namibia safari malaria

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Namibia Traveler View

Travel health notices, vaccines and medicines, non-vaccine-preventable diseases, stay healthy and safe.

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After Your Trip

There are no notices currently in effect for Namibia.

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Check the vaccines and medicines list and visit your doctor at least a month before your trip to get vaccines or medicines you may need. If you or your doctor need help finding a location that provides certain vaccines or medicines, visit the Find a Clinic page.

Routine vaccines

Recommendations.

Make sure you are up-to-date on all routine vaccines before every trip. Some of these vaccines include

• Chickenpox (Varicella)
• Diphtheria-Tetanus-Pertussis
• Flu (influenza)
• Measles-Mumps-Rubella (MMR)

Immunization schedules

All eligible travelers should be up to date with their COVID-19 vaccines. Please see  Your COVID-19 Vaccination  for more information. 

COVID-19 vaccine

Hepatitis A

Recommended for unvaccinated travelers one year old or older going to Namibia.

Infants 6 to 11 months old should also be vaccinated against Hepatitis A. The dose does not count toward the routine 2-dose series.

Travelers allergic to a vaccine component or who are younger than 6 months should receive a single dose of immune globulin, which provides effective protection for up to 2 months depending on dosage given.

Unvaccinated travelers who are over 40 years old, immunocompromised, or have chronic medical conditions planning to depart to a risk area in less than 2 weeks should get the initial dose of vaccine and at the same appointment receive immune globulin.

Hepatitis A - CDC Yellow Book

Dosing info - Hep A

Hepatitis B

Recommended for unvaccinated travelers of all ages traveling to Namibia.

Hepatitis B - CDC Yellow Book

Dosing info - Hep B

CDC recommends that travelers going to certain areas of Namibia take prescription medicine to prevent malaria. Depending on the medicine you take, you will need to start taking this medicine multiple days before your trip, as well as during and after your trip. Talk to your doctor about which malaria medication you should take.

Find  country-specific information  about malaria.

Malaria - CDC Yellow Book

Considerations when choosing a drug for malaria prophylaxis (CDC Yellow Book)

Malaria information for Namibia.

Cases of measles are on the rise worldwide. Travelers are at risk of measles if they have not been fully vaccinated at least two weeks prior to departure, or have not had measles in the past, and travel internationally to areas where measles is spreading.

All international travelers should be fully vaccinated against measles with the measles-mumps-rubella (MMR) vaccine, including an early dose for infants 6–11 months, according to  CDC’s measles vaccination recommendations for international travel .

Measles (Rubeola) - CDC Yellow Book

Dogs infected with rabies are commonly found in Namibia.

Rabies is also present in some terrestrial wildlife species.

If rabies exposures occur while in Namibia, rabies vaccines are typically available throughout most of the country.

Rabies pre-exposure vaccination considerations include whether travelers 1) will be performing occupational or recreational activities that increase risk for exposure to potentially rabid animals and 2) might have difficulty getting prompt access to safe post-exposure prophylaxis.

Please consult with a healthcare provider to determine whether you should receive pre-exposure vaccination before travel.

For more information, see country rabies status assessments .

Rabies - CDC Yellow Book

Recommended for most travelers, especially those staying with friends or relatives or visiting smaller cities or rural areas.

Typhoid - CDC Yellow Book

Dosing info - Typhoid

Yellow Fever

Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1

Yellow Fever - CDC Yellow Book

• Avoid contaminated water

Leptospirosis

How most people get sick (most common modes of transmission)

• Touching urine or other body fluids from an animal infected with leptospirosis
• Swimming or wading in urine-contaminated fresh water, or contact with urine-contaminated mud
• Drinking water or eating food contaminated with animal urine
• Avoid contaminated water and soil
• Avoid floodwater

Clinical Guidance

Schistosomiasis

• Wading, swimming, bathing, or washing in contaminated freshwater streams, rivers, ponds, lakes, or untreated pools.

Avoid bug bites

African tick-bite fever.

• Avoid Bug Bites

African Tick-bite fever

Chikungunya

• Mosquito bite

Crimean-Congo Hemorrhagic fever

• Tick bite 
• Touching the body fluids of a person or animal infected with CCHF
• Mosquito bite

Leishmaniasis

• Sand fly bite
• Avoid animals

Rift Valley Fever

• Touching blood, body fluids, or tissue of infected livestock

Rift Valley fever

Airborne & droplet

• Breathing in air or accidentally eating food contaminated with the urine, droppings, or saliva of infected rodents
• Bite from an infected rodent
• Less commonly, being around someone sick with hantavirus (only occurs with Andes virus)
• Avoid rodents and areas where they live
• Avoid sick people

Tuberculosis (TB)

• Breathe in TB bacteria that is in the air from an infected and contagious person coughing, speaking, or singing.

Learn actions you can take to stay healthy and safe on your trip. Vaccines cannot protect you from many diseases in Namibia, so your behaviors are important.

Eat and drink safely

Food and water standards around the world vary based on the destination. Standards may also differ within a country and risk may change depending on activity type (e.g., hiking versus business trip). You can learn more about safe food and drink choices when traveling by accessing the resources below.

• Choose Safe Food and Drinks When Traveling
• Water Treatment Options When Hiking, Camping or Traveling
• Global Water, Sanitation and Hygiene (WASH)
• Avoid Contaminated Water During Travel

You can also visit the Department of State Country Information Pages for additional information about food and water safety.

Prevent bug bites

Bugs (like mosquitoes, ticks, and fleas) can spread a number of diseases in Namibia. Many of these diseases cannot be prevented with a vaccine or medicine. You can reduce your risk by taking steps to prevent bug bites.

What can I do to prevent bug bites?

• Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
• Use an appropriate insect repellent (see below).
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Do not use permethrin directly on skin.
• Stay and sleep in air-conditioned or screened rooms.
• Use a bed net if the area where you are sleeping is exposed to the outdoors.

What type of insect repellent should I use?

• FOR PROTECTION AGAINST TICKS AND MOSQUITOES: Use a repellent that contains 20% or more DEET for protection that lasts up to several hours.
• Picaridin (also known as KBR 3023, Bayrepel, and icaridin)
• Oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD)
• 2-undecanone
• Always use insect repellent as directed.

What should I do if I am bitten by bugs?

• Avoid scratching bug bites, and apply hydrocortisone cream or calamine lotion to reduce the itching.
• Check your entire body for ticks after outdoor activity. Be sure to remove ticks properly.

What can I do to avoid bed bugs?

Although bed bugs do not carry disease, they are an annoyance. See our information page about avoiding bug bites for some easy tips to avoid them. For more information on bed bugs, see Bed Bugs .

For more detailed information on avoiding bug bites, see Avoid Bug Bites .

Stay safe outdoors

If your travel plans in Namibia include outdoor activities, take these steps to stay safe and healthy during your trip.

• Stay alert to changing weather conditions and adjust your plans if conditions become unsafe.
• Prepare for activities by wearing the right clothes and packing protective items, such as bug spray, sunscreen, and a basic first aid kit.
• Consider learning basic first aid and CPR before travel. Bring a travel health kit with items appropriate for your activities.
• If you are outside for many hours in heat, eat salty snacks and drink water to stay hydrated and replace salt lost through sweating.
• Protect yourself from UV radiation : use sunscreen with an SPF of at least 15, wear protective clothing, and seek shade during the hottest time of day (10 a.m.–4 p.m.).
• Be especially careful during summer months and at high elevation. Because sunlight reflects off snow, sand, and water, sun exposure may be increased during activities like skiing, swimming, and sailing.
• Very cold temperatures can be dangerous. Dress in layers and cover heads, hands, and feet properly if you are visiting a cold location.

Stay safe around water

• Swim only in designated swimming areas. Obey lifeguards and warning flags on beaches.
• Practice safe boating—follow all boating safety laws, do not drink alcohol if driving a boat, and always wear a life jacket.
• Do not dive into shallow water.
• Do not swim in freshwater in developing areas or where sanitation is poor.
• Avoid swallowing water when swimming. Untreated water can carry germs that make you sick.
• To prevent infections, wear shoes on beaches where there may be animal waste.

Schistosomiasis, a parasitic infection that can be spread in fresh water, is found in Namibia. Avoid swimming in fresh, unchlorinated water, such as lakes, ponds, or rivers.

Keep away from animals

Most animals avoid people, but they may attack if they feel threatened, are protecting their young or territory, or if they are injured or ill. Animal bites and scratches can lead to serious diseases such as rabies.

Follow these tips to protect yourself:

• Do not touch or feed any animals you do not know.
• Do not allow animals to lick open wounds, and do not get animal saliva in your eyes or mouth.
• Avoid rodents and their urine and feces.
• Traveling pets should be supervised closely and not allowed to come in contact with local animals.
• If you wake in a room with a bat, seek medical care immediately. Bat bites may be hard to see.

All animals can pose a threat, but be extra careful around dogs, bats, monkeys, sea animals such as jellyfish, and snakes. If you are bitten or scratched by an animal, immediately:

• Wash the wound with soap and clean water.
• Go to a doctor right away.
• Tell your doctor about your injury when you get back to the United States.

Consider buying medical evacuation insurance. Rabies is a deadly disease that must be treated quickly, and treatment may not be available in some countries.

Reduce your exposure to germs

Follow these tips to avoid getting sick or spreading illness to others while traveling:

• Wash your hands often, especially before eating.
• If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).
• Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
• Try to avoid contact with people who are sick.
• If you are sick, stay home or in your hotel room, unless you need medical care.

Avoid sharing body fluids

Diseases can be spread through body fluids, such as saliva, blood, vomit, and semen.

Protect yourself:

• Use latex condoms correctly.
• Do not inject drugs.
• Limit alcohol consumption. People take more risks when intoxicated.
• Do not share needles or any devices that can break the skin. That includes needles for tattoos, piercings, and acupuncture.
• If you receive medical or dental care, make sure the equipment is disinfected or sanitized.

Know how to get medical care while traveling

Plan for how you will get health care during your trip, should the need arise:

• Carry a list of local doctors and hospitals at your destination.
• Review your health insurance plan to determine what medical services it would cover during your trip. Consider purchasing travel health and medical evacuation insurance.
• Carry a card that identifies, in the local language, your blood type, chronic conditions or serious allergies, and the generic names of any medications you take.
• Some prescription drugs may be illegal in other countries. Call Namibia’s embassy to verify that all of your prescription(s) are legal to bring with you.
• Bring all the medicines (including over-the-counter medicines) you think you might need during your trip, including extra in case of travel delays. Ask your doctor to help you get prescriptions filled early if you need to.

Many foreign hospitals and clinics are accredited by the Joint Commission International. A list of accredited facilities is available at their website ( www.jointcommissioninternational.org ).

In some countries, medicine (prescription and over-the-counter) may be substandard or counterfeit. Bring the medicines you will need from the United States to avoid having to buy them at your destination.

Malaria is a risk in some parts of Namibia. If you are going to a risk area, fill your malaria prescription before you leave, and take enough with you for the entire length of your trip. Follow your doctor’s instructions for taking the pills; some need to be started before you leave.

Select safe transportation

Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.

In many places cars, buses, large trucks, rickshaws, bikes, people on foot, and even animals share the same lanes of traffic, increasing the risk for crashes.

Be smart when you are traveling on foot.

• Use sidewalks and marked crosswalks.
• Pay attention to the traffic around you, especially in crowded areas.
• Remember, people on foot do not always have the right of way in other countries.

Riding/Driving

Choose a safe vehicle.

• Choose official taxis or public transportation, such as trains and buses.
• Ride only in cars that have seatbelts.
• Avoid overcrowded, overloaded, top-heavy buses and minivans.
• Avoid riding on motorcycles or motorbikes, especially motorbike taxis. (Many crashes are caused by inexperienced motorbike drivers.)
• Choose newer vehicles—they may have more safety features, such as airbags, and be more reliable.
• Choose larger vehicles, which may provide more protection in crashes.

Think about the driver.

• Do not drive after drinking alcohol or ride with someone who has been drinking.
• Consider hiring a licensed, trained driver familiar with the area.
• Arrange payment before departing.

Follow basic safety tips.

• Wear a seatbelt at all times.
• Sit in the back seat of cars and taxis.
• When on motorbikes or bicycles, always wear a helmet. (Bring a helmet from home, if needed.)
• Avoid driving at night; street lighting in certain parts of Namibia may be poor.
• Do not use a cell phone or text while driving (illegal in many countries).
• Travel during daylight hours only, especially in rural areas.
• If you choose to drive a vehicle in Namibia, learn the local traffic laws and have the proper paperwork.
• Get any driving permits and insurance you may need. Get an International Driving Permit (IDP). Carry the IDP and a US-issued driver's license at all times.
• Check with your auto insurance policy's international coverage, and get more coverage if needed. Make sure you have liability insurance.
• Avoid using local, unscheduled aircraft.
• If possible, fly on larger planes (more than 30 seats); larger airplanes are more likely to have regular safety inspections.
• Try to schedule flights during daylight hours and in good weather.

Medical Evacuation Insurance

If you are seriously injured, emergency care may not be available or may not meet US standards. Trauma care centers are uncommon outside urban areas. Having medical evacuation insurance can be helpful for these reasons.

Helpful Resources

Road Safety Overseas (Information from the US Department of State): Includes tips on driving in other countries, International Driving Permits, auto insurance, and other resources.

The Association for International Road Travel has country-specific Road Travel Reports available for most countries for a minimal fee.

Traffic flows on the left side of the road in Namibia.

• Always pay close attention to the flow of traffic, especially when crossing the street.
• LOOK RIGHT for approaching traffic.

Maintain personal security

Use the same common sense traveling overseas that you would at home, and always stay alert and aware of your surroundings.

Before you leave

• Research your destination(s), including local laws, customs, and culture.
• Monitor travel advisories and alerts and read travel tips from the US Department of State.
• Enroll in the Smart Traveler Enrollment Program (STEP) .
• Leave a copy of your itinerary, contact information, credit cards, and passport with someone at home.
• Pack as light as possible, and leave at home any item you could not replace.

While at your destination(s)

• Carry contact information for the nearest US embassy or consulate .
• Carry a photocopy of your passport and entry stamp; leave the actual passport securely in your hotel.
• Follow all local laws and social customs.
• Do not wear expensive clothing or jewelry.
• Always keep hotel doors locked, and store valuables in secure areas.
• If possible, choose hotel rooms between the 2nd and 6th floors.

Healthy Travel Packing List

Use the Healthy Travel Packing List for Namibia for a list of health-related items to consider packing for your trip. Talk to your doctor about which items are most important for you.

