Malaria is the most dangerous disease in Africa, and the greatest risk to the traveller. It occurs in most of Botswana (predominantly from November to June), and is most common in the north, so it is essential that you take all possible precautions against it.

Prophylaxis regimes aim to infuse your bloodstream with drugs that inhibit and kill the malaria parasites that are injected into you by a biting mosquito. This is why you must start to take the drugs before you arrive in a malarial area – so that they are established in your bloodstream from day one. Unfortunately, the malaria parasites continually adapt to the drugs used to combat them, so the recommended regimes must also adapt and change in order to remain effective. None is 100% effective, and all require time to kill the parasites – so, unless there is a medical indication for stopping, it is important to complete the course as directed after leaving the area (usually one to four weeks, depending on the regime).

It is vital that you seek current advice on the best anti-malarials to take. If mefloquine (Lariam) is suggested, start this two weeks before departure to check that it suits you; stop it immediately if it seems to cause depression or anxiety, visual or hearing disturbances, severe headaches, fits or changes in heart rhythm. Side effects such as nightmares or dizziness are not medical reasons for stopping unless they are sufficiently debilitating or annoying. Anyone who is pregnant, has been treated for psychiatric problems, is epileptic, has suffered fits in the past, or who has a close blood relative who is epileptic, should avoid mefloquine. The usual alternative is chloroquine (Nivaquine) weekly plus proguanil (Paludrine) daily. The latter is the most likely regime to be offered for Botswana at the time of writing. However, if your trip includes visits to other African countries where there is a higher prevalence of more resistant falciparum malaria then other prophylactic drugs may be suggested. These include mefloquine (as described above), doxycycline (a daily antibiotic) or Malarone (also taken once daily, but needing to be continued for only one week after leaving the area).

Prophylaxis does not stop you catching malaria, however, although it significantly reduces your chances of fully developing the disease and will lessen its severity. Falciparum (cerebral) malaria is the most common in Africa, and usually fatal if untreated, so it is worth your while trying to avoid it.

It is unwise to travel in malarial parts of Africa, including most of Botswana, whilst pregnant or with young children: the risk of malaria in many areas is considerable and such travellers are likely to succumb rapidly.

Because the strains of malaria, and the drugs used to combat them, change frequently, it is important to get the latest advice before you travel. Normally it is better to obtain this from a specialist travel clinic than from your local doctor, who may not be up-to-date with the latest drugs and developments. For details of relevant clinics, see below.