Protection against malaria is absolutely essential. The disease, caused by a parasite carried in the saliva of female Anopheles mosquitoes , is endemic everywhere in India except high-altitude regions of Ladakh, Himachal Pradesh, Kashmir and Sikkim, and is nowadays regarded as the big killer in the subcontinent. It has a variable incubation period of a few days to several weeks, so you can become ill long after being bitten. Programmes to eradicate the disease by spraying mosquito-infested areas and distributing free preventative tablets have proved disastrous; within a short space of time, the Anopheles develop immunities to the insecticides, while the malaria parasite itself constantly mutates into drug-resistant strains, rendering the old cures ineffective.

 

It is vital for travellers to take preventative tablets according to a strict routine, and to cover the period before and after your trip. The drug used is chloroquine (trade names include Nivaquin, Avloclor and Resochin), usually two tablets weekly, but India has chloroquine-resistant strains, and you'll need to supplement it with daily proguanil ( Paludrine ) or weekly Maloprim . In India chloroquine is easy to come by but proguanil isn't, so stock up before you arrive. Unfortunately, the highly effective weekly anti-malarial Larium ( Mefloquine ), can cause horrible side effects (see below). Australian authorities are now prescribing the antibiotic Doxycycline instead of Mefloquine. As the malaria parasite can incubate in your system without showing symptoms for more than a month, it is essential to continue to take preventative tablets for at least four weeks after returning home: the most common way of catching malaria is by forgetting to do this.

Side-effects of anti-malaria drugs may include itching, rashes, hair loss and sight problems. In the case of Larium some people may experience disorientation, depression and sleep disturbance; if you're intending to use Larium you should begin to take it two weeks before you depart to see whether it will agree with your metabolism, though normally you only need to begin taking anti-malaria medication a week before your departure date. If you plan on diving, you should perhaps avoid Mefloquine, as there is a worry about possible side effects for divers.