Why does CDC recommend packing these health-related items?

It’s best to be prepared to prevent and treat common illnesses and injuries. Some supplies and medicines may be difficult to find at your destination, may have different names, or may have different ingredients than what you normally use.

If you are not feeling well after your trip, you may need to see a doctor. If you need help finding a travel medicine specialist, see Find a Clinic . Be sure to tell your doctor about your travel, including where you went and what you did on your trip. Also tell your doctor if you were bitten or scratched by an animal while traveling.

If your doctor prescribed antimalarial medicine for your trip, keep taking the rest of your pills after you return home. If you stop taking your medicine too soon, you could still get sick.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the doctor about your travel history.

For more information on what to do if you are sick after your trip, see Getting Sick after Travel .

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The 20 Best Malaria-Free Safari Destinations

Find the ultimate malaria free safari.

Malaria-free safaris are increasing in popularity as young families, pregnant ladies, and others unable or unwilling to take anti-malarial medication still want to experience an African safari.

Whatever the reason for wanting to avoid taking anti-malarial precautions or medications, the good news is that there are many excellent malaria-free safari destinations open to you. These malaria-free safari destinations are spread across ecologically diverse regions of South Africa and Namibia, with some of the best national parks in the world and world-class game viewing.

So, if you want to have a true safari experience and see the big five without worrying about malaria medication or precautions, here’s our list of the very best destinations for malaria-free safaris:

Skip to section:

About malaria

South Africa malaria-free safaris

• Eastern Cape malaria-free safaris
• Northern Cape malaria-free safaris
• Waterberg (Limpopo) malaria free safaris
• North West Province malaria-free safaris

Namibia malaria-free safaris

Map of all malaria-free safari destinations

Book a malaria-free safari

What is malaria?

Malaria is an infectious disease carried by female mosquitos that affects humans and other animals, and can be transmitted by just one mosquito bite. Symptoms usually begin ten to fifteen days after being bitten by an infected mosquito, and typically include fever, tiredness, vomiting, and headaches. ( Read one travellers’ experience of getting malaria in Uganda .)

I n severe cases, malaria can cause yellow skin, seizures, coma, or death, though the high mortality figures of malaria are primarily a reflection of the poor health care in many parts of Africa. The vast majority of tourists who get malaria have fast access to medicine, doctors, clean water and food, and make a complete recovery.

Malaria Free Safari Destinations in South Africa

Malaria is present in many parts of South Africa, and some of the best national parks and game reserves in South Africa – such as the Kruger National Park and others in the north-eastern regions of Mpumalanga and KwaZulu-Natal – are not in the malaria-free zone.

However, many award-winning game reserves in South Africa have been established in other regions over the years, relocating large numbers of animals with healthy populations of the big five, wild dog and cheetah, resulting in some phenomenal game-viewing.

South Africa’s Eastern Cape

A safari in the Eastern Cape offers the ideal opportunity to combine a drive along South Africa’s world-famous Garden Route with a malaria-free safari experience at one of the many high-quality private reserves.

All game reserves in the Eastern Cape are completely malaria-free and tend to be fully inclusive. This means that meals, game drives , and other safari activities are included in the per night cost.

1. Addo Elephant Park, South Africa

A herd of elephants enjoying a sundowner at Addo Elephant Park, South Africa

One of South Africa’s most scenic national parks with rolling green hills and lush, evergreen forest make this a perfect year-round malaria-free safari destination. Addo Elephant Park is home to around 500 elephants roaming freely across the 125,000-hectare reserve; the greatest density of elephants per square kilometer in Africa.

Other wildlife includes the rest of the big five, zebra, kudu , red hartebeest, over 400 bird species, and the endemic, protected flightless dung beetle . The park extends to the coast where South Africa’s second-largest African penguin colony can be seen, and sightings of whales, great white sharks, and southern right whales are common.

Accommodation around Addo: There’s a good choice of accommodation in and around the park, from luxury lodges and forest cabins and chalets to pitched tents or camping spots. Find prices & book >>

2. Kwandwe Private Game Reserve, South Africa

A male lion strolls the bush of Kwandwe Private Game Reserve, South Africa

Big 5 destination Kwandwe Private Game Reserve covers 54,000 acres of private wilderness area. The reserve includes 30 kilometers of the Great Fish River, meaning a diverse landscape and varied wildlife sightings.

The reserve has some great family-friendly safari options offering child-focused wildlife activities such as making plaster casts of animal footprints and visits to animal orphanages, to help make your South African family safari more meaningful.

Accommodation at Kwandwe: There are four properties in the reserve with 22 beds in total, meaning not too many other people or safari trucks around when you’re doing your game drives. Melton Manor and Uplands Homestead are exclusive-use lodges for families or small groups. Find prices & book >>

3. Samara Private Game Reserve, South Africa

A herd of Eland at Samara, South Africa, looking for danger

Set amongst wildlife-rich rivers, mountains, and open plains, luxury private game reserve Samara offers guests some of the most breath-taking landscapes in South Africa.

Home to a very successful cheetah regeneration program, the reserve gives a good chance of spotting these beautiful cats, alongside the big 5 and large herds of eland.

Accommodation at Samara: Samara offers two exclusive onsite lodges – the Karoo Lodge and Manor House. Find prices & book >>

4. Amakhala Game Reserve, South Africa

Giraffe-spotting on a game drive

The Amakhala Game Reserve is an 18,000-acre joint conservation effort where a former farming area has been rewilded. Wildlife likely to be encountered on game drives in the reserve includes the big five, as well as cheetah , giraffe , zebra, wildebeest, and plenty of antelope species.

Accommodation options: There are 10 owner-managed properties across the reserve, ranging from restored country homes to tented camps, ensuring there’s something for everyone.

An all-inclusive safari experience and a range of wildlife-focused activities are offered at each property. Find prices & book >>

5. Kariega Game Reserve, South Africa

Three luxury safari lodges at Kariega, South Africa

Kariega is a family-owned and run big five reserve incorporating 10,000 hectares of pristine African wilderness and two large rivers – the Kariega and the Bushmans rivers – giving access to the sea.

The reserve offers abundant game viewing, and in addition to the big 5, game to spot at Kariega includes hippo, hyena, giraffe, zebra, wildebeest, eland, kudu, waterbuck and a variety of other antelope, as well as a myriad of bird species.

Kariega is a particularly family-friendly game lodge offering a daily children’s programme at the Kids on Safari center.

Accommodation at Kariega Game Reserve: The reserve offers five safari lodges at a variety of price points, though all are at the high end, with quality and service to match. Find prices & book >>

6. Shamwari Game Reserve, South Africa

One of Shamwari’s waterside lodges

Big five reserve Shamwari prides itself on being both friendly (the name means “my friend” in Shona), and child-friendly.

Childminding services are available on request, along with a host of kid-specific activities to keep them occupied – including the conservation focused ‘Kids on Safari’ program.

What’s particularly nice (and somewhat unusual) about Shamwari for young families is that children from four upwards are permitted on game drives. Just a 2 hour drive from Port Elizabeth, Shamwari is easily accessible.

Accommodation options: Shamwari has seven lodges and one explorer camp, each with a distinct vibe. From exclusive tranquillity, effortless family enjoyment, or the back-to-nature appeal of a luxury tented camp. Find prices & book >>

South Africa’s Northern Cape

South Africa’s Northern Cape offers tranquility and huge open spaces with some of the largest national parks in Africa. The legendary Kalahari Desert makes up a large portion of the Northern Cape, with the Gariep River winding to the Atlantic and providing a water source to the varied wildlife in the region.

7. Tswalu Kalahari Game Reserve, South Africa

The pool area at Tswalu, South Africa

Tswalu Kalahari is the largest privately owned game reserve in South Africa – 100,000 hectares located in the Southern Kalahari, close to the Botswana border. Although the reserve is huge, visitor numbers are kept to just 30 at a time, with all guests enjoying a private guided experience to optimise their time there.

Aside from the excellent game drives, activities include horse riding, habituated meerkat colony walks, sleep-outs under the stars, and black rhino walking safaris. Children of all ages are welcome, and for families, Tswalu makes for a truly unique and memorable (malaria-free!) safari experience.

Accommodation options: Accommodation is luxurious with a choice of two lodges, the secluded Tarkuni (a private home with 5 suites), and The Motse (a spacious lodge with nine suites). Find prices & book >>

8. The Kgalagadi Transfrontier Park, South Africa

Desert scenery at Kgalagadi National Park, South Africa

The Kgalagadi Transfrontier Park is one of Southern Africa’s largest and is shared between both Botswana and South Africa.

Wildlife includes some of the largest lions and antelope in the world, plus leopard, cheetah, and both brown and spotted hyenas – along with plenty of meerkat colony activity! Self-drive safaris are very much on offer in this park, making for flexible and self-paced game drives.

Accommodation options: There are three rest camps in the park with a range of accommodation types to suit a variety of tastes and budgets including, chalets, family chalets, and campsites. Find prices & book >>

9. Ai-Ais/Richtersveld Transfrontier Park, South Africa and Namibia

A zebra family at Ai-Ais Richtersveld Transfrontier National Park

Ai-Ais Richtersveld Transfrontier National Park is a beautiful desert park on South Africa’s far northern border with Namibia. The landscape is barren at first glance, but on closer inspection, home to an abundance of wildlife adapted to the harsh terrain.

With some good luck over 50 species of mammals – including leopard, hyena, and zebras – lizards, tortoises, scorpions and 200 species of birds can be spotted!

Accommodation options: SANParks run a handful of basic rest camps across the park, some with cabins and others with campsites only. You’ll need to bring your own supplies and drinking water. Find prices & book >>

South Africa’s North West Province

One of South Africa’s smallest provinces, the North West Province is bordered by Botswana to the north and is made up of scattered trees and grassland, providing the ideal habitat for a big 5 South African safari.

10. Madikwe Game Reserve, South Africa

Views of the bush from a Madikwe balcony

Located on the Botswana border a 3.5-hour drive from Johannesburg, Madikwe is a wild and remote reserve that’s home to the big five, and is famous for its thriving population of wild dog, as well as gemsbok, springbok, zebra, giraffe and over 340 species of birds.

Accommodation options: The reserve has a large selection of camps and lodges, including the lovely Jaci’s Lodges, Mateya Safari Lodge, Madikwe Safari Lodge, and Little Madikwe Hills. Find prices & book >>

The Waterburg Region, Limpopo Province, South Africa

The Waterberg Region is a malaria-free district of Limpopo Province, in an area teeming with wildlife, spectacular scenery, and many private game reserves with excellent accommodation offering truly intimate safari experiences. Here’s our pick of the best:

11. The Ant Collection, South Africa

Horseback safari at the Ant Collection, South Africa

Two family-owned and operated lodges – Ant’s Nest and Ant’s Hill – located in their own spectacular private game reserve. The reserve is a real haven for animals (over 40 species) and people looking for a wonderful, malaria-free safari. As well as game drives, there’s horse riding, elephant safaris, and swimming available, amongst other activities.

Accommodation options: The Ant’s Nest and Ant’s Hill offer very family-friendly, luxurious accommodation that is intimate and homely. Find prices & book >>

1 2. Entabeni Safari Conservancy, South Africa

Three of Entabeni’s rhinos grazing in front of a signature rocky outcrop

Entabeni means ‘place of the mountain’, a private reserve spread over five ecosystems including wetlands, grass plains, craggy escarpments, and cliffs. Large animals such as elephants and rhinos are plentiful, along with leopards, cheetahs, and buffalo.

There’s a choice of activities other than game drives to keep you entertained, such as bush walks, sunset lake cruises, horse riding, and helicopter air safaris. Children are welcomed but must be six or over to join a game drive.

Accommodation options: Lodging includes Lakeside Lodge on the shores of Lake Entabeni and Wildside Safari Camp. Find prices & book >>

13. Jembisa Bush Home, South Africa

Forest views at Jembisa, South Africa

Multi-award winning Jembisa is a stylish bush home in its own private wildlife reserve, offering a unique safari experience in the beautiful Palala River wilderness. There’s a plethora of wildlife (though no elephant or lion from the big five, which can be viewed on an off-site excursion), and a wide range of wildlife and safari activities (mountain biking, river walks, and tracking classes) that are flexible to suit all ages and interests.

Accommodation options: Jembissa Bush Home has a colonial safari atmosphere with excellent staff and guides providing a flexible, family-friendly bush experience. Find prices & book >>

14. Leobo Private Reserve, South Africa

Bush views from open lounge area at the Leobo lodge

Leobo Private Reserve  is encompassed by rugged rocks, mountains, bushveld savannah, rivers, gorges, and an abundance of wildlife, and is one of only a handful of sole-use private reserves in Africa – allowing guests full access to the entire estate and all its facilities. Teeming with plains game, as well as hippo, there’s also a wide array of activities for all ages including paintballing, quad bikes, shooting, fishing, and more.

Accommodation options: The lodge has luxury 9 chalets with views over the Palala valley – and a stunning swimming pool built into the side of the mountain. It’s fully staffed and rented exclusively, so is perfect for families or groups of friends. Find prices & book >>

15. Mabalingwe Nature Reserve, South Africa

Main Mabalingwe lodge at sunset

The Mabalingwe biome , made up of 8,500 hectares of bushveld, provides wonderful game-viewing opportunities year-round. The reserve is very family-friendly, and the rolling grasslands make game-viewing a breeze. Home to the big five, and also hippo, giraffe, hyena, and sable, the reserve has a variety of family and child-friendly activities to go alongside their day and night game drives.

Accommodation options: There are many types of accommodation available including chalets, campsites, and bush lodges. Find prices & book >>

16. Pilanesberg National Park, South Africa

Hot air ballooning over Pilanesberg National Park

A beautiful 50,000-hectare malaria-free national park just a few hours’ drive north-west from Johannesburg. Centered around an extinct volcano crater, its setting is unique and home to the big five along with plenty of other game. You can choose between a self-drive safari and DIY accommodation, or private lodge safari. Either way, the Pilanesberg National Park is a mesmerizing location to take advantage of hot air balloon safaris over the bush at dawn.

Accommodation options: Due to its location near Sun City, there’s a huge range of accommodation options in and around Pilanesberg to suit all tastes and budgets. Find prices & book >>

17. Welgevonden Game Reserve & Marakele National Park, South Africa

Drinks time at Welgevenden’s pool area

Adjoining areas Welgevonden Game Reserve  and Marakele National Park are in the process of removing their fences to allow the game to roam in a larger area. Both parks are home to the big five, as well as 30 more mammal species and over 250 species of birds. Marakele is more for intrepid safari-goers than luxury safari seekers – you’ll definitely need your own four-wheel-drive car, whilst Welgevonden as a private game reserve has a focus on high-end luxury.

