can also be transmitted though sharing syringes or by blood transfusions that contain the parasite.

The parasite that causes this disease is the protozoan parasite from the Plasmodium family. The Anopheles mosquito is generally responsible for transmitting the parasite that causes malaria.

The most dangerous type of malaria comes from the parasite Plasmodium falciparum. This parasite multiplies very quickly in the blood over a short time and causes symptoms very quickly too and it is the form of malaria that is usually fatal without treatment. The other parasites which cause malaria; Plasmodium vivax, Plasmodium ovale and Plasmodium malariae all result in much milder disease that is not generally fatal.

Malaria most commonly occurs in countries where there are jungles, swamps or marshes, which is why it is commonly called “marsh fever”, “jungle fever” or “swamp fever”. Malaria is extremely common in Africa, India and in some other developing countries too.

Facts about malaria

• According to the World Health Organisation (WHO), around 40% of the world’s population is at risk of catching malaria, especially those people living in the poorest countries in the world
• According to the latest World WHO malaria report, there were 263 million cases of malaria in 2023 compared to 252 million cases in 2022
• The estimated number of malaria deaths stood at 597 000 in 2023 compared to 600 000 in 2022.
• Around 20% of children in Africa die of malaria each year
• Malaria causes around 880,000 deaths each year, with 90% of those deaths occurring in sub-Saharan Africa
• Around 85% of all malaria-related deaths occur in children under five years of age
• Malaria is curable with the right medication and death can prevented if medication is administered and the condition is properly managed
• More than 1,000,000 people die of malaria each year, mainly in Africa and mainly babies, children and pregnant women
• People travelling overseas are normally given malaria tablets before they travel to prevent infection of some genus
• Malaria is a serious health problem for both the pregnant woman and the unborn child
• The incubation period for malaria is 7-30 days – the incubation period defines the period from when the person is bitten by the infected mosquito to when they display symptoms of malaria
• People with the gene for sickle cell anaemia, haemoglobin C, thalassaemia trait or deficiency of the enzyme glucose-6 phosphate dehydrogenase (G6PD) have some partial protection against developing malaria
• There are still a number of malaria endemic zones in various developing countries all around the world
• The literacy of the household in developing countries in malaria zones has a great bearing on whether they understand that preventative measures (using a net around the bed etc) can greatly reduce risk of malaria
• There is some concern about knowledge of malaria and prevention of malaria in remote areas of malaria regions and scientists recommend better access to medical posts in these areas

Symptoms of malaria

Symptoms of malaria fall into two categories: uncomplicated malaria and severe malaria.

Uncomplicated malaria

Uncomplicated malaria generally presents with the following symptoms (which recur every few days):

• Chills
• Fever
• Headache
• Muscle aches and pains
• Nausea and vomiting
• Sweating

If the parasite that is causing the infection is P. falciparum the following symptoms may also be present:

• Fast breathing and coughing
• Jaundice
• Liver enlargement

Severe malaria

Severe malaria is caused when the P. falciparum parasite is causing the infection and the infected person has other serious underlying health conditions. Severe malaria is also very common in people with no previous immunity and in pregnant women and young children.

Symptoms of severe malaria include:

• Cerebral malaria (this is also a complication of malaria)
• Decreased blood platelets, which means decreased ability for the body to stem blood flow and heal from any cuts or other injuries internally
• Fluid build-up in the lungs, which causes breathing difficulties
• Haemoglobin in the urine
• Severe anaemia
• Shock

Other rarer symptoms of severe malaria include:

• Acute kidney failure
• Excessive acidity in the blood and other body tissue fluids
• Hyperparasitaemia – an excessive amount of parasites in the red blood cells
• Hypoglycemia (low blood glucose levels)

Causes of malaria

Malaria is caused by the protozoan parasite from the Plasmodium family. There are four species of the parasite with one of them (Plasmodium falciparum) being the most fatal, developing symptoms very rapidly.

Malaria can also be caused by the following:

• Blood – if transfusion of blood is contaminated with the protozoan parasite this can also develop malaria
• Needle syringe – people who share a syringe needle (or if they are not re-used in a clinic) that is contaminated with the protozoan parasite can also develop malaria

Prevention of malaria

Non-preventable risk factors

Malaria may be unpreventable in certain circumstances:

• Contaminated blood transfusion – a person who needs to receive a blood transfusion has no choice and if they receive blood which is contaminated with the parasite that causes malaria, it is difficult to prevent. The clinic where the blood is received needs to ensure they vet their blood for any contamination and get rid of it as that is the only way to prevent malaria due to this cause

Preventable risk factors

There are certain general precautions which need to be taken in order to prevent malaria:

• Avoid malaria-prone countries – it is advisable to avoid visiting countries with known malaria outbreaks in the season when infection mainly occurs
• Avoid mosquito’s – avoid exposure to mosquito’s to prevent being bitten is the simplest strategy
• Avoid swamps or jungles – swampy and marshy areas or jungles, are a breeding ground for mosquito’s and they are a high risk area for being bitten by a mosquito carrying the Plasmodium parasite
• Avoid villages in developing countries – people who live in the most remote villages, away from medical outposts, who do not own radios, are not literate and are poor, are more likely to develop malaria
• Cover bare skin outside at night – it is not advisable to go outside at night with bare skin, especially in areas where there is still water as there could be mosquito’s there that carry the Plasmodium parasite and cause malaria
• Don’t share syringes – sharing needles is a high risk for a number of health conditions, not just malaria. Syringes must be used only once to prevent contamination and transmission of disease
• Fly screens – put fly screens over windows and doors so that when the doors and windows are opened at night, mosquitos cannot enter the house
• Insect repellant – wear some form of insect repellant (preferably a natural one without strong chemicals) on skin that is not covered, when outside at night. Take special care of protecting children’s delicate skin
• Keep babies and children protected – at highest risk of developing malaria are young children and babies, especially in malaria zones in developing countries (most commonly in Sub-Saharan African countries)
• Long sleeves outdoors – wear long sleeves when in areas known to be mosquito habitats, to prevent exposing bare skin for mosquito’s to bite
• Mosquito net – Use a mosquito net over your bed and especially over a child’s bed as they can be more susceptible to the worst effects of malaria

Complications of malaria

Malaria is a very serious disease and will cause a number of fatalities, due mainly to the Plasmodium falciparum stain of parasite and more often in pregnant women and young children. Other than fatality, the main serious complications that can occur are:

Anaemia

The malaria infection with the various strains of parasites tends to cause a widespread destruction of the red blood cells, which will lead to severe anaemia. Anaemia causes lethargy and a range of other symptoms, which can only be reversed with supplementation, either with folic acid, iron or vitamin B12 (cyanocobalamin). In severe cases, a blood transfusion may be required. Many pregnant women with malaria are at the greatest risk for anaemia, both with themselves and with their unborn child. Young children with malaria are also likely to develop anaemia due to the malaria infection.

Cerebral malaria

A very rare complication of malaria causes infected red blood cells to block blood vessels leading to the brain and this makes the brain tissue swell, which can lead to seizures, brain damage and coma.

Ruptured spleen

Quite often the spleen becomes enlarges and then ruptures in a number of cases of people with malaria. Most cases of rupture of the spleen occur during a very acute infection of malaria and are usually associated with infection with the Plasmodium vivax parasite. Experts believe that lack of prior immunity to malaria is the major predisposing factor that leads to the rupture of the spleen in these cases.

When to see a doctor about malaria

People who have been in a country (or area) which is known for malaria infections and who think they may have been bitten by a mosquito, irrespective of whether or not they have developed any of the symptoms of malaria, should visit their doctor to be provided with medication to prevent malaria.

Anyone who intends to travel to any country where malaria is prevalent (especially Africa) must see their doctor several weeks prior to their travel, in order to be prescribed with anti-malaria medication which can protect against the development of malaria, even if bitten by a parasite-carrying mosquito.

Diagnosis of malaria

Malaria is initially diagnosed through the following methods:

• Medical history of symptoms – the doctor will ask a series of questions about the severity and duration of symptoms, when they started and how often they occur
• Physical examination – a doctor will examine the person with suspected malaria to detect the severity of the condition and symptoms
• Blood test – a blood test will be requested to test the blood for the species of the parasite and determine treatment . A blood test can also test if there is any drug resistance to the medications prescribed for malaria to determine if a change of medications is warranted

In remote areas and developing countries, malaria is often not diagnosed until it is fairly obvious from the symptoms that the disease is quite progressed and this means it will often be fatal as there has been no treatment.

Medical outposts usually use the following to diagnose earlier cases of malaria:

• Malaria test kits – a “dipstick” or “cassette” format is used to detect antigens derived from malaria parasites using the test kit. Results are obtained within 2-15 minutes. These mini-test kits are used in remote areas as an alternative to studies under the microscope as they are not available in these areas and the test kits provide a very useful tool in quickly diagnosing malaria as treatment can then be applied to help reduce risk of fatality

Conventional treatment of malaria

Treatment of malaria is through medication if an infection is present, but prevention is recommended to avoid mosquito’s and avoid malaria in the first place.

Medication

Malaria is normally treated based on a variety of factors, namely the species of the parasite, the health of the person infected and where the disease was contracted, as well as whether the strain is a resistant or non-resistant one.

• Artemisinin based combination therapy (ACT) – this is the latest medication combination used to treat malaria as there has been an increase in Plasmodium falciparum parasite resistance against the older anti-malaria medications. The ACT consists of:
  • Artemether-lumefantrine and dihydroartemisinin-piperaquine – these two drugs are very effective in combination for treating uncomplicated malaria
• Anti-malarial medications – these are the traditional medications used to treat malaria, but there has been an increase in Plasmodium falciparum parasite anti-malarial drug resistance (which is why ACT therapy is being more recommended today):
  • Amodiaquine – this quinine-type medication is usually used either alone or in combination with sulphadoxine-pyrimethamine in pregnant women with a malaria infection with less side effects than other anti-malaria medications
  • Chloroquine – this medications is used for non-resistant strains of malaria infections
  • Clindamycine – for non-resistant strains of malaria
  • Doxycycline – this is an antibiotic used to kill the parasite and prevent secondary infection
  • Mefloquine – this medication is similar to quinine
  • Primaquine – this is a quinine-type anti-malarial medication used to treat malaria
  • Quinine gluconate & sulphate – this is an anti-malarial drug used for a resistant malaria infection
  • Sulphadoxine-pyrimethamine – this medication is used in combination with the anti-malarial amodiaquine especially in pregnant women as it has less side effects than other medications
  • Tetracycline – this is an antibiotic used to kill the parasite and prevent secondary infection

Precautions to avoid malaria infection in the first place

There are certain general precautions which need to be taken in order to prevent malaria from occurring:

• Avoid malaria-prone countries – it is advisable to avoid visiting countries with known malaria outbreaks in the season when infection mainly occurs
• Avoid mosquito’s – avoid exposure to mosquito’s to prevent being bitten is the simplest strategy
• Fly screens – put fly screens over windows and doors so that when the doors and windows are opened at night, mosquito’s cannot enter the house
• Insect repellant – wear some form of insect repellant (preferably a natural one without strong chemicals) on skin that is not covered, when outside at night. Take special care of protecting children’s delicate skin
• Long sleeves outdoors – wear long sleeves when in areas known to be mosquito habitats, to prevent exposing bare skin for mosquito’s to bite
• Mosquito net – Use a mosquito net over your bed and especially over a child’s bed as they can be more susceptible to the worst effects of malaria

Alternative / complementary treatment of malaria

Never try to self-treat or self-diagnose malaria, as it could be potentially fatal

Always seek medical advice and treatment and apply common sense to prevent infection in the first place.

Alternative / complementary treatments should be viewed only as a way of boosting the immune system to help it fight off the malaria infection and prevent recurrence. Always consult with your doctor before trying any of the treatments recommended, as they may adversely conflict with your medications.

Herbs

The following are the herbs which have been traditionally used by certain cultures to treat malaria infection as a resource on where modern treatments have been derived:

• Annual wormwood (Artemisia annua L) – the Chinese herb Artemisia annua L. (annual wormwood) contains the anti-malarial substance artemisin, which studies show is effective at fighting malaria infection. The active compound in this herb is artemisin, which have been synthesised by modern medicine for use in anti-malaria medication
• Peruvian bark (Cinchona pubescens) – the bark of the tree Cinchona pubescens is the original source of quinine, the substance which is used to effectively treat malaria. This herbal preparation needs to be standardised because risk for over-dosage and toxicity from over-dosage is high

Vitamins

There are a number of vitamins which may help to provide relief for symptoms:

• Vitamin A – several studies show that children in African who have malaria are also deficient in the potent antioxidant vitamin A, which is important because deficiency in this vitamin seriously affects mortality of any type of illness. The antioxidant effect of vitamin A may be needed to help boost the immune system to effectively fight off the parasite causing the malaria, which is deficient in people who are low in this nutrient (children especially). A randomised double blind study showed that vitamin A, in combination with zinc reduced not only symptoms of malaria, but also levels of the parasite Plasmodium falciparum in the body of those children who were supplemented with these nutrients in Burkina Fosa, Africa
• Vitamin C – the potent antioxidant vitamin C provides a huge boost to help the immune system more effectively fight off any infection from any pathogen. Studies show that children infected with malaria tend to have lower blood levels of vitamin C (ascorbic acid) than their healthy counterparts
• Vitamin E – the potent antioxidant vitamin E provides a huge boost to help the immune system more effectively fight off any infection from any pathogen

Minerals

There are a number of minerals which may help to provide relief for symptoms:

• Zinc – the very potent antioxidant mineral zinc help the immune system fight off infection and reduces recovery time from infections. A randomised, double blind study showed that zinc, in combination with vitamin A reduced not only symptoms of malaria, but also levels of the parasite Plasmodium falciparum in the body of those children who were supplemented with these nutrients in Burkina Fosa, Africa

Other nutrients

There are other nutrients which may help to provide relief for symptoms:

• Alpha-lipoic acid – studies show that the potent antioxidant alpha-lipoic acid is beneficial because it provides a huge boost to the immune system to more effectively fight off any infection and that the parasite that causes malaria is killed by alpha-lipoic acid in vitro (test tubes) so far, so more studies need to be performed before this can be recommended as an adjunct to conventional treatment
• Quinine – the natural substance quinine is used to fight malaria infections and it has now been used to create medication specifically for fighting a malaria infection

Dietary modifications

There are a number of dietary modification strategies which may help to provide relief for symptoms:

• Adequate liquids – it is important to be drinking enough water, diluted fruit juice or herbal tea (such as chamomile, elderberry, peppermint, rosehip) to keep the body hydrated in order to help it better fight the malaria infection
• Avoid drinking alcohol – drinking alcohol when you have a malaria infection and taking any type of medication for the infection is not recommended. The alcohol can interfere with the action of the medication and it also does not help the body deal with the malaria infection
• Increase intake of vegetables – a diet with increased intake of fresh (preferably organic) vegetables (about 5-6 servings per day) is recommended for people with jaundice, to help hydrate the body and provide more antioxidants and other nutrients to help the body more effectively deal with the malaria infection by providing a boost to the immune system
• Increase intake of fruits – a diet with increased intake of fresh (preferably organic) fruits (about 3-4 servings per day) is recommended for people with jaundice, to help hydrate the body and provide more antioxidants and other nutrients to help the body more effectively deal with the malaria infection

Lifestyle modifications

There are a number of lifestyle modifications which may help to provide relief for symptoms:

• Rest – it is very important to give the body the best chance at recovery and resting (sleeping or just lying down not being active) will be recommended by your doctor when you have malaria. Rest allows the body to concentrate its energy on boosting the immune system and using all its resources to fighting the malaria parasitic infection without having to waste resources on other bodily processes

Alternative treatments

There are no other alternative treatments recommended for malaria.

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with malaria

Self care

There are a number of strategies which are recommended to help deal with malaria:

• Adequate fluids – it is important to be drinking enough water, diluted fruit juice or herbal tea to keep the body hydrated in order to help it better fight the malaria infection
• Avoid alcohol – drinking alcohol when you have a malaria infection and taking any type of medication for the infection is not recommended. The alcohol can interfere with the action of the medication and it also does not help the body with dealing with the malaria infection
• Rest – it is very important to give the body the best chance at recovery and resting (sleeping or just lying down not being active) will be recommended by your doctor when you have malaria. Rest allows the body to concentrate its energy on boosting the immune system and using all its resources to fighting the malaria parasitic infection without having to waste resources on other bodily processes
• Take medications as prescribed – it is really important to take all of the medications that your doctor has prescribed in order to have the best chance of reducing the parasite numbers and heal the malaria infection

Caring for someone with malaria

Partner

There are a number of strategies you can use to help a partner who has malaria:

• Allow adequate rest – it is very important for your partner to rest, in order to allow their body to heal from the malaria. Let your partner rest, sleep or lie down and provide them food, drink and medication when they require it, in order to help them recover more quickly
• Don’t smoke – it is not beneficial for your partner if you smoke cigarettes, which are an irritant. If you need to smoke, do so outside and not anywhere near your partner
• Provide fluids – it is important for your partner to be drinking enough water, diluted fruit juice or herbal tea to keep the body hydrated in order to help it better fight the malaria infection, so provide fluids on a regular basis

Friends

There are a number of strategies you can use to help a friend who has malaria:

• Don’t smoke – it is not beneficial for your friend if you smoke cigarettes, which are an irritant. If you need to smoke, do so outside and not anywhere near your friend

Parents

There are a number of strategies you can use to help a child who has malaria:

• Allow adequate rest – it is very important for your child to rest, in order to allow their body to heal from the malaria. Let your child rest, sleep or lie down and provide them food, drink and medication when they require it, in order to help them recover more quickly
• Don’t smoke – it is not beneficial for your child if you smoke cigarettes, which are an irritant. If you need to smoke, do so outside and not anywhere near your child
• Provide fluids – it is important for your child to be drinking enough water, diluted fruit juice or herbal tea to keep the body hydrated in order to help it better fight the malaria infection, so provide fluids on a regular basis

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Last reviewed and updated: 17 October 2025