Can I skip the meds if I only go to the highlands?

No. While the transmission risk is lower in the high-altitude central plateau, malaria is still present. Doctors recommend full protection for the entire country.

When are mosquitoes most active?

They are most active from dusk until dawn. This is when you must be most vigilant about wearing long sleeves and applying fresh repellent.

What should I do if I get a fever?

Seek medical attention immediately. Any unexplained fever during or up to one year after your trip must be tested for malaria. Do not wait to see if it passes.

Preventing Malaria While Traveling in Madagascar

Malaria is present throughout Madagascar, so you must combine prescription antimalarials with aggressive mosquito bite prevention. Take your medication exactly as prescribed and use DEET-based repellent every single day, regardless of your altitude or region.

Get a prescription 4-6 weeks before departure. Visit a travel clinic to get a prescription for Malarone (atovaquone/proguanil) or Doxycycline. Start taking the medication 1-2 days before you enter the country to ensure it is in your system.
Use 30-50% DEET repellent. Apply a repellent containing 30-50% DEET to all exposed skin. If you are using sunscreen, apply the sunscreen first, let it dry for 10 minutes, then apply the repellent.
Treat your clothing with Permethrin. Spray your clothes, socks, and shoes with Permethrin before you leave home. This stays effective through several washes and acts as a second barrier if mosquitoes bite through fabric.
Sleep under a treated bed net. If your accommodation isn't fully screened or air-conditioned, use a permethrin-treated mosquito net. Tuck the edges firmly under your mattress to ensure no gaps.

Can I skip the meds if I only go to the highlands?: No. While the transmission risk is lower in the high-altitude central plateau, malaria is still present. Doctors recommend full protection for the entire country.
When are mosquitoes most active?: They are most active from dusk until dawn. This is when you must be most vigilant about wearing long sleeves and applying fresh repellent.
What should I do if I get a fever?: Seek medical attention immediately. Any unexplained fever during or up to one year after your trip must be tested for malaria. Do not wait to see if it passes.