Accommodation options: Are plentiful and varied inside the reserve, with a host of luxurious and extremely hospitable lodges and camps to choose from. Find prices & book >>

Malaria Free Safari Destinations in Namibia

Malaria is prevalent in eastern and northern Namibia from November to June, but from July to September there’s no malaria risk in Namibia’s northern regions of Etosha or Damaraland.  This means that with the right timing, it’s possible to visit two of Namibia’s standout safari destinations with the guarantee of no malaria. Further south in Namibia the Namib-Naukluft National Park is malaria-free year-round.

18. Etosha National Park

An encounter with Etosha’s huge elephants

Whilst you’ll need to time your trip to Etosha between July and September to ensure a malaria-free safari, these are also the dry months with water sources drying up and wildlife congregating around waterholes – making it an excellent time to spot game. The white salt pan makes for a dramatic game-viewing backdrop, and along the pan’s southern edge is a collection of waterholes that are a magnet for wildlife. Common sightings are herds of zebra and huge elephants, rhinos and giraffe, with the big five all present. Read more about Etosha National Park .

Accommodation options in Etosha: There are three main camps in Etosha giving a range of options –  from great camping facilities to mid-range chalets and a few high-end bungalows. Close to the main gates of the park, there is also a range of mid-range accommodation options and full-on luxury lodge-type nature reserves such as Onguma. Find prices & book >>

19. Damaraland

Elephants congregating around a large watering hole in Damaraland

One of Namibia’s lesser-known gems, Damaraland is a dry, mountainous region in northern Namibia with desert-adapted wildlife including elephant, rhino, giraffe, and lion wandering the fenceless terrain.  Seeing wildlife in this beautifully stark environment is a thrilling addition to any safari, and combines well with time in nearby Etosha National Park.

Accommodation options in Etosha: Damaraland is a large area with a handful of luxurious lodges dotted around. Find prices & book >>

20. Sossusvlei

The orange dunes of Sossusvlei sand dunes in Namibia’s Namib-Naukluft National Park

At first glance, Sossusvlei and the surrounding Namib-Naukluft National Park seems like a lifeless pan in the south of Namibia. Aside from the shape-shifting red sand dunes and nearby photographer’s dreams of Deadvlei and Sesriem Canyon, there’s actually lots of wildlife on view across the park. Namib-Naukluft provides sanctuary to large mammals such as the black rhino and herds of gemsbok, Hartmann’s mountain zebra, springbok, ostrich and giraffe, and to predators such as spotted and brown hyena, leopard and cheetah.

Accommodation options in Sossusvlei: The only accommodation in the park comes in the form of several campsites in the north, though with minimal facilities – you’ll need to be 100% self-sufficient, with firewood, water, and food. There are plenty of accommodation options around the fringes, particularly Sesriem, which is the best base for trips to Sossusvlei. Find prices & book >>

Map of where to enjoy malaria free safaris

That’s our pick of the very best malaria-free safari options in Africa. Are there any other parks or game reserves you would add to this list? Please let us know in the comments section below!

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• Malaria-Free Safari in Namibia

Africa's best authentic tailor-made safaris

By Devryn Panaino

Safari Travel Planner

Malaria-free safaris are an excellent option if you’re traveling with children if you’re elderly, if you’re pregnant, or in any way unable to take anti-malaria medication.

Sossusvlei may seem like a lifeless pan surrounded by the arid Namib Desert in the south of the Namib-Naukluft National Park in Namibia, however, the area is surrounded by red dunes that seemingly go on forever in every direction.

These dunes are among the most sought-after in Namibia for their height and shape, making them perfect for all kinds of activities that will bring out your adventurous spirit.

In addition, the scenery in nearby Deadvlei and Sesriem Canyon is a photographer’s dream, with brilliant colors and a silent window into a world that has been around since before antiquity – an amazing contrast to the ever-shifting sands that characterize the dunes.

From November to June malaria is prevalent in north and east Namibia, so that may strike Etosha National Park from your itinerary.

However, you can still get a malaria-free safari fix by visiting a game reserve in the Waterberg region or at Okonjima (over 12s only), where the AfriCat Foundation rehabilitates cheetahs and leopards.

Having said that, during the dry months of July to September, there’s no risk of malaria in Namibia’s flagship National Park.

The dry months are the best time to go to Etosha anyway, as this is when the park’s water sources dry up and the animals congregate around waterholes, making it incredibly easy to spot them.

Just park off your car near a waterhole and wait for the zebras, springbok, giraffe, lions, elephants and rhino to arrive!

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15 days self drive safari, ideal for families

On this trip through Namibia, the focus is on families with children. Less kilometer per day and, where possible, a pool to let off steam and cool down to ensure that the back seats in the car are not taken apart and the milk bottle does not fly forward too often. Malaria is far away and long game drives are also optional. This self-drive tour takes you to famous sights for two weeks and gives you the opportunity to experience them in a relaxed and intensive way. We are happy to adapt the trip to your family wishes.

You can choose between simple accommodation, more luxury and camping in between.

Duration: 15 days

But do take care: Once Namibia - Always Namibia!

Safari Overview - Namibia Family Safari

• Day 1: Windhoek - Arrival, Vehicle take over and city tour through Namibia's capital city
• Day 2-3: Drive via Kalahari Desert to the well known elephants at Okambara
• Day 4: Kalahari Desert - Red Sand for digging in the Kalahari
• Day 5-6: Farmland near Maltahöhe - Real farm with castle next door
• Day 7-8: Namib Desert - Climbing the dunes and Sesriem Canyon
• Day 9-11: Atlantic coast - Sea, beach, the "Little Five", quad biking, petting seals
• Day 12: Erongo Mountains - Climbing on and through granite rocks, visiting the San
• Day 13-14: Game park - game drives and tracking
• Day 15: Journey home - Goodbye Namibia!

From N$ 33.000 (Camping / Lodge) From N$ 44.000   (Lodge - Comfort) From N$ 53.500 (Lodge - Luxury)

Rate example per person during the low season. Here you can find the detailed rates.

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Tour overview- "Nambia for families"

Day 1: arrival in namibia ~ 45 km.

Upon your arrival at Hosea Kutako International Airport, approximately 45 km east of Windhoek, you will be met by a car rental representative and transferred to Windhoek where you pick up your vehicle with all necessary instructions and information. You will then drive to your accommodation to freshen up and rest. In the afternoon, you will be picked up by your guide from Bwana Tucke-Tucke for an interesting  Windhoek city tour , where you will see historic buildings and the township of Katutura. In the evening you can go out for a relaxed dinner. We can recommend Joe's Beerhouse, Cape Town Fish Market or The Stellenbosch.

Services included:

• Pick up at the airport and vehicle introduction.
• Windhoek city tour
• Accommodation (Comfort): Sonneneck Guesthouse
• Accommodation (Luxury): Heinitzburg

Lodge / Camping

• Accommodation:  Sonneneck Guesthouse

Christ church (Christuskirche) in Windhoek

City Tour with Bwana Tucke-Tucke

Dinner in Joe's Beerhouse

View from Heinitzburg Hotel

Day 2: okambara elephant lodge ~ 150 km (2,5h).

After a good night's sleep you can buy provisions at the supermarket. Drive through the Namibian hinterland past farms to Okambara. The pool area invites you to cool down. To end the day with pleasure, the waterhole at the lodge is particularly suitable.

• Breakfast, Dinner, Accommodation
• Comfort / Luxury: Okambara Elephant Lodge

Lodge/Camping

• Breakfast, Dinner, Accommodation
• Comfort: Okambara Elephant Lodge

Day 3: Okambara Elephant Lodge ~ 0 km 

Another day is at your disposal in this dreamlike environment. The lodge offers a farm tour, walks and predator feeding. At Okambara you will experience Namibia up close. Elephants, giraffes, zebras, springboks and many other species can be seen on exciting game drives through the 15,000 hectare nature reserve. The farm can also be explored very well on foot. You can get close to nature on a walk to the watering hole or a challenging mountain hike. In the evening the little ones fall tired into bed.

Okambara elephants

Lounge at Okambara

Cheetah feeding

Day 4: Red Kalahari Desert ~ 135 km (2h)

Along lonely farm roads, game reserves and red dunes today you end in the middle of the Kalahari . At Kalahari Anib Lodge we recommend the sundowner tour in the open safari vehicle through the dunes in the afternoon. There are short and longer hiking trails, a huge pool and e-bikes bookable on site.

For camping and self-catering enthusiasts, we recommend the Jansen Kalahari Guest Farm, very family friendly and owner-managed!

• Comfort / Luxury: Kalahari Anib Lodge
• Self-Catering Bungalow: Jansen Kalahari Guest Farm

Swimmig Pool at Kalahari Anib Lodge

Giraffes in the Kalahari

Meerkats guard their burrow

Male ostrich guards the nest

Day 5: farm duwisib ~ 230 km (3.5h).

The journey continues west. The guest farm Duwisib is located on the edge of the beautiful Namib Desert and is the perfect stopover on the way to Sossusvlei, Lüderitz or the Fish River Canyon. During your stay at the small and personal guest farm you will experience real Namibian hospitality. Before dinner, it's worth taking a stroll to Barron's View, the farm's idyllic sundowner spot.

• Comfort / Luxury: Duwisib Guestfarm
• Camping: Duwisib Guestfarm

Swimmig Pool at Duwisib Guestfarm

Duwisib - Cozy farm rooms

Duwisib: a real guestfarm

View point "Baron's View"

Day 6: farm duwisib ~ 0 km.

Experience the remoteness of the south on a 4x4 drive around the farm. You will get an interesting insight into the fauna and flora of this region and learn about agricultural aspects of farm life that have evolved over the past centuries. Guide and farm owner Christian Frank-Schultz shares his in-depth knowledge and is happy to answer your questions.

Next to the farm is Duwisib Castle . Duwisib Castle is one of the most bizarre German colonial buildings in Namibia due to its appearance, location and history. This building owes its origin to the dream of the Saxon artillery officer Hansheinrich von Wolf. He had come to South West Africa as a Protective Force (Schutztruppen) officer during the Herero War and, after marrying a wealthy American woman during a home leave in 1907, intended to settle permanently in German Southwest Africa in order to establish a horse stud farm here.

Nature drive at Duwisib

Bokkies (goats)

Duwisib Castle

A real small castle in Namibia

Day 7: on the way to sossusvlei ~ 165 km (3h).

After breakfast you continue your journy. You can stop in the desert town of Betta and buy provisions and refuel. Drive along the NamibRand Nature Reserve to Sesriem.

Should the children still have enough energy in the afternoon or early evening (which is likely), we recommend a short visit to the Elim Dune, the first major sand dune in this area. It is on the right hand side when coming from Sesriem, a few kilometers from the entrance gate. The ascent is easy, from the top you have fantastic views over the Namib Dune Sea to the west and the Namib-Naukluft Park to the east. The beautiful sunsets and the breathtaking fauna and flora will leave a lasting impression on you.

• Comfort: Desert Quiver Camp / Luxury: Dead Valley Lodge
• Camping:  Sesriem Campsite

Day 8: Sossusvlei, Dead Vlei & Sesriem ~ 130 km (3,5h)

You stay very close to Sesriem, the gateway to a self-guided excursion into the dunes of Sossusvlei . For photographer families, we recommend starting as early as possible. The sand is also not quite as hot for barefoot children in the early morning. The opening hours of the entrance gate can be found in the lodge. The journey to Sossusvlei takes about 1 hour. For sporty families it is worth to climb "Big Daddy", the largest dune in this region. It takes about an hour to an hour and a half to go up, the descent - sliding or running - only takes a couple of minutes and the way back to the parking area through the surreal Dead Vlei is well worth it. In any case, you should plan some time for the giant sandpit Sossusvlei.

On the way back, it is definitely worth visiting the Sesriem Canyon , a deeply eroded section of the Tsauchab Dry River, which carries water every 10 years during the rainy season and floods the dunes of Sossusvlei. Children can let off steam here, climbing, collecting stones and piling them up into towers.

Desert Quiver Lodge after sunset

Morning drive to Sossusvlei

Dune climbing

On the top of the "Big Daddy"

A special experience for children and young people: The Namib ​​Dune Sea

Dead Vlei with camelthorn skelettons

Sesriem Canyon

Sesriem: Canyon of the Tsauchab Revier

Day 9: through the namib naukluft park to swakopmund ~ 345 km (5h).

Today the driving distance is a bit longer. But that doesn't matter: In Solitaire you can refuel and buy a few snacks. The apple pie available at the Solitaire Bakery has gained some popularity. People who like apple pie say "rightly so".

On the way through the desert you can see antelopes and mountain zebras from time to time. You can also get out of the car to stretch your legs. Impressive is the Welwitschia Mirabilis - an endemic desert plant and the lunar landscape just before Swakopmund.

Swakopmund itself is located directly on the Atlantic coast and is an activity hotspot for young and old. The cooler air is a welcome change from the (guaranteed) summery temperatures of the last few days. In the evening one of Swakopmund's nice restaurants awaits you.

• Comfort: Meike's Guesthouse / Luxury: The Delight
• Accommodation
• Comfort:  Meike's Guesthouse

In the Namib Naukluft Park

Stopover in Solitaire

Zebras in the Namib Naukluft Park

Somewhere on the way to Swakopmund

Day 10 & 11: swakopmund and surrounds ~ 0 km .

Swakopmund does not get boring. Not only magnificent buildings should be mentioned, but also the beach promenade, the aquarium and much more. Of particular tourist importance is also the wider surroundings. Especially the coastal road towards Walvis Bay , bordered on one side by the Atlantic Ocean and on the opposite side by high sand dunes, leaves unforgettable impressions. You can spend the day on the beach or participate in various activities. Quad bike tours, skydiving, panoramic flights, desert trips to the small hidden 5, boat trips, etc. are offered. North of Swakopmund you reach Cape Cross, one of the world's largest seal colonies.

Find a list of some activities in Swakopmund

• Breakfast, Accommodation

Architecture in Swakopmund

Beach day in Walvis Bay

Desert tour in the Namib close to Swakopmund

Namaqua chameleon

Quad Bike tour - Suitable for teenagers

Humpback whale in party mood

Seal tour in Walvis Bay

In the aquarium in Swakopmund

Day 12: erongo mountains ~ 200 km (3h).

After filling up on snacks and petrol, you drive via Spitzkoppe into the Erongo Mountains. Spitzkoppe is one of the most photographed mountain motifs in Namibia, as this inselberg rises abruptly from a relatively flat environment 700 m high, with the height above sea level being 1728 m. Here you can climb wonderfully and go in search of rock engravings. Your stay over is a bit further in the Erongo Mountains.

