Safety of medication while diving and drug resistance considerations are the most pressing issues. As divers venture deeper into the African tropics the risks of contracting Malaria increase proportionally. Lack of medical facilities, transportation and communication add additional complexity to managing this medical emergency. Understanding Malaria prophylaxis and general preventative measures is therefore of the utmost importance. The following section covers utmost important considerations in selecting and using Malaria prophylactic measures and medications. The medical treatment of Malaria, which is complex and requires close medical supervision, falls outside the scope of this document.  If you think that you may have Malaria or are concerned about unexplained symptoms after visiting a malaria area, contact DAN immediately. The three most important guidelines regarding Malaria prevention and survival are: 

1. Do Not Get Bitten
2. Seek Immediate Medical Attention If You Suspect Malaria
3. Take “The Pill” (Anti-Malaria Tablets / Prophylaxis)

(1) Do not get bitten

Where possible, stay indoors from dusk to dawn

- If you have to be outside between dusk and dawn – cover up
- Long sleeves, long trousers, socks, shoes (90% of mosquito bites occur below the knee)
- Apply DEET containing insect-repellent to all exposed areas of skin, repeat four-hourly
- Sleep in mosquito-proof accommodation:
           - Air-conditioned, and / or proper mosquito gauze
           - Buildings / tents, regularly treated with pyrethrum-based insect repellent / insecticide
           - Burn mosquito coils / mats
           - Sleep under an insecticide impregnated (Permacote® / Peripel®) mosquito net (very effective)

(2) Seek immediate medical attention if you suspect Malaria

 - Any flu-like illness starting 7 days or more after entering a Malaria endemic area is Malaria until proven otherwise.
 - The diagnosis is made on a blood smear or a rapid malaria antigen finger prick test.
 - One negative smear / rapid test does NOT exclude the diagnosis:

            - Repeat the smear / rapid test until the diagnosis is made,
            - another illness is conclusively diagnosed or
            - spontaneous recovery occurs e.g., from influenza.

(3) Take “The pill"
There are several dangerous myths regarding Malaria prophylaxis. Please note that:
 - Prophylaxis does not make the diagnosis more difficult
 - It does protect against the development of cerebral Malaria
 - Prophylaxis is not 100% effective - hence the importance of avoiding bites
 - Not all anti-Malaria medication is safe with diving
 - Malaria is often fatal – making prophylaxis justified

Anti-Malaria drugs, like all drugs, have potential side-effects. The majority of side-effects decrease with time. Serious side-effects are rare and can be avoided by careful selection of a tablet or combination of tablets to suit your requirements (Country, region and season).