I spend about half my time working in Equatorial Guinea (West Africa), and have been doing so now for 6 years. For the whole time I have been on various types of Malaria medication.
I started on Chloroquine, which gave me mouth ulcers (and was allegedly not much use anyway, because the malaria parasite had already acquired a resistance to it). I had to change to something else. The other options at the time were Mefloquine (Lariam) or Doxycycline. My GP did not want to put me on Lariam because I am diabetic, so I went onto Doxy, which gave me no side effects at all. I know several people who were taking Lariam, and maybe 25% of them experienced hallucinations or other weird “mental” moments as a result. The one advantage Lariam has over all other malaria drugs is, you take it weekly instead of daily. I have never come across Savarine.
Doxycycline is a good drug, but it is basically a powerful antibiotic, not a purpose-designed anti-malaria drug. No doubt because of this, there are theories and rumours around such that Doxy can degrade your immune system if you take it for too long. I took Doxy for one year, then on the advice of our paramedic in Equatorial Guinea, I switched to Malarone. I have been taking it for 4 years now and have never had any problems (no malaria, no side effects). The only problem with Malarone is, it is very expensive. It can be used as a prophylaxis (ie, prevention), or as a treatment if you should get malaria. Malarone is effective against all types of malaria. You have to remember to keep taking it for a week after leaving the malaria zone (this applies to all anti-malaria drugs).
I should explain something about the different types of Malaria. There are 4 main types: Falciparum, Vivax, Ovale and Malariae. The ones to worry about in Africa are Falciparum and Vivax. Vivax is the less serious variant, although it can “hide” in your liver and recur sometimes years after you first get it. Falciparum on the other hand is often fatal if untreated, and it can kill you very quickly. It is unfortunately the prevalent type in West and Central Africa.
As far as specific risk is concerned, this is what my employer’s risk matrix says:
· Morocco: very limited Vivax risk in Khourigba province. Some Falciparum risk along the border between Western Sahara and Mauretania.
· Mauretania: Falciparum risk in the whole country except the provinces of Dakhlet Nouadhibou and Tiris Zemmour.
· Mali: Falciparum risk everywhere including main cities.
The malaria risk in the Sahara is seasonal (ie worse during the northern hemisphere summer), while in sub-Saharan Africa it exists all year round. Personally I would not take any preventative malaria medication in Morocco or Western Sahara, and I would only take it in Mali between May and November. For a short trip I might take Doxy instead of Malarone. I would however always have Malarone on hand for treatment if required.
Last point: there is another reportedly good malaria treatment drug available now, called RIARMET or COARTEM. I have no idea how much it costs or how easy it is to find.
Of course, the best thing is not to get bitten: use mozzie nets, DEET repellent, wear light coloured clothes with long sleeves at night (the falciparum-carrying mozzies are most active at night) and try not to camp near standing water.
Moto ergo sum