A visit to the San Living Museum is well worth it. Here you can learn to start a campfire without a lighter, hunt with bow and arrow or build necklaces from ostrich eggshells. An unforgettable experience for children.

• Comfort: Omandumba Guestfarm / Luxury: The Erongo Wild
• Campsite:  Omandumba

The magical Spitzkoppe

Rock arch at the Spitzkoppe

Boulders in the Erongo - ideal for playing hide and seek

Living Museum of the San at Omandumba

Day 13 & 14: private game reserve ~ 120 km (2h).

Via the small town of Omaruru (Children can have an icecream) you drive to Erindi or TimBila Game Reserve. The next 2 days will be spent with game drives, night drives, guided walks and wildlife tracking in the private game park. Here you can observe all kinds of antelopes, elephants and even lions.

• Comfort / Luxury: Erindi Game Reserve
• Camping: Timbila Safari Lodge

Elephant game drive

Herd of zebra

Wild Dog Tracking

Lions on a game drive

Day 15: back to windhoek – farewell from namibia  ~ 180 km (2h).

It is the last day of your safari. Say goodbye to the wilderness and to Namibia! Depending on your return flight, you may still have some time for souvenir shopping in Windhoek. The drive to Windhoek takes about three hours.

You will return your vehicle to the car rental agency in Windhoek and be transferred to Hosea Kutako International Airport, as arranged at the beginning of your safari.

For weeks the children won't be talking about anything other than their impressions of their Namibian family safari.

• Breakfast, Airport transfer
• Airport transfer

Good-bye Namibia!

Rates / Info-Namibia price guarantee

As with single bookings, our price guarantee also applies when booking a complete safari, meaning that you pay exactly the same amount as you would when booking the tour yourself (exception goes for campsite bookings).

• The price indicated is based on bookings for two people.
• Children under 6 years of age that stay in their parents' room are free of charge in most accommodations
• Children between 6 and 12 years (sharing a room) usually pay 50% of the costs
• Children aged 13 and over usually pay the full accommodation price
• For groups of four the rate will decrease as the rental car costs will be divided by the number of persons. This will be taken into account upon your booking request.

Low season 2024

01.01.2024 - 30.06.2024

From N$ 33.000 (Camping/Lodge) From N$ 44.000 (Lodge - Comfort) From N$ 53.500 (Lodge - Luxury)

High season 2024

01.07.2024 - 31.12.2024

From N$ 36.000 (Camping/Lodge) From N$ 47.000 (Lodge - Comfort) From N$ 59.500 (Lodge - Luxury)

The standard rates of the tours are approximate costs to give you an idea of the budget you can work with. The price is subject to availability of the accommodation and the rental vehicle and might change slightly if we have to book alternatives. We prefer working with smaller, more personal accommodation facilities and car rental companies, guaranteeing a consistent quality of service. Thus it is advisable to book at least one year in advance, especially when planning to travel during Namibia's touristic high season. Should we need to book alternative accommodation / rental vehicle we try to stick to this policy.

Tour enquiry "Namibia Family Safari"

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Dream holiday Namibia

After receiving your booking request, we will check availability of accommodation, before getting back to you with the exact cost of the tour. For special requests (amendments to the routing / accommodation / time frame.....) please use the field "Your message to us".

Should you prefer a complete individual routing for your self-drive or fly-in safari, please fill out our "dream travel questionnaire".

Dream Travel

• Accommodation, activities and meals as per itinerary
• 4x4 rental vehicle with the lowest excess
• Airport transfers
• 24 hour backup support
• Detailed tour description with insider hints, telephone list for emergencies, vouchers – all sent in advance by e-mail for you to print and to familiarise yourself with.

Services excluded: 

• International flight
• Personal travel insurances
• Park and entrance fees
• Drinks and missing meals in the itinerary

Travel information / FAQs

Namibia is a safe country to travel in and with its good infrastructure it is ideal for self-drive safaris. Especially those, who like to get an individual impression of the country a tour in a rented vehicle is highly recommendable. You’ll have the opportunity to learn a lot about the country and people and also to experience a lot off the beaten track.

Here we answer the most important and most frequently asked questions:

To be able to really enjoy your self-drive safari you should be open-minded, serene and patient to a certain extent – in Africa and thus also in Namibia, the clocks often tick a bit differently.

On the other hand, compared to other African countries, Namibia is in many regards nearly European. Not without reason Namibia is seen as the perfect country for introducing novices to the African continent.

With the material and pre-information provided like route descriptions, distances and approximate travelling times you will be well prepared for your safari. However, one should be an experienced driver and should be in the possession of the licence for more than just a couple of weeks. 4x4 experience is not necessary. The tarred and gravel roads are overall in good condition.

The driving routes and distances have been selected in a way that you can have a rather relaxed experience.  

In Namibia you don’t need to be scared (just respectful) of spiders, snakes and lions, but rather of overestimating your own driving capabilities. Every car rental company will tell you that the average travelling speed on gravel roads should not exceed 80 km/h and 120 km/h on tarred roads. However, on some gravel roads 80 km/h is already too fast. Take your time – you are on vacation! And please take note of the road signs.

On arrival, when taking over your vehicle you will receive an orientation on driving in Namibia and on road safety. It is essential that you follow the instructions given by the car rental company:

Here some safety guidelines for driving in Namibia in advance:

• Namibia has left-hand traffic – Please stick to it.
• Please avoid driving at night!
• Off the accelerator on gravel roads – maximum 80 km/h. Especially on gravel roads: reduce speed before entering a bend! Also when the road visibility is not clear. Abrupt reduction of speed can lead to losing control of the vehicle and in the worst case “rolling” the car.
• Only over-take when visibility is 100%.
• Always lock your rental vehicle and don’t leave valuables visible from outside in an unmonitored car.

Many rental vehicles are equipped with tracking devices. Should you have an accident and the evaluated data shows that you were speeding your insurance will be nil and void. 

You need your national driver’s licence in connection with an international licence for driving in Namibia.

All accommodations described in the itinerary are known to us and classified as good to excellent (service, cleanliness, location, facilities). Most of them only have a limited number of beds though and when fully booked we have to book alternatives. These changes are subject to availability at the time of booking. When having to book alternative lodges, hotels or B&Bs we always strive to find accommodation of the same quality.

In most of the lodges dinner and breakfast are included in the rates. In towns you have the option to visit restaurants of your choice for dinner, thus only breakfast is included.

The campsites have also been chosen with care. All team members of Info-Namibia are dedicated campers and value good campsites.

In the itinerary of a lodge or lodge/camping safari we have chosen locations where you have access to supplies. Camping vehicles are equipped with a fridge for storing perishables up to five days.

It is always advisable to visit the website of your Ministry of Foreign Affairs before travelling abroad.

Please see the "African Risk Map". Copyright © Control Risks 2019

In general, this can be said: Namibia is a politically stable country. Compared to other African countries the crime rate is very low, however as a tourist (and as any inhabitant) there are certain ground rules to adhere to:

• Don’t do anything, you wouldn’t do at home. For example, don’t let any stranger assist you when drawing money at an ATM.
• In town and especially in outskirts you should not travel on foot carrying valuables.
• Avoid walking around in darkness. In Swakopmund one can make an exception when walking to or from a restaurant in the evenings, but please inform yourself at the reception of your accommodation.
• Should you want to use a taxi service, please use official taxis (CityCab, etc.) or make use of Leva (Namibia-Uber).

Changing money: At the airport in Windhoek you can exchange foreign cash at the teller or you can draw money at the ATM. This goes for all bigger towns in Namibia. Best ATM when using foreign cards are Nedbank (green) or Standard Bank (blue). Draw or exchange about N$ 5000 per person at the beginning of your tour and try to pay with credit card during the rest of your travel. Visa and MasterCard are widely accepted.

Costs for provisions during the safari: As mentioned above, dinner and breakfast are usually included in the lodge tour. Lunch and any missing, additional meals in restaurants can usually be paid with credit card.

On the mixed lodge/camping tour the accommodations and campsites are pre-paid.

Costs for supplies in shops are comparable to Europe or the USA. Eating out in restaurants is normally less expensive than in Europe.

Fuel: A large cost factor are costs for fuel. You can calculate with an average consumption of 10 litres on 100 km. One litre of fuel costs about N$ 12 (dated 07.04.2020). For a 2000 km journey you will need about 200 litres of fuel, which will cost you about N$ 2400.

Souvenirs: You can buy beautiful souvenirs relatively cheap all over the country.  Local producers of jewellery and artefacts benefit from this income.

Gratuities: A 10% gratuity for a good service in restaurants is common in Namibia. For services at fuel stations (re-fuelling, washing the windscreen…) a tip of N$ 5 is a guideline. Many accommodation facilities have a general “tip box”, the content of which gets equally distributed amongst all staff members. Tips are normally given once at the end of the stay and are usually about N$ 50 per person per night. Of course, the amount you want to give as gratuity is at your own discretion.

• You definitely need a passport which is at least 6 months valid and which has two open pages when entering the country.
• Most Europeans (as well as US citizens and many others) receive a visa free of charge when entering the country. This visa is valid for the duration of the intended stay (make sure!). The maximum given stay is 90 days.
• It is your responsibility to inform yourself about the visa regulations that adhere to your nationality before travelling to Namibia.
• Double check the entry stamp at immigrations on the duration of validity of your visa.
• Should you be travelling with minor children, please let us know as special documents are needed for that. 

Namibia does not prescribe any vaccination, but check with countries where you might be in transit! Malaria is restricted to certain areas of the country. Depending where you want to travel to, we will advise about malaria. As with the visa regulations please always inform yourself at your own Ministry of Foreign Affairs about regulations

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Malaria Made Simple: How to Stay Safe on African Safaris

Some of the most regularly asked questions we get from clients are about the malaria risks on African safaris. In this guide to malaria, we set out all the facts about this potentially deadly disease. From transmission to prevention to everything in between, we’ll make it plain and simple to understand malaria.

Without wanting to scare you, we want to be sure you know how serious malaria is, and why protecting yourself against it is vital. Know the facts. This will help you to be prepared and stay safe on African safaris.

Malaria: Quick Facts

• Malaria is a serious and potentially fatal tropical disease, spread by mosquitoes in malaria-endemic areas
• Not all areas in all countries are malaria areas. A number of factors are involved including season, altitude and vector control (mosquito elimination programs)
• Malaria is not contagious (spread from human to human)
• The risk of contracting malaria can be significantly reduced using prophylaxis (anti-malaria medicine) and non-drug measures (avoiding being bitten)
• Choice of prophylaxis needs to be made on a person-by-person basis, in consultation with a medical practitioner, taking into account a number of factors including their medical history and other medication
• Pregnant women are more susceptible to malaria and both the disease and its treatment may affect the unborn baby. We advise that pregnant women and those wanting to fall pregnant avoid malaria areas. Ask one of our consultants for great safari options that avoid malaria areas
• While the most common (and most serious) version of malaria ( P. falciparum ) presents within 7 to 10 days, other variants ( P. Ovale or P. Vivax ) may only present in months to years, or cause relapses
• Malaria usually presents with fever and flu-like symptoms. If you experience any symptoms during or after a visit to a malaria area, seek medical help immediately

Malaria Lifecycle - what is it?

Malaria is transmitted by the female Anopheles mosquito. The mosquito bites the human and injects the malaria parasite into the blood, from where it travels into the liver and multiplies and changes. The parasites then infect the red blood cells. It is at this point that the person will become symptomatic.

The parasite at this stage can be picked up again by a mosquito that bites the human. It undergoes another lifecycle in the mosquito’s stomach. From there the parasite travels to the mosquito’s salivary glands, and the whole process starts again.

Transmission of Malaria - how do you get it?

As described above in the lifecycle section, malaria is transmitted by being bitten by the female Anopheles mosquito.

Malaria is not contagious, i.e. it can’t spread from person to person like a cold. It is also not sexually transmitted.

The only other (highly unusual) routes of transmission are from blood transfusions, organ transplants or needle-sharing with an infected person. It can also be passed from mother to child during pregnancy or delivery.

Symptoms of Malaria

The symptoms of malaria usually mimic those of flu (tiredness, sweats and chills, headache, painful muscles etc.), and generally include a fever. Nausea, vomiting and diarrhea may also occur. Symptoms usually begin 10 days to a month after infection but, depending on the strain, can present earlier, or as much as a year later.

If left untreated, symptoms can rapidly progress to mental confusion, seizure, kidney failure, coma and death.

Should you feel ill in any way during your stay in a malaria area, or after leaving the area, consult your medical practitioner immediately and be sure to tell them that you’ve been to a malaria-endemic area.

Diagnosing Malaria

Malaria can only be reliably diagnosed – and which strain it is – on examination of a blood sample under a microscope. The test must be performed without delay. If, however, you are in the middle of nowhere, with no access to a lab, and you present with malaria symptoms, backup treatment should be started while you get to the closest medical facility. Do not delay.

Treatment for Malaria

Malaria is treatable, and it is vital to treat it  immediately .

While it is possible (and wise) to take standby treatment, such as Coartem®, as part of your medical kit this should not, under any circumstances, be considered as an alternative to seeking medical care. It is indicated for the treatment of uncomplicated malaria and may well treat you, BUT if you have severe malaria it may progress very quickly and require other medicines, such as quinine.

We can’t state it too many times: untreated or improperly treated malaria can be fatal, and it can get severe, quickly.

If you suspect you have malaria, seek medical help immediately.

Preventing Malaria - staying safe on African safaris

A number of steps can be taken to keep yourself safe from malaria while on safari in Africa. While none are 100% effective at preventing malaria, combining them all will significantly reduce your risk.

Non-Drug Measures

The most effective way of avoiding malaria is to avoid being bitten by mosquitoes. While this sounds impossible when you’re coming to Africa to spend your time outdoors, there are a large number of things you can do to keep the little critters at bay:

• Cover up between dusk and dawn when the mozzies bite. Be sure to pack long sleeves and long pants (preferably light-coloured)
• Always sleep under a mosquito net
• Use insect repellants, both on yourself and in your accommodation

Prophylaxis

There are three main options when it comes to anti-malarial medicines. Prophylaxis should be used in conjunction with the non-drug measures mentioned above. The choice of which medicine should be used must be decided on a person-by-person basis in consultation with your medical practitioner.

A number of factors will influence the choice of medicine. These include underlying medical conditions, other medication being taken and tolerance of the chosen prophylactic medicine.

Should you be travelling with children, be pregnant (or wanting to fall pregnant), breastfeeding or have any underlying medical conditions or concomitant medications, it is even more vital to discuss prophylactic options with your doctor or a travel clinic well in advance of your safari.

We advise starting your malaria prophylaxis well in advance, to ensure that you tolerate it. Should you experience side effects, consult your medical practitioner.

The three medicines from which to choose are:

Doxycycline.

Some tradenames: Efracea®; Periostat®; Vibramycin-D®; Vibrox®; Doryx®; Oracea®; Doxymal®

Taken daily (100 mg), starting at least 48 hours before entering the malaria area, daily while in the area, and daily for four weeks after leaving the area.

The most commonly experienced side effects are gastrointestinal (nausea, vomiting, diarrhea). Taking the medication with the biggest meal of the day helps to minimize this. Doxycycline may also cause oesophagitis (burning throat), but swallowing the pill with a large glass of water and staying upright for a while after taking will prevent it.

Doxycycline may interfere with the efficacy of the oral contraceptive pill. Avoid milk/dairy products for a couple of hours as it may affect absorption.

Some tradenames: Lariam®; Mefliam®

Taken weekly (250 mg), starting at least 10 days before entering the malaria area, weekly (on the same day of the week) while in the area, and weekly for four weeks after leaving the area.

Mefloquine is contraindicated in people with a history of epilepsy, cardiac problems or psychiatric problems. The drug may cause psychiatric side effects ranging from mild anxiety and nightmares to, in the most severe cases, psychosis. Report any such side effects to your doctor, as you may need to change to an alternative malaria prophylaxis medication.

Atovaquone/Proguanil

Some tradenames: Malarone®; Malanil®; Numal®

Taken daily (250 mg/100 mg), starting 48 hours before entering the malaria area, daily while in the area, and daily for one week after leaving the area.

The most common side effects are headache and nausea, vomiting and/or diarrhea. Again, taking the medicine with a big meal can minimize this.

Where is Malaria a risk? Malaria by Area in Africa

The highest transmission of malaria occurs in Sub-Saharan Africa – the countries with warm, wet climates.

All of the countries visited on safaris offered by ABS are malaria-endemic (see below for WHO country-by-country classification). It is important, however, to note that in many of the countries (especially South Africa, Namibia and Botswana), only certain parts of the country are malarial, while other parts are completely malaria-free.

Transmission of malaria doesn’t occur in some areas:

• In the cold season
• In extremely dry, desert areas
• At high altitude
• In areas with good mosquito elimination programs

Below we include the malaria areas by country, as described by the World Health Organisation's (WHO) International Travel and Health . Please note that in some countries only certain parts are malarial. If you are unsure about where your safari goes or if it includes visits to malaria areas, contact our African Budget Safari consultant and we will happily help you.

Malaria risk due predominantly to P. falciparum exists throughout the year in the low‐altitude areas of Mpumalanga Province (including the Kruger National Park), Limpopo Province and north‐eastern KwaZulu‐Natal as far south as the Tugela River. Risk is highest from October to May inclusive.

Malaria risk due predominantly to P. falciparum exists from November to June inclusive in the following regions: Ohangwena, Omaheke, Omusati, Oshana, Oshikoto and Otjozondjupa. Risk exists throughout the year along the Kunene River and in the Caprivi and Kavango regions.

Malaria risk due predominantly to P. falciparum exists from November to May/June in the northern parts of the country: Bobirwa, Boteti, Chobe, Ngamiland, Okavango, Tutume districts/sub‐districts.

Malaria risk due predominantly to P. falciparum exists from November to June inclusive in areas below 1200 m and throughout the year in the Zambezi Valley. In Bulawayo and Harare, the risk is negligible.  

Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country.

Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country below 1800 m.

Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Normally, there is little risk in the city of Nairobi and in the highlands (above 2500 m) of Central, Eastern, Nyanza, Rift Valley and Western provinces.

Take a look at the  Complete African Safari Medical Guide  for health and safety tips or view the  10 Safest Countries in Africa to Visit .

For more information about preventing malaria and preparing for your African safari trip, ask one of our capable and experienced travel fanatics .

Briony Chisholm Wordsmith & Pharmacist

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Malaria risk factors in northern Namibia: The importance of occupation, age and mobility in characterizing high-risk populations

Jennifer l. smith.

1 Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America

Davis Mumbengegwi

2 Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia

Erastus Haindongo

3 School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia

Carmen Cueto

Kathryn w. roberts, roly gosling, petrina uusiku.

4 National Ministry of Health and Social Services, Windhoek, Namibia

Immo Kleinschmidt

5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom

6 Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom

Adam Bennett

Hugh j. sturrock, associated data.

All data have been submitted the data to Dryad Repository ( https://doi.org/10.7272/Q6V40SFJ ).

In areas of low and unstable transmission, malaria cases occur in populations with lower access to malaria services and interventions, and in groups with specific malaria risk exposures often away from the household. In support of the Namibian National Vector Borne Disease Program’s drive to better target interventions based upon risk, we implemented a health facility-based case control study aimed to identify risk factors for symptomatic malaria in Zambezi Region, northern Namibia. A total of 770 febrile individuals reporting to 6 health facilities and testing positive by rapid diagnostic test (RDT) between February 2015 and April 2016 were recruited as cases; 641 febrile individuals testing negative by RDT at the same health facilities through June 2016 were recruited as controls. Data on socio-demographics, housing construction, overnight travel, use of malaria prevention and outdoor behaviors at night were collected through interview and recorded on a tablet-based questionnaire. Remotely-sensed environmental data were extracted for geo-located village residence locations. Multivariable logistic regression was conducted to identify risk factors and latent class analyses (LCA) used to identify and characterize high-risk subgroups. The majority of participants (87% of cases and 69% of controls) were recruited during the 2016 transmission season, an outbreak year in Southern Africa. After adjustment, cases were more likely to be cattle herders (Adjusted Odds Ratio (aOR): 4.46 95%CI 1.05–18.96), members of the police or other security personnel (aOR: 4.60 95%CI: 1.16–18.16), and pensioners/unemployed persons (aOR: 2.25 95%CI 1.24–4.08), compared to agricultural workers (most common category). Children (aOR 2.28 95%CI 1.13–4.59) and self-identified students were at higher risk of malaria (aOR: 4.32 95%CI 2.31–8.10). Other actionable risk factors for malaria included housing and behavioral characteristics, including traditional home construction and sleeping in an open structure (versus modern structure: aOR: 2.01 95%CI 1.45–2.79 and aOR: 4.76 95%CI: 2.14–10.57); cross border travel in the prior 30 days (aOR: 10.55 95%CI 2.94–37.84); and outdoor agricultural work at night (aOR: 2.09 95%CI 1.12–3.87). Malaria preventive activities were all protective and included personal use of an insecticide treated net (ITN) (aOR: 0.61 95%CI 0.42–0.87), adequate household ITN coverage (aOR: 0.63 95%CI 0.42–0.94), and household indoor residual spraying (IRS) in the past year (versus never sprayed: (aOR: 0.63 95%CI 0.44–0.90). A number of environmental factors were associated with increased risk of malaria, including lower temperatures, higher rainfall and increased vegetation for the 30 days prior to diagnosis and residing more than 5 minutes from a health facility. LCA identified six classes of cases, with class membership strongly correlated with occupation, age and select behavioral risk factors. Use of ITNs and IRS coverage was similarly low across classes. For malaria elimination these high-risk groups will need targeted and tailored intervention strategies, for example, by implementing alternative delivery methods of interventions through schools and worksites, as well as the use of specific interventions that address outdoor transmission.

Namibia is a low malaria transmission country in southern Africa that has successfully reduced the burden of malaria over the past decade through the large-scale deployment of indoor residual spraying (IRS), distribution and use of long-lasting insecticide-treated bed nets (ITNs), increased use of rapid diagnostic tests (RDTs) and treatment with artemisinin-based combination therapy (ACT) [ 1 ]. The country aimed to eliminate malaria by 2020, but has experienced a number of outbreaks of malaria in northern Namibia since 2016 [ 2 ]. New approaches are urgently needed to understand and address persistent low levels of transmission and prevent seasonal epidemics of malaria.

In low malaria transmission settings, it is common to observe a shift in epidemiology towards older age groups as well as clustering of infections by location, time and within sub-populations with shared risk factors for infection [ 3 ]. Previous studies in North West and central Namibia established the importance of malaria importation and local risk factors in determining patterns of disease, including spatial clustering of infection and cross-border travel [ 4 , 5 ]. An understanding of spatial clustering has helped to inform the design of geographically targeted interventions such as reactive case detection (RACD) [ 5 , 6 ], reactive focal mass drug administration (rfMDA) [ 7 ] and foci investigations. However, the effectiveness of these strategies will be limited in populations where treatment-seeking is low, asymptomatic infection is more common, the population is highly mobile or residents are frequently absent or large numbers of infections are among non-resident populations. An evidence-based and transparent approach to describing local populations at high risk of infection can provide critical information on coverage gaps, mobility patterns and drivers of infection to inform proactive and tailored intervention strategies.

Malaria Indicator Surveys (MIS) and other cross-sectional studies are often used to provide malaria control programs with useful information on malaria associated risk factors. In low transmission settings such as Namibia, an MIS can identify asymptomatic infections but without more sensitive methods to measure exposure (such as serology) is unlikely to provide useful information to the national malaria control program (NMCP) on new malaria risk factors, because of the low chance of detecting malaria in the community and high expense [ 4 , 8 – 11 ]. Case-control methodologies are a classic epidemiological approach used in rapid outbreak investigations, including for malaria [ 12 – 18 ] and for investigation of rare diseases. As such, this approach is particularly well suited to risk-factor identification in malaria elimination settings, where cases are few and cross-sectional surveys are likely to be underpowered. Detailed information on behavioral and occupational exposures, along with standard questions on use of malaria prevention tools, can characterize important individual risk factors and intervention targets. A remaining challenge is to understand how risk factors co-occur and translate results into actionable risk profiles for specific populations. Latent class analysis (LCA) is a type of mixture modeling that assumes the population consists of unknown sub-populations (latent classes) that differ in their mix of included variables and provides the ability to identify these latent classes. LCA has been used to characterize patterns of multi-risk profiles in relation to HIV and HCV [ 19 – 21 ] and can offer insights to optimize implementation of preventive measures.

This paper presents results from a case-control study in Zambezi Region, Namibia, which investigated local risk factors for malaria and overlap between behavioral and epidemiological risk factors, in order to profile distinct high risk populations and hence identify potential targets for interventions.

Study setting

The study was undertaken in Zambezi Region, located in the north-east corner of Namibia, and bordered by Angola, Zambia, and Botswana. Historically, it has some of the highest rates of malaria incidence in Namibia. From 2004 to 2015, the annual parasite incidence in Zambezi fell from over 600 to 17.1 cases per 1000 [ 22 ]. Zambezi Region is geographically diverse, encompassing floodplains, woodlands and wetlands along the Zambezi River. The area is largely agricultural, rural and poor, with the 2011 census estimating that nearly a third (30.2%) of the population is engaged in subsistence agriculture [ 23 ]. Malaria transmission is highly seasonal and typically occurs between November and June, with peak case numbers occurring between February and April corresponding to the rainy season. Reported malaria cases are almost all due to Plasmodium falciparum and the most common malaria vector species is Anopheles arabiensis [ 24 , 25 ].

The study area encompassed a geographical area of about 9500 km 2 in Western Zambezi region and was the site for a number of baseline epidemiological studies prior to the start of a large trial in January 2016 to evaluate the impact of targeted intervention strategies on malaria transmission [ 26 ] ( Fig 1 ). The study area borders with Angola, Botswana, and Zambia and includes one official border crossing with Zambia. A total of 12 health facilities provide primary care services, including free malaria testing and treatment for Namibians, to the approximately 32,500 residents.

Study design

This was a health facility based, case-control study conducted over two malaria transmission seasons. Case and control recruitment was carried out between February 2015 and April 2016, with control recruitment extended through June 2016 to reach the desired sample size. Eligibility criteria for all participants included current or prior history of fever within 48 hours and valid test for malaria by the Carestart ™ Malaria HRP-2/pLDH (Pf/pan) Combo rapid diagnostic test (RDT) at one of six randomly selected health facilities. The malaria case definition included all passively detected cases of malaria confirmed by RDT. Controls were selected from individuals presenting at the same health facilities as those who tested negative for malaria by RDT. Individuals who reported taking malaria prophylaxis or treatment within the past 14 days or having a previous diagnosis of malaria within the past 30 days were ineligible.

Controls were frequency matched to incident cases by gender and within broad age categories (less than five years, five to 14 years, 15 to 59 years and 60 years and above). Both age and gender are known to be important risk factors for malaria and frequency matching ensures sufficient power to investigate specific behavioral risk factors within populations that are generally underrepresented at health facilities (i.e. adult males). Numbers of controls by age and gender were allocated to health facilities for recruitment based on probability proportional to the size (PPS) of the population in the catchment. This ensured that the distribution of controls matched the underlying population distribution for optimal identification of malaria hotspots and risk mapping. Catchment populations were calculated by aggregating a gridded population surface for 2015 from WorldPop [ 27 ] within geographical catchment areas, as defined by Alegana et al [ 28 ]. At each health facility, the first incident control that matched an existing recruitment profile was recruited into the study.

Data collection

Following routine diagnosis by health facility staff based on malaria RDT result, research assistants based at health facilities screened individuals for eligibility as a case or a control. Consenting participants were interviewed using a tablet-based questionnaire in Open Data Kit (ODK) and asked a set of standardized, pre-tested questions on demographics, socio-economic variables, household construction, use of malaria prevention measures, overnight travel outside their main residence in the past 30 days and outdoor activities during sundown and sunup in the prior two weeks.

Data processing and definitions

Questionnaire data were uploaded from the tablet into a secured centralized server on a daily basis and used to generate control profiles for recruitment, based on incident case demographics. Control profiles were allocated to facilities for recruitment using probability proportional to size (PPS) of the catchment population. Regular data checks and processing were carried out in R version 3.4 in order to track recruitment, as well as identify and correct any data entry errors in a timely manner.

A categorical variable was used to indicate calendar quarters and control for differing distributions of case and controls recruited into the study. For descriptive summaries, a binary variable was created to distinguish individuals recruited early in the transmission season, when cumulative cases were below 20% of annual total (November to February). Occupational variables were grouped according to broad categories and combined if numbers represented less than 5% of cases or controls. Where individuals declined to answer a question or a low proportion (<5%) responded “Don’t know”, responses were recategorized as missing and dropped from logistic regression analyses. Selected outdoor occupations were identified a priori as potentially high risk (cattle herders, agricultural workers, police and security guards) based on night-time exposures discussed during formative research and were kept as separate categories in exploratory analyses. A principal components analysis (PCA) was conducted to capture variation among self-reported household assets, including electronic goods, electricity, personal effects and transportation related assets. The first component was included in the model as a socioeconomic measure, in addition to water source, latrine type and education. Following Tusting et al [ 29 ], a housing variable was generated to distinguish traditional homes (ones with mud walls, thatched roofs and earth floors) from modern homes [ 29 ]. Tents and structures with open walls were considered as separate categories. In addition, binary variables were generated for sleeping outdoors in the past two weeks and sleeping in a room with open eaves.

Travel destinations and village residences were geo-referenced to a specific longitude and latitude using a range of sources. A comprehensive database of village locations in Zambezi Region generated during a complete enumeration of all households within the study area in early 2015 was used as the gold standard [ 30 ]. Locations outside of the study area were geo-referenced using the 2011 census database and electronic gazetteers, including GeoNet Names Server [ 31 ], Google Earth [ 32 ], and Falling grain [ 33 ]. The majority of cases (94.2%) and controls (96.4%) were successfully geolocated to a village residence with coordinates and 87.6% of trip destinations. The remaining locations were assigned to a constituency. Domestic travel destinations were categorized as having “high” risk of malaria transmission if they were located in areas of Zambezi Region where the relative case burden within the encompassing health facility catchment area was known to be above 10% of the regional total in 2016. In the absence of sub-regional data, areas located in endemic northern regions were also classified as “high” compared to other areas of Namibia. An individual’s most recent trip was used to characterize travel duration. Migration within the past six months from domestic or international locations was captured as a categorical variable.

Satellite-derived environmental data were extracted from Google Earth Engine [ 34 ] for each participant’s village location for spatial analysis and inclusion in logistic regression models, including elevation, land cover type, distance to permanent water bodies and average measures of land surface temperature (LST), total rainfall and enhanced vegetation index (EVI; a proxy for vegetation coverage) for the 30 days prior to diagnosis. A summary of the source of each of these data sets and the resolution available is included in S1 Table .

Statistical analysis

Assuming a probability of exposure among controls of 0.1 and an odds of acquiring malaria in exposed subjects relative to unexposed subjects of 2.25, a minimum target of 221 cases and 442 controls was required to reject the null hypothesis that there is no difference between cases and controls (i.e. odds ratio of 1), with 80% power and an α of 0.05.

STATA 13.0 (Stata Corporation, College Station, TX, USA) was used for descriptive and multivariable modelling. Latent class analyses were carried out in MPlus (Version 8.4, Muthen & Muthen) and maps created in ArcMap version 10.1 (ESRI, Redlands, CA).

The number, gender ratio and age distribution of cases and controls was described, with breakdown by season. As controls were frequency matched to cases by age, gender and calendar time, they were not representative of the underlying age and gender distribution of the source population. The 2011 census data was used to calculate the expected age and gender distribution in the general population in Zambezi Region, and define a second set of 641 hypothetical controls. These were compared to the age and gender distribution of cases using Pearson’s chi-squared test for association and used to calculate unadjusted odds ratios and corresponding 95% confidence intervals for these risk factors. Bivariate associations between all other exposures and case status were assessed using logistic regression with the Huber White sandwich estimator for standard errors, including a fixed effect to capture clustering at the health facility level and adjusting for age, gender, calendar quarter and year.

Collinearity between behavioral and environmental exposures was assessed during the model building process by comparing p-values within bivariate models and calculating variance inflation factors (VIF), where a VIF over 10 was taken to indicate collinearity. Reported frequency of sleeping under a net and sleeping under a net the previous night were strongly associated (p<0.0001), therefore the latter measure was retained in the model as a more reliable measure. Continuous variables were initially plotted using the ‘lowess’ command in STATA and divided into categories based on natural breaks or three to four centiles for the unadjusted analysis. All continuous variables were then assessed as either continuous or categorical in the final model and the best fitting version retained based on the Bayesian information criterion (BIC) value.

Multivariable logistic regression models were built using a backwards stepwise approach, retaining variables in the final model that had a p-value <0.05 or changed any adjusted odds ratio (aOR) more than 10%. Travel, agricultural work and net use were identified as time-varying exposures in the raw data, and plausible effect modification assessed a by adding covariate-by-time period interaction terms to the final multivariable model. In addition, a sensitivity analyses was run to investigate whether the results were affected by the period during which a disproportionate number of controls were recruited relative to cases (10 cases and 142 controls recruited outside of the main malaria transmission season of November to May). An interaction term was also evaluated to assess whether the risk associated with outdoor activities varied according to reported use of bite prevention measures and season. Residuals from the final model were exported and tested using Moran’s I for evidence of spatial autocorrelation in R.

A latent class analysis (LCA) was conducted to explore overlap in behavioral and epidemiological risk factors and to profile distinct high risk populations who may require specific intervention approaches. LCA is a statistical tool to identify homogenous, mutually exclusive groups or classes within a heterogenous population [ 35 ]. The LCA model included all variables indicating risk behaviors related to malaria in the univariate analysis, sex, and age group. All categorical variables were coded as dummy variables in MPlus. Multiple models were estimated with varying numbers of classes (from one to eight classes) and no covariates in MPlus, using the maximum likelihood solution from running 100 iterations for each model from randomly generated seed values. The Bayesian information criterion (BIC) was used to determine the best-fitting model, and checked against the adjusted BIC (aBIC), in the context of entropy (a summary measure of classification certainty) and epidemiological meaningfulness of class structure. For subsequent descriptive analyses, participants were allocated to the latent class for which they had the highest posterior membership probability.

Ethical approval

Institutional Review Board approval for this study was obtained from the University of California San Francisco, the University of Namibia, and the Ministry of Health and Social Services of Namibia. Written consent by signature or finger print was provided from all consenting participants. Consent for individuals aged under 18 years was provided by a parent or guardian. Assent was collected for all children over 12 years old. All individuals identified as cases with positive RDT result received the national first-line malaria treatment (Coartem [artemether-lumefantrine]) in accordance with the existing standard of care at the health facility.

Descriptive analysis

A total of 1417 individuals were tested by RDT and eligible to participate in the study, including 772 RDT+ malaria cases and 645 RDT- febrile controls. This includes 86% of all incident cases reported through routine surveillance systems in the period between January and April 2016 from the 6 included health facilities. Most cases who declined to participate did not provide a reason, but of six individuals who cited reasons: one case felt too ill while the others cited concerns around the procedures or lacked time to participate. A total of 770 cases and 641 controls were interviewed at the clinics, the majority of whom (87% of cases and 69% of controls) were recruited during the second transmission season in 2016 ( Fig 2 ). This period coincided with a malaria outbreak across northern Namibia and other parts of Southern Africa [ 2 ].

Summary characteristics of malaria cases and controls are described for each of the two transmission seasons in Table 1 . Control recruitment in a 2:1 ratio to cases was not possible in the second transmission season, due to the high burden of cases. The vast majority (99.5%) of participants reported they were residents within Namibia and most cases and controls had Namibian citizenship (83.3% and 90.6%), primary education or lower (78.8% and 71.5%) and reported relatively low net usage (39.4% and 58.8%) and spray coverage (33.4% and 40.3%) in their sleeping structure. Peak transmission in 2016 shifted to later in the season, with four-fifths (80.2%) of cases arising after February, compared to roughly two- thirds (64.8%) in 2015.

MMP: mobile and migrant population;

1 Within the past six months,

2 Within the past 30 days,

3 Non-endemic or lower endemic area (<10% of case burden in Zambezi Region).

Mobility patterns

A total of 198 participants (14%) reported taking at least one trip in the past 30 days, with a minority of cases and controls (1.2% and 2.5%) reporting more than one trip. Travel characteristics are reported in Table 2 . Recent cross border travel was rare, but more common amongst cases than controls (2.2% and 1.1%). A majority of cross border travel was by Zambian citizens (68%) and a key location was nearby districts in Western Province, Zambia. In contrast, overnight travel within Namibia was less common amongst cases than controls (7.5% and 16.2%). Most (82%) overnight trips were within Zambezi Region, although a minority of participants traveled to other areas within Namibia.

1 If >1 destination, characteristics summarized for destination with highest risk,

2 Funerals, health, church and shopping.

Both domestic and cross-border travel tended to be seasonal and occurred during the rainy season ( Fig 3 ). However, the majority of cross-border travel in cases (82%) occurred early in the transmission season compared to in controls (82% vs 14%) ( Table 2 ), indicating a high-risk window of travel time December to February that corresponds with the agricultural season and holiday festivities.

Risk factors for malaria

A full table of unadjusted odds ratios for potential risk factors is included in S2 Table . Variables retained in the final model are described below and unadjusted and adjusted odds ratios for these selected variables are shown in Fig 4 . After adjusting for all risk factors, there was no evidence supporting spatial correlation in the residuals (Moran’s I p = .706).

Socio-demographic risk factors

Using the census controls as a reference, the crude odds of malaria was higher in males (Odds ratio (OR) 1.25 95% CI 1.00–1.54; p = 0.04) and lower in children aged 0–4 years, compared to older age categories. The odds of malaria were 0.63 (95% CI 0.45–0.88) in the youngest age group and ranged from 1.09 (95% CI 0.74–1.26) in adults aged 15–59 years to 1.74 in children aged 5–14 years (95% CI 1.43–2.11).

Non-Namibian nationality was identified as a risk factor in the unadjusted analysis of the study data ( S2 Table ), as its effects were accounted for by associated variables (cross-border travel, migration and occupational categories). Use of an in-residence tap for drinking water was protective compared to an open well (Adjusted Odds Ratio (aOR): 0.34 95%CI 0.17–0.69), while cases were more likely to report surface water as their main source of drinking water (aOR: 2.10 95%CI 1.03–4.27). Other socioeconomic indicators, such as lower education and a lower score on the PCA asset index, were associated with a higher risk of malaria in the unadjusted but not adjusted analysis ( S2 Table ).

Occupation and outdoor activities

The risk of malaria was higher in cattle herders (aOR: 4.46 95%CI 1.05–18.96), members of the police or other security personnel (aOR: 4.60 95%CI: 1.16–18.16), and pensioners/unemployed persons (aOR: 2.25 95%CI 1.24–4.08) compared to agricultural workers (most common). After adjusting for age, children (aOR 2.28 95%CI 1.13–4.59) and students were at higher risk of malaria (aOR 4.32 95%CI 2.31–8.10). There were high levels of overlap between specific occupational categories and reported outdoor behaviors associated with malaria in the unadjusted analyses ( S2 Table ), such as playing and studying outside at night. Collinear behavioral variables were dropped from the final model but retained in the latent class analysis to better profile sub-groups with similar characteristics.

In the final model ( Fig 4 ), agricultural work carried out between sundown and sunup was independently associated with a higher risk of malaria (aOR: 2.09 95%CI 1.12–3.87), whereas frequenting outdoor bars at night was associated with four-fold reduction in the odds of malaria (aOR: 0.38 95%CI 0.17–0.85). While there was insufficient power to test interactions in the final model, stratified chi-squared tests and a bivariate model of gender and bar attendance suggested that this protective effect may be present in females ( χ 2 p = 0.005 and OR: 0.10, 95%CI [0.01–0.87], p = 0.04) but not males ( χ 2 p = 0.21 and OR: 0.71, 95%CI [0.31–1.61], p = 0.41). There was insufficient power to assess whether the risk associated with outdoor activities varied with use of bite prevention, with a minority of cases (3.6%) and controls (6.7%) reporting using any form of protection against mosquito bites while engaged in outdoor activities between sunup and sundown.

Travel-related risk factors

Overnight cross border travel within the past month was associated with an increased risk of malaria (aOR: 10.55 95%CI 2.94–37.84), while domestic travel to low risk destinations was protective (aOR: 0.38 95%CI 0.17–0.85).

Housing and malaria interventions

Traditional home construction and sleeping in an open structure was associated with an increased odds of malaria (aOR: 2.01 95%CI 1.45–2.79 and aOR: 4.76 95%CI: 2.14–10.57) compared to homes built using modern construction materials. Cases were ten times more likely to sleep in a tent than controls, but there was weak evidence to support this association in the multivariable model (aOR: 16.34 95%CI 0.28–957). Openings to the outside (such as a gap between the walls and roof) were present in all traditional structures and so left out of the final model.

All malaria preventive activities were strongly protective against malaria. The risk of malaria was lower in homes with adequate household net coverage and in persons who reported sleeping under a net the previous night (aOR: 0.63 95%CI 0.42–0.94 and aOR: 0.61 95%CI 0.42–0.87), suggesting a household level protective effect persists after accounting for individual net use. An interaction between net use and occupational category suggested that individual net use was protective in children, unemployed persons and skilled/semi-skilled workers (p = 0.006, 0.099, and 0.015), but not in students, agricultural workers, or police/security guards (p = 0.465, 0.997, and 0.137). Neither of the two controls that were occupied as cattle herders reported using a net and so this interaction was not included in the final model. Any indoor residual spraying on the walls of the sleeping structure was associated with a lower risk of malaria, either within the past year (aOR: 0.63 95%CI 0.44–0.90) or more than one year ago (aOR: 0.44 95%CI 0.23–0.82) compared to never having been sprayed.

Environmental and seasonal risk factors

Residing more than 5 minutes from a health facility was associated with a higher risk of malaria (aOR: 1.63 95%CI 1.10–1.67). Environmental factors were strongly associated with malaria risk, with each millimeter of rainfall in the month prior to presentation associated with a 2% increase in the adjusted odds of malaria (aOR: 1.01 95%CI: 1.01–1.02). Similarly, higher levels of vegetation measured by EVI were associated with increasing odds of malaria ( Fig 4 ). After adjusting for other environmental risk factors, higher levels of LST remained associated with lower risk of malaria.

Increased levels of rainfall and vegetation in 2016 compared to 2015 (p<0.0001 by t-test) likely partly account for higher levels of malaria transmission. However, even after accounting for environmental variables in the final model and variation between calendar quarters, there was weak evidence of higher risk of malaria in 2016 (aOR: 1.60 95%CI 1.02–2.52).

Sensitivity analyses

Further analyses were performed in which the characteristics of controls recruited during the main transmission season (between 1 November and 31 May) were compared to those recruited outside the main transmission season; no notable changes were evident in the risk factors for malaria using the full dataset compared to the restricted dataset but estimates were slightly more precise (data not shown).

LCA results: High risk profiles

After comparison of fit statistics, a model with six classes was found to be the best fit for the data [BIC (6 class) = 11343; BIC (5 class) = 11423]; higher numbers of classes resulted in numerical difficulties. The conditional probabilities of each malaria risk factor associated with clusters are shown in Fig 5 and S3 Table , and group characteristics in Table 3 . Clusters were named to best represent the characteristics of each cluster, which were strongly correlated with occupation, age and select behavioral risk factors. Use of malaria prevention was similar across classes, suggesting low net use and IRS are likely to contribute to transmission in all groups.

The item-response probabilities represent the probability of a positive response on a variable, given membership in a given class.

IQR: inter-quartile range; SES: socioeconomic status.

Class 1 –Young children (n = 57 , 7 . 4%) : were a smaller risk group but included a relatively high proportion of migrants (15%) and cross-border travelers (5%). The group had the highest proportion of foreign-born individuals (28%) and were largely rural and poor, with the majority living further than 5 minutes from a health facility (68%) and in the lowest socioeconomic tertile (70%). This group was less likely than other classes to have been active outdoors between sunset and sunrise, suggesting that transmission occurs in the home or while sleeping outdoors.

Class 2 –Namibian pensioners (n = 54 , 7 . 0%) : were another small risk group comprised of individuals identified as pensioners or unemployed who were predominantly Namibian (92%), local residents (98%), female (70%) and aged 60 years and above. A fifth (20%) reported agricultural work at night with most outdoor activities reported after sunset and early in the morning. These cases predominately arose later in the transmission season (89%) and during the 2016 outbreak (94%).

Class 3 –Primary school-age children (n = 168 , 21 . 8%) : were a large risk group and included children aged 5–14 years (median age 8 and IQR 8–11 years). Members of this group were more likely to sleep in the open (9%) and without a net the previous night (65%). Reported outdoor exposure was primarily after sunset, and members engaged in play or domestic activities. These cases were identified earlier in the transmission season (25% in February) compared to many other groups and had a relatively large burden in the 2016 outbreak, along with pensioners and students.

Class 4 –(Self-identified) Students (n = 106 , 13 . 8%) : were at higher risk of malaria than those who self-identified as children, for largely unknown reasons. These individuals tended to be slightly older (median age 11 and IQR = 9–13 years) than Class 3. Compared to other groups, members of this class were more likely to be male and live more than 15 minutes from a health facility (37%). Although IRS at their main place of residence was relatively high, the study did not capture sleeping at a school dormitory and many individuals reported sleeping without a net the previous night (69%).

Class 5 –Adults; non-agricultural workers (n = 278 , 36 . 1%) : broadly included young adults (median age 21 and IQR 17–30 years) with outdoor non-agricultural occupations, such as cattle herders, security personnel and police officers, and rangers. This class also included a subset of younger unemployed persons and older students who were included here as a function of age and lack of agricultural exposures. While overall 15% of individuals in this class identified themselves as non-Namibian, there was variation within occupational subgroups. For example, a higher proportion of cattle herders were Zambian (69%) and were diagnosed early in the transmission season (31%) compared to unemployed persons (16% Zambian and 10% early in the season). This class had the lowest net use of all groups (28%).

Class 6 –Adults; agricultural workers (n = 107 , 13 . 9%) : included adults (median age 33 and IQR 25–46 years) who identified as agricultural workers. While this broad occupational category did not have a high risk of malaria, other high risk characteristics tend to co-occur and define members of this group, including agricultural work at night (38%), foreign citizenship (31%), cross-border migration (9%) and recent domestic or cross-border travel (12% and 5%). These cases were identified earlier in the transmission season (28% in February) compared to many other groups.

In this assessment of risk factors associated with symptomatic malaria in Zambezi Region, our findings support the presence of 6 distinct malaria high-risk subgroups primarily defined by key risk factors like occupation and age. In terms of the burden of disease, key groups were adults with outdoor occupational exposures in Classes 5 and 6 (including subpopulations of cattle herders, unemployed persons, and farmers who work outdoors at night), and school age children. Use of malaria prevention was similarly low within these groups, suggesting that they are frequently missed by intervention campaigns and some sleep in informal or temporary housing structures without nets or protected by IRS. Environmental factors were strongly related to malaria risk, and occupational risk factors indicate that outdoor biting and transmission away from the home is likely to be important in this setting. Based on these findings, tailored strategies are warranted to address transmission within different subpopulations and improve overall coverage and impact of public health interventions. This study describes a robust methodology for understanding populations at greater risk of malaria transmission where risk factors overlap or co-occur.

Overall, study findings point towards exposures occurring outdoors and away from home, and a need to investigate worksites as potentially important sites of transmission linking villages within foci. Results from our analyses suggest that adults with outdoor occupational exposures, including field workers and cattle herders working in agricultural areas, are an important risk group in this setting. A cross-sectional survey in 2015 in Zambezi Region reported a similar five-fold increase in the odds of malaria infection associated with agricultural occupations and cattle herders, detected by loop-mediated isothermal amplification [ 30 ]. Despite the ubiquity of malaria in rural, farming areas across sub-Saharan Africa and well documented risk in seasonal migrants and permanent agricultural workers in Ethiopia [ 36 , 37 ], few studies have explicitly investigated how agricultural exposures (including occupation and land cover) influence individual malaria risk [ 38 , 39 ]. The effect of agricultural practices and crop types may vary, with differences in effect estimates influenced by vector bionomics, human population susceptibility and other mediating factors like access to and use of malaria prevention [ 40 – 42 ]. Recent entomological assessments within the study area found that vectors will bite outdoors throughout the hours of 7pm to 7am, with peaks between 10-12pm and 3-5am [ 43 ]. Amongst agricultural workers in the current study, the marginal effect of working outdoors early in the morning and/or evenings translated to a 12% increase in the odds of being a case, reinforcing the importance of behavioral differences as a mediator of vector-human contact. Other outdoor occupations such as cattle herders, security guards, police offices and rangers had a relatively high risk of malaria, and unemployed persons also reported frequent outdoor exposures such as agricultural activities and sleeping outside at night. Surprisingly, after controlling for other risk-factors in the model, spending time outdoors at bars between biting hours was associated with a lower risk of malaria [ 44 ]. This protective effect was observed only in females, some of whom worked at the location, and suggests the presence of uncontrolled confounding or selection bias in relation to behavioral risk or treatment seeking behaviors. Alternatively, this finding could be due to chance, given the low prevalence of this exposure and small sample size.

The study found a higher risk of malaria in cross-border travelers compared to those who did not travel or those who traveled domestically, despite the low occurrence of cross-border travel. Trips were overwhelmingly for family and work-related reasons, with cross border trips of longer duration and lower frequency than domestic travel. Specific sub-groups of cases, including cattle herders, agricultural workers and young children, were more likely to identify as non-Namibian (70%, 31% and 28% respectively) and migrants or cross-border travelers compared to other groups. Cross-border travelers are a known high risk group across southern Africa, and their vulnerability to infection is attributed to lower access to health services and use of malaria prevention at their destination, in combination with travel to/from higher transmission settings [ 4 , 45 – 48 ]. Domestic travel to low risk areas (defined as areas with no transmission or <10% of the regional total in Zambezi Region) was protective against malaria and there was no evidence of an association between malaria and travel to higher risk areas within Namibia. Research by Tessema et al. complements these findings and, using genetic data derived in part from this study, demonstrated high levels of genetic parasite connectivity to neighboring countries and in particular, Western Zambia [ 49 ]. In this setting, it is likely that health facility data underrepresent seasonal workers and young children who may accompany their parents for seasonal work, due to the remoteness of worksites and potential concerns around payment in relation to residency status. This study highlights the diversity of mobile populations in northern Namibia, and illustrates the need to tailor community-based solutions to local contexts to address population mobility [ 50 ].

Self-identified students accounted for nearly a quarter of malaria cases and school-aged children represented half of all cases in the study area. Malaria is prevalent in school-aged populations across moderate and high transmission contexts [ 51 – 53 ], behavioral risk factors that lead to increased exposure of these age groups to malaria as well as effective control measures that target younger children. In this study, there was a clear shift in the burden of cases towards younger age groups between 2015 and the outbreak in 2016 ( Table 1 ), reflecting the impact of the epidemic on a susceptible population in a normally low endemic context. Net and IRS coverage was insufficient across all populations, but learners in grades 9–12 may be particularly exposed when staying away from home during exam periods (February to November). During this time, students typically stay on or near school grounds and sleep in tents or hostels with little or no access to bednets. School-based malaria interventions are a staple intervention in higher burden settings and in Namibia, offer a targeted approach to improve intervention coverage and hence impact on transmission dynamics. School-based interventions are able to leverage a trained cadre of teachers, making them cost-efficient agents for combining malaria prevention education with distribution of LLINs [ 54 , 55 ] and have been successfully integrated with existing neglected tropical disease (NTD) mass drug administration campaigns [ 56 ]. Housing improvements at dormitories would be a low cost and potentially high impact intervention. Preventive treatment (PT) of malaria in school-age children has shown impact on prevalence of asexual parasites and gametocytes, clinical malaria and anaemia across transmission settings [ 57 , 58 ]. Vector control and rapid access to case management through school platforms would be relatively cost-effective, while highly targeted intermittent PT to hotspots might be feasible, in conjunction with drug resistance monitoring and management [ 59 ].

Our study supported many established risk factors for malaria including: housing type, malaria prevention measures, including individual net use, household net coverage, and IRS coverage, and environmental factors including weather and distance to health facility. A higher risk of malaria was associated with traditional or informal housing structures, including those with open eves, open sides and tents. These findings are corroborated by the literature, in which improved housing is consistently associated with reduced risk of a range of malaria outcomes [ 29 , 60 – 63 ] and provides barriers to mosquito entry [ 64 , 65 ]. The protective effect of ITNs is well established in areas of stable and unstable malaria transmission [ 66 ], and a universal net distribution took place in Zambezi region in 2013 [ 1 ]. Since this, their distribution has been restricted to vulnerable populations through antenatal clinics and, more recently, in a targeted approach to some of the high-risk populations identified in this study. In elimination settings, programs may be challenged by lower uptake of some interventions due to the perception that malaria is no longer a risk, which should be managed through targeted messaging and health promotion [ 67 ]. In contrast, IRS is currently a cornerstone of the malaria elimination strategy in Namibia, which used predominantly DDT for malaria vector control up till 2017. DDT is typically expected to be effective over a six to 12 month time frame [ 68 ], but this study found a protective effect of IRS within the past year or ever, compared to never having been sprayed. Some of this apparent effect may be capturing residual confounding related to socioeconomic status or proximity to a road/village center. Taken within the context of low coverage of malaria preventive measures, these findings suggest that a large proportion of transmission still occurs indoors in Zambezi region and effective control will require targeted scale up of these interventions. Climatic risk factors including temperature, vegetation (EVI) (a proxy measure of relative humidity [ 69 ]) and precipitation in the month prior to diagnosis suggest that transmission varies on relatively small scales [ 4 , 70 , 71 ]. After accounting for rainfall, increased risk associated with higher EVI and lower temperatures is likely to relate to greater availability of larval habitats [ 72 ] and lower thermal optima for mosquito and parasite development [ 73 ]. These relationships are difficult to disentangle from seasonal variation in risk-behaviors, such as agricultural work, which occur in areas with higher vegetation and during the wet season. Increased distance to health facility was associated with a higher risk of malaria, which likely reflects lower access to care and socioeconomic vulnerability, as found in previous studies using DHS data [ 28 ]. Individuals who reported surface water as their main source of drinking water were more likely to have malaria, and may indicate the presence of vector breeding sites near a household or act as a proxy measure of socioeconomic status.

The main limitation of this study lies in its health facility-based design, which limits inference to symptomatic and higher density infections diagnosed by RDT and treatment seeking populations. Case recruitment at health facilities remains the most feasible option in low endemic settings, and selection of controls from this same population avoids documented selection biases due to treatment seeking [ 4 , 28 ]. However, sub-populations with lower treatment seeking behaviors are likely to be underrepresented in both case and control data. In addition, the large malaria outbreak across southern Africa in 2016 presented a key operational challenge during implementation, and resulted in a higher case burden, challenges in recruitment of controls and altered transmission dynamics. Associations and identified risk factors in non-epidemic years may differ. In general, matching was successful only in the first transmission season, when incident case numbers were lower and it was possible to recruit control profiles within a shorter time frame. The results from the sensitivity analysis, which restricted the sample to controls recruited within the same timeframe as incident cases, did not result in changes to the model. Potential sources of measurement error that could introduce misclassification in exposures include recall bias for self-reported measures of net usage and travel history, geolocation errors and uncertainty around relevant periods of exposure due to variation in the length of time between infection and diagnosis. Finally, statistical power to assess interactions was limited by the small sample size of some occupational sub-groups and low prevalence of other specific risk factors.

The findings from this study have important programmatic implications. Routine surveillance data should collect detailed occupational data to allow monitoring within sub-groups and IRS should be scaled up to achieve high coverage of vector control interventions amongst high risk groups. Intervention approaches can be targeted and tailored for specific groups and delivery strategies adapted to leverage existing occupational and educational networks and thereby improve access and community engagement in target populations. Community and school-based intervention campaigns are a natural fit as community leaders and teachers are likely to know who is travelling or engaged in particular occupational categories. Ethiopia implemented a successful community-based test and treat strategy in the home villages of returning migrant workers [ 74 ]. Police and security services are another easy group to target through intersectoral engagement and existing organizational structures, which has been done successfully in the Greater Mekong Subregion [ 75 ]. Worksites where seasonal agricultural workers congregate away from their home and experience gaps in protection are another access point for targeted interventions. Existing quantitative and qualitative methods used in HIV can provide effective tools to adapt and integrate routine surveillance and response activities for high-risk populations [ 76 ]. Furthermore, there is a need to pair entomological data collection with targeted surveys to understand the role of vector characteristics, including seasonal patterns and biting behaviors, on transmission at these locations. Future work is needed to understand the role of malaria high risk populations in driving transmission and the potential impact of targeted interventions.

Conclusions

In this low endemic, cross-border setting, there are distinct malaria high risk populations with clearly identified exposures to infection and gaps in preventative interventions. Targeted and tailored intervention strategies are needed to extend coverage to these risk groups, including delivery through schools and worksites. Low IRS coverage and ITN use, coupled with outdoor exposures, suggest that targeted scale up of vector control activities should also consider specific interventions to address outdoor transmission and provide protection against outdoor biting. Adapting routine malaria surveillance and response to include high-risk populations is an area of growing concern as countries move closer to elimination and seek to prevent outbreaks and reintroduction of parasites through cross border movement from neighboring endemic areas. The findings from this study and other surveillance data are increasingly used to guide detailed formative work to support programs in planning for targeted surveillance and response strategies.

Supporting information

Acknowledgments.

We are grateful to the residents of Zambezi Region for their help and cooperation with the study; to the National Ministry of Health and Social Services and Regional Directorate of Health in Zambezi Region.

Funding Statement

This work was supported by a grant from the Bill & Melinda Gates Foundation to the Malaria Elimination Initiative at UCSF (OPP1160129). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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​Wildlife & Animals – Namibia

Anthony is a renowned Africa expert and author of many Lonely Planet guidebooks, including the 'Botswana & Namibia' guide.

Anthony is a renowned Africa expert and author of the 'Botswana & Namibia' Lonely Planet guide.

Anthony is the author of the 'Botswana & Namibia' Lonely Planet guide.

Because of the arid environment, wildlife numbers are relatively low in Namibia, but animals are easy to spot. All of the big predators are present, and cheetah is especially common throughout. Huge herds of animals, elephant in particular, can be seen in the Dry season at Etosha pan.

Wildlife Highlights

Damaraland is home to a healthy population of desert-adapted elephant , a smaller population of black rhino can be tracked in a similar environment. The secretive brown hyena is sometimes seen lurking around seal colonies on the coast. Other marine wildlife includes the rare heaviside's dolphin and migrating southern right whale .

Best Time for Wildlife Viewing

Namibia is relatively dry throughout the year, but there are two rainy seasons. The little rains are from November to December and the main rainy season is from January to April . During the rains, vegetation grows throughout the region and wildlife tends to scatter and is harder to find. The end of the Dry season (July-October) is the best time to see animals at the waterholes. This coincides with the busiest tourist season.

Wildlife Rating

• Expert Rating 3.8 /5 17 Wildlife Reviews
• User Rating 4.7 /5 207 Wildlife Reviews

Wildlife Rating per Major Park

• Etosha NP 4.7 /5 142 Wildlife Ratings
• Namib-Naukluft NP 3.4 /5 80 Wildlife Ratings
• Skeleton Coast NP 3.5 /5 42 Wildlife Ratings

Recommended Wildlife Books

• Wildlife of Namibia Useful coverage of Namibia’s mammals and other wildlife. Neil Macleod and Nikos Petrou
• Stuarts' Field Guide to Mammals of Southern Africa Complete for Namibia and southern Africa. App available. Chris Stuart and Mathilde Stuart
• The Kingdon Pocket Guide to African Mammals (2nd edition; book and app) Complete info for serious wildlife-lovers. Jonathan Kingdon
• The Safari Companion: A Guide to Watching African Mammals Mammal behavior is the main focus of this superb guide. Richard D. Estes
• Tracker Manual: A Practical Guide to Animal Tracking in Southern Africa Get to know the spoor of some more common animals. Alex van den Heever, Renias Mhlongo and Karel Benadie

Wildlife Photos

Want To Visit Namibia?

198 Namibia Safaris

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Safari Tours to Namibia

19-Day Namibia Self Drive Adventure

$8,838 pp (USD)

Namibia: Self-drive Mid-range Lodge & Tented Camp

You Visit: Windhoek (Start) , Kalahari Region, Fish River Canyon (|Ai-|Ais/Richtersveld TP) , Aus (Town) , Namib-Naukluft NP (Namib Desert) , Swakopmund (City) , Damaraland, Etosha NP, Eastern Etosha NP, Erongo Mountains (Mountain Range) , Windhoek Airport (End)

Wayfairer Travel

4.8 /5  –  152 Reviews

3-Day Etosha Guided Camping Safari Experience

$669 pp (USD)

Namibia: Shared tour (max 6 people per vehicle) Budget Camping

You Visit: Windhoek (Start) , Etosha NP, Windhoek (End)

People Tours And Safari

4.9 /5  –  35 Reviews

13-Day All Inclusive Namibia Ultra Luxury Fly-in Safari

$27,694 to $29,487 pp (USD)

Namibia: Private tour Luxury+ Lodge & Tented Camp

You Visit: Windhoek (Start) , Eastern Etosha NP, Kaokoland, Skeleton Coast NP, Namib-Naukluft NP (Namib Desert) , Windhoek Airport (End)

Secret Namibia

5.0 /5  –  21 Reviews

Tswalu Kalahari

South Africa’s largest private game reserve, Tswalu Kalahari is inhabited by over 80 mammal species including meerkat and desert rhino.

South Africa’s largest private game reserve, Tswalu Kalahari encompasses around 272,000 acres of dramatic mountains, rolling dunes and scrubby grasslands, inhabited by over 80 mammal and 240 bird species. Opportunities abound to observe rare animals such as roan and sable antelope as well as meerkats, desert rhino and magnificent black-maned Kalahari lions. Just 10 vehicles enjoy access to this terrain ensuring that safaris here are exclusive and personal experiences. Another major bonus is that this region is malaria-free, so families with young children can enjoy a stress-free holiday.

Guests at Tswalu Kalahari can choose from two accommodation options. The Motse comprises of 9 secluded “legae” or “little houses” in the Tswana language. Each of these are fashioned from sand, stone and thatch, featuring open fireplaces, personal sundecks, indoor and outdoor showers, with three units designed specifically for families. The Tarkuni offers 5 luxury suites, a peaceful pool and traditional ‘boma’. With  its own team of staff including a chef, private vehicle, guide and tracker, this homestead can be booked for exclusive use.

Aside from productive game drives across the enchanting landscape, guests at Tswalu Kalahari can take part in guided walks, safaris on horseback, ancient rock art excursions and sleepouts at “Malori”. Meaning “dreamer” in Tswana, this raised platform is built to resemble a weaver’s nest with a small thatch overhang, providing the option of shelter should you tire of sleeping beneath a blanket of stars. Romantic candlelit dinners can also be arranged here, with sundowners drinks and canapes to savour as the sun sinks beneath the horizon.   

Tswalu Kalahari also offers one of Southern Africa’s most exclusive interactions – a chance for guests to view meerkats. The reserve has two colonies of habituated meerkats that have grown accustomed to humans, allowing guests to approach for close observations. The region is also home to other unsual carnivores such as bat eared fox, aardwolf, brown hyena and small spotted genet.

How to get to Tswalu Kalahari

Tswalu Kalahari is located close to the border between South Africa and Botswana. It can be reached by daily scheduled service from either Cape Town or Johannesburg’s international airports. Flight times are 90 minutes and 2 hours respectively.

Activities at Tswalu Kalahari

• Game drives
• Guided walks
• Horseback safaris
• Meerkat encounters
• Private dining

*Some activities are available at extra cost.

Tswalu Kalahari Highlights

• South Africa’s largest private reserve
• Home to a wealth of wildlife from black-maned Kalahari lions to meerkats
• Malaria-free so ideal for families with young children
• A wide array of activities including walks and sleepouts
• Easily reached by daily scheduled flights

Find out more about our tailor made African safaris. Get in touch with one of our Destination Specialists.

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Below are some of our preferred tented camps and lodges in malaria free game reserves. Please contact us to tailor accommodation options to suit the style of your trip and your budget.

Kwandwe Private Game Reserve

Malaria-free Kwandwe Private Game Reserve on South Africa’s Eastern Cape offers five safari lodges, each designed to showcase the remote beauty of the surrounding landscape.

Madikwe Hills Private Game Lodge

A secluded retreat within the exclusive 185,000 acre Madikwe Game Reserve, Madikwe Hills Private Game Lodge offers guests two accommodation options.

Madikwe River Lodge

Family-friendly Madikwe River Lodge is a relaxed, comfortable safari lodge set in South Africa's wonderful, malaria-free Madikwe Game Reserve which is home to all of the iconic "Big 5" and much more.

Shamwari Game Reserve

On South Africa’s pristine Eastern Cape, Shamwari Game Reserve is an excellent safari destination being malaria-free and home to fantastic wildlife including all of the legendary "Big 5".

Tau Game Lodge

Located on the malaria-free Madikwe Game Reserve, Tau Game Lodge offers an authentic safari experience in a relaxed, family-friendly atmosphere.

Tuningi Safari Lodge

On the vast Madikwe Game Reserve is the luxurious Tuningi Safari Lodge as well as family-friendly Little Tuningi, a self-contained private villa.

South Africa Itineraries

The following tours are private, independent and can be easily customised to suit your personal travelling requirements. Please contact us to begin designing your personalised South Africa experience.

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Namibia joins “Zero Malaria Starts With Me” campaign

Namibia joins 21 other African Countries with the recent launch of the ‘Zero Malaria Starts with Me’ campaign. 

This pan-African movement aims to accelerate prevention efforts against malaria and calls on individuals, communities, political leaders, and private sector to make a personal commitment towards malaria prevention.  

The recent increase in malaria cases requires innovative strategies and greater resource allocation if we are to see a reversal of increase in cases.  The latest WHO’s World malaria report, estimated 241 million malaria cases and 627 000 malaria deaths worldwide in 2020, representing 14 million more cases in 2020 compared to 2019, and 69 000 more deaths. Namibia recorded more than 20,000 malaria cases and over 50 deaths nation-wide.  

Speaking at the launch of the Zero Malaria Starts with me campaign, the Deputy Minister of Health and Social Services, Honorable Dr Ester Muinjangue said that Namibia prioritized the elimination of malaria.  She noted that malaria prevention is challenging due to ‘low utilization of malaria prevention interventions including resistance by community members to have their structures sprayed during the annual indoor residual spraying campaign; inadequate financing for the elimination programme; insecticide resistance; and high cross-border transmission among others’. She said that the “Zero Malaria Starts with Me” campaign is intended to raise awareness at the highest political level and encourage a multi-sectoral approach to addressing this key public health issue.  It is also a call for community leadership and ownership for malaria control. Namibia will now use this slogan in prevention messages as the country intends to intensify its communication campaign.  

WHO Representative, Dr Charles Sagoe-Moses, in a speech read on his behalf, said that the COVID-19 pandemic struck at a point when global progress against malaria had already plateaued.  By around 2017, there were signs that the phenomenal gains made since 2000—including a 27% reduction in global malaria case incidence and a nearly 51% reduction in the malaria mortality rate—were stalling.  He said that Namibia reported an overall increase in the number of malaria cases between 2019 and 2020. With a total of 13,530 cases reported in 2020 compared to 3,404 cases in 2019.  He further referred to an increase in the number of deaths in 2020 compared to the 2019, with 43 and 7 deaths respectively.

He appreciated the campaign as it is a long-term behavioural campaign and that its launching will ensure increased and sustained demand for quality malaria prevention and care services. The campaign also aim to strengthen engagement of community leadership to emphasize the importance, safety and effectiveness of the insecticides being used for the Insecticide Residual House Spraying (IRS).  

In Namibia the Insecticide Residual House Spraying (IRS) campaign has been faced with the challenge of low coverage due to locked structures and refusals, the reasons for this included lack of prior notification to households on when the IRS campaign would take place and inconveniences caused to the households as they need to prepare the structures for spraying.  Additionally, some communities believed that the IRS insecticide is not effective nor safe for their families and livestock. The main aim of the IRS is to reduce the mosquito population that causes malaria  before the malaria season.  The campaign intends to mobilize communities about the IRS to ensure households are prepared for the IRS campaigns. 

The implementation of malaria prevention interventions will become easier  if communities feel that they “own” the programme and are actively involved, which is likely to increase coverage, bringing us a step closer to malaria elimination.   

Tel: +264 (0) 61 255 121 Email: kaunatjikec [at] who.int

Medical Officer: Maternal Health 

Tel: +264-61-255 121/191

Fax: +264-61-204 6202

E-mail: sirakk [at] who.int  

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Zero malaria starts with me.

26 May 2022

Namibia’s malaria cases have been increasing steadily over the past few years and this necessitated WHO support to government through the Ministry of Health and Social Services (MOHSS) to intensify malaria control interventions. WHO and MOHSS have been implementing a larviciding demonstration project for the past three years in five malarious districts selected from 5 regions namely Omusati, Oshikoto, Ohangwena, Kavango East and Kavango West.

Dr Charles Sagoe-Moses, WHO Representative and the Hon. Governor Bonifatius Wakudumo of the Kavango East Region visited projects in Mayana village in the Kavango East Region on 28 April 2022. The aim was to assess the impact of the 3-year pilot project aimed to bring malaria transmission to zero through larvaciding using environmentally friendly chemicals. They observed the implementation of different adult mosquito collection methodologies for monitoring the adult mosquito population density in the villages as well as the larval habitat mapping. They were also acquainted to the larval survey which is implemented for monitoring larvae activity and density in the breeding sites, and larviciding demonstration for controlling the mosquito larvae before they become adults.

Dr Sagoe-Moses and Hon Wakudumo further engaged the village leadership and beneficiaries to assess the impact of the project on the community and how well it was accepted. The community leadership, the beneficiaries and the field staff of the project shared their appreciation of the project and testified how it reduced the mosquitoes as well as the malaria cases in the villages. The project also demonstrated that with proper training and guidance, lay persons from the community can implement sophisticated vector control activities successfully, hence the need to strengthen community engagement and community ownership of the malaria control activities.

With the advent of COVID-19, an increase in malaria cases was observed globally and in country. In 2020 WHO’s World malaria report estimated 241 million malaria cases and 627 000 malaria deaths worldwide in 2020, representing 14 million more cases in 2020 compared to 2019, and 69 000 more deaths. Namibia recorded more than 13,633 malaria cases and over 40 deaths nation-wide in the same year. In 2021, Namibia reported 13,740 malaria cases like that of 2020 and 15 deaths, a reduction from 43 deaths reported in 2020.

The project aims to strengthen National capabilities for the implementation and scaling up of evidence-based, innovative, diversified and environmentally sound malaria vector control interventions with particular focus on winter larviciding as an additional vector control tool to achieve malaria elimination by 2022. The project is funded by with funding from Global Environment Facility / United Nations Environment Programme / World Health Organization – African Region (GEF/UNEP/WHO-AFRO),

10 study villages were selected, and 35 field team members were recruited, including twenty (20) community members, 10 field operators and five (5) district coordinators i.e. environmental health practitioners (EHPs).

The project will end in June 2022 and its findings will contribute to scaling up diversified and environmentally sound malaria vector control interventions in the WHO Africa region and eventually contribute to malaria elimination.

For Additional Information or to Request Interviews, Please contact:

Mrs Celia Kaunatjike

Tel: +264 (0) 61 255 121 Email: [email protected]

Dr. Sirak Hailