Malaria Prevention in Tanzania — 2026 Guide
Tanzania has high malaria transmission throughout the country at altitudes below 1,800m. This includes all popular tourist destinations — Zanzibar, the Serengeti, Ngorongoro Crater floor, Tarangire, and coastal Dar es Salaam. The only significant exception is the upper slopes of Mount Kilimanjaro and Mount Meru above 1,800m.
Critical Warning: Malaria risk exists across virtually all of Tanzania. Zanzibar, despite being an island, has significant malaria transmission. All travellers to Tanzania must take antimalarials — the only exception is Kilimanjaro climbers who stay above 1,800m for the entire trip (unlikely given travel to/from the mountain).
Malaria Risk by Region
Tanzania is classified as a high malaria transmission country by the WHO. Risk is present everywhere below 1,800m altitude, including major tourist circuits.
| Region | Risk Level | Peak Season | Notes |
|---|---|---|---|
| Dar es Salaam | High | Year-round (peaks Mar–Jun) | Hot, humid coastal city; consistent transmission near marshes and drains |
| Zanzibar (Unguja & Pemba) | High | Mar – Jun, Nov – Dec | Despite being an island, malaria is endemic; rice paddies and standing water |
| Serengeti & Ngorongoro | High (seasonal) | Mar – Jun, Nov – Dec | Safari plains at ~1,200–1,600m; risk increases with rains and around rivers |
| Tarangire & Lake Manyara | High (seasonal) | Mar – Jun, Nov – Dec | River and swamp areas attract mosquitoes; popular safari circuit |
| Lake Victoria basin (Mwanza) | Very High | Year-round | Lake creates extensive breeding habitat; among the highest burden areas |
| Southern Highlands (Iringa, Mbeya) | Moderate | Dec – May | Altitude 1,500–2,000m; risk in lower valleys, minimal above 1,800m |
| Mt Kilimanjaro (above 1,800m) | Very Low | — | Minimal risk above 1,800m; however, Moshi town (800m) at the base IS a malaria area |
| Selous / Ruaha (south) | High | Year-round | Remote southern parks; hot, low-altitude bush; high mosquito density |
Key fact: Tanzania records approximately 6.3 million confirmed malaria cases and 17,000 deaths annually (WHO 2024). The country carries ~4% of the global malaria burden. P. falciparum is responsible for >99% of infections.
Antimalarial Medication Comparison
All travellers to Tanzania should take antimalarials regardless of itinerary (unless staying exclusively above 1,800m). Consult a travel clinic 4–6 weeks before departure.
| Medication | Dosing | Start | Continue After | UK Cost | US Cost | Side Effects |
|---|---|---|---|---|---|---|
| Malarone (Atovaquone/Proguanil) |
1 tablet daily | 1–2 days before | 7 days | £40–£90 (2–3 weeks) | $60–$180 (2–3 weeks) | Mild nausea, headache |
| Doxycycline | 100mg daily | 1–2 days before | 28 days | £5–£15 (4 weeks) | $10–$30 (4 weeks) | Sun sensitivity, oesophageal irritation |
| Mefloquine (Lariam) |
1 tablet weekly | 2–3 weeks before | 4 weeks | £15–£30 (4 weeks) | $40–$80 (4 weeks) | Vivid dreams, dizziness, psychiatric (trial beforehand) |
Kilimanjaro climbers: You still need antimalarials. Even though the summit is at 5,895m, you spend days at Moshi (800m) before and after the climb, pass through forest zones (1,000–1,800m) on the first and last days, and likely visit safari parks or Zanzibar before/after. Take antimalarials for the entire Tanzania trip.
Prevention Methods
1. Insect Repellent
- Use 30–50% DEET on all exposed skin from dusk to dawn
- In Zanzibar, apply repellent during evening beach walks — onshore breezes reduce but do not eliminate mosquitoes
- Reapply after swimming in the ocean or sweating during safari drives
- Available locally: OFF!, Peaceful Sleep, and locally-made repellents in Dar pharmacies
2. Mosquito Nets
- Safari tented camps in the Serengeti/Ngorongoro typically provide treated nets
- Zanzibar beach lodges vary — budget places may not have nets; bring your own
- Government-distributed LLINs are common in local homes; tourists should verify provision
3. Protective Clothing
- Long sleeves and trousers from dusk (6pm) to dawn (6am)
- In Zanzibar, lightweight loose-fitting clothes are comfortable in the heat and culturally appropriate
- Spray safari clothing with permethrin before the trip
4. Destination-Specific Tips
- Zanzibar: The spice island’s rice paddies and tropical vegetation support year-round breeding; do not assume “island = safe”
- Serengeti: River crossings and waterholes attract mosquitoes; be especially cautious at riverside camps
- Kilimanjaro: Moshi town and the forest zone (Day 1 and descent) have active mosquitoes
Recognising Malaria Symptoms
Symptoms appear 7 days to 12 months after exposure. Tanzania’s dominant P. falciparum can cause severe, potentially fatal malaria within 24–48 hours of symptom onset.
Early Symptoms
- High fever with chills and sweating
- Severe headache, body aches
- Nausea, vomiting, diarrhoea
- Fatigue and weakness
- Often mistaken for flu or food poisoning
Severe Malaria (Emergency)
- Confusion, loss of consciousness
- Seizures
- Difficulty breathing
- Dark urine (blackwater fever)
- Severe jaundice
- Inability to eat or drink
Kilimanjaro climbers note: Altitude sickness and malaria share overlapping symptoms (headache, nausea, fatigue). If you develop fever after descending from Kilimanjaro, suspect malaria and get tested immediately.
Emergency Treatment in Tanzania
- RDTs available at pharmacies and dispensaries for TSh 2,000–5,000 (~$0.80–$2)
- ACT (Artemether-Lumefantrine) is the national first-line treatment
- Severe malaria: IV artesunate in hospital setting
- Private hospitals in Dar and Arusha offer faster, higher-quality care
Key Hospitals
| City | Hospital | Phone |
|---|---|---|
| Dar es Salaam | Aga Khan Hospital | +255 22 211 5151 |
| Dar es Salaam | Muhimbili National Hospital | +255 22 215 0596 |
| Arusha | Arusha Lutheran Medical Centre | +255 27 254 8030 |
| Zanzibar | Mnazi Mmoja Hospital | +255 24 223 1071 |
| Moshi | KCMC (Kilimanjaro Christian Medical Centre) | +255 27 275 4377 |
Children & Pregnant Women
Children
- Children under 5 bear the heaviest malaria burden in Tanzania — they account for ~60% of malaria deaths
- Malarone paediatric tablets for children ≥5kg; Mefloquine from 5kg (quarter tablets)
- Doxycycline not recommended under 12
- Kilimanjaro treks are generally not recommended for children under 10 — altitude and malaria risk
- Zanzibar family holidays require full antimalarial cover for children
Pregnant Women
- Avoid non-essential travel to Tanzania during pregnancy — high malaria risk nationwide
- Mefloquine is the only antimalarial approved for all three trimesters
- Malaria in pregnancy contributes to maternal anaemia, low birth weight, and stillbirth
- Kilimanjaro is contraindicated during pregnancy (altitude + malaria risk)
Malaria Statistics — Tanzania
| Annual confirmed cases | ~6.3 million (WHO 2024) |
| Annual deaths | ~17,000 |
| Global malaria burden share | ~4% |
| Predominant species | P. falciparum (>99%) |
| Zanzibar prevalence | Declining but still endemic (~1% parasite rate) |
| Peak transmission | March – June (long rains), Nov – Dec (short rains) |
| Altitude threshold | Minimal risk above 1,800m |
Emergency Numbers
- Emergency: 112 / 114
- Ambulance: 114
- Police: 112
- Fire: 114