malaria protection

As one of the most dangerous and widespread diseases in the world, malaria is a condition that is constantly evolving. By looking at how the condition has changed and spread throughout the world, we can gain a clearer understanding of how to avoid it effectively when travelling.

Every traveller should be aware of the potential risks posed by infectious conditions such as malaria. Put simply, malaria is a serious tropical disease, spread by mosquitos. It can be fatal if left untreated, and a single mosquito bite is all it takes for someone to become infected with malaria.[1]

Despite still being a significant travel health risk today, the origins of malaria date back millions and millions of years. In fact, fossil mosquitoes have been found in geological strata 30 million years old.[2] What’s more, a variety of studies have suggested that P.falciparum malaria probably jumped from great apes to man, most likely by a single host transfer by vector mosquitos.[3] Findings indicate that malaria traces back to gorillas.[4]

As well as having a long and complex history behind it, the condition also has a huge geographical spread. Let’s take a closer look at malaria risk levels across time periods and around the world.

A timeline of malaria

We’ve already mentioned that, as well as being a dangerous and widespread condition, malaria is also an ancient one. In truth, the origins of malaria dates back hundreds of millions of years, yet it remains a significant health risk in several parts of the world today. Below is a timeline of how malaria has transformed over millennia.

Half a billion years ago: Existence of a pre-parasitic ancestor of the vector mosquito

150 million – 200 million years ago: Appearance of early Dipterans, ancestors of mosquitoes

130 million years ago: Evolution of two-host life cycle in Dipterans and vertebrates

130 million years ago: Divergence of the bird and mammalian malaria parasites

100 million years ago: Divergence of P.malariae, P.ovale and P.vivax lineage

5 million years ago: Evolution of P.falciparum

2-3 million years ago: Divergence of P.vivax from P.cynomolgi

10,000 years ago: Malaria appears in Africa

10,000 – 5,000 years ago: Malaria appears in Mesopotamia, the Indian peninsula and South-East Asia

4000 – 10,000 years ago: Appearance of the lethal strain of P.falciparum

5000 years ago: Malaria appears in China

4000 – 5000 years ago: In Africa, Anophelines develop highly anthropophilic habits

3000 years ago: The lethal P.falciparum strain of malaria reaches India

2500 – 2000 years ago: Malaria reaches the shores of the Mediterranean

1000 – 500 years ago: Malaria reaches Northern Europe

Late 15th Century: Malaria reaches the New World and much of the western hemisphere

Mid-18th Century: Malaria spreads across North America

19th Century: Malaria is now present across the globe

Early 20th Century: Millions of people die from malaria all over the world

Early 1950s: Malaria has almost disappeared from North America and from almost all of Europe

Present: Malaria fatalities almost entirely limited to sub-Saharan Africa.

Malaria worldwide

anti malarialThe World Health Organisation (WHO) estimates that 219 million cases of malaria occurred across the globe in 2017. Of these cases, around 435,000 people died from the disease. This number mostly consisted of children under 5 years of age in sub-Saharan Africa.[5]

International travellers could find themselves at risk of malaria infection in 87 countries around the world, most notably in Africa, Asia and the Americas. Those who do become infected with malaria often experience initial flu-like symptoms, as well as fever and chills. If left untreated, these symptoms can escalate into severe complications and even fatality.

Symptoms of malaria usually appear after a period of seven days or longer, though it can be sooner.

Malaria is caused by the Plasmodium parasite, transmitted by female Anopheles mosquitos which bite between dusk and dawn. Five strands of the Plasmodium virus regularly infect humans. These are falciparum, vivax, ovale, malariae and knowlesi.[6] While P.falciparum is the most dangerous strand, P.vivax is now the most geographically widespread of the human malarias, as it is estimated to account for 100-300 million clinical cases of the infection across Asia, Central and South America, and the Middle East.[7]

The deadly P.falciparum strand of malaria is considered a serious public health concern in most countries within sub-Saharan Africa.

Preventing malaria

In many instances, malaria can be prevented. An easy way to remember the precautions you should take is by thinking of them as the ABCD approach.[8] This consists of:

Awareness of risk: find out whether your destination carries a risk of malaria before you travel

Bite prevention: avoid mosquito bites by using things such as insect repellent and an insecticide-treated mosquito net. You should also cover your arms and legs whenever possible

Check whether you need anti-malarial medication: Explore the various treatment options available. Always ensure you use the right dose and finish your course of medication

Diagnosis: Seek immediate medical advice if you develop any malaria symptoms for as long as up to a year after you return from your travels abroad.

Always speak to your GP if you’re planning to visit an area where there is a malaria risk.

Malaria risk countries

One of the most important questions to ask yourself when travelling is whether malaria is a risk factor in your destination. Being aware of potential malaria risks before you travel is essential, as the most serious forms of malaria can become life-threatening after just 24 hours.[9]

Most malaria cases in 2017 were within the WHO African Region (92%, or around 200 million). This is followed by the WHO South-East Asia Region (5% of cases) and the WHO Eastern Mediterranean Region (2%).[10]

Almost 80% of global malaria cases occurred within just 15 countries in sub-Saharan Africa and India, and five countries accounted for almost half of all malaria instances worldwide: Nigeria (25%), Democratic Republic of the Congo (11%), Mozambique (5%), India (4%) and Uganda (4%).[11]

If you’re planning to travel further than Europe, you should carefully research any potential malaria risks in your area.

Understanding malaria is key to avoiding the condition when travelling further afield. If you’re worried that you may be at risk of the condition while travelling, contact Express Pharmacy today. We can provide effective anti-malarial medication such as Malarone and Doxycycline. Speak to one of our pharmacists today by calling 0208 23 07 03 or by using our discreet online Live Chat service.


[1] NHS UK. Malaria Overview. 2018 [Accessed March 2019]

[2] Carter, R., Mendis, K.N. Evolutionary and Historical Aspects of the Burden of Malaria. Clinical Microbiology Reviews. October 2002; 15(4) [Accessed March 2019]

[3] Alcock, K. Cerebral malaria may have passed from gorillas to us. 2010 [Accessed March 2010]

[4] Liu, W. et al. Origins of the human malaria parasite Plasmodium falciparum in gorillas. Nature. September 2010 [Accessed March 2019]

[5] World Health Organisation. Malaria, Information for Travellers. 2019 [Accessed March 2019]

[6] Public Health England. Advisory Committee for Malaria Prevention. Guidelines for malaria prevention in travellers from the UK. 2018 [Accessed March 2019]

[7] Rich, S.M., Ayala, F.J. Evolutionary Origins of Human Malaria Parasites. Springer US. 2006 [Accessed March 2019]

[8] NHS UK. Malaria. 2018 [Accessed March 2019]

[9] NHS Fit For Travel. Malaria. 2019 [Accessed March 2019]

[10] Travel Health Pro. Malaria Factsheet. 2019 [Accessed March 2019]

[11] World Health Organisation. World Malaria Report 2018 [Accessed March 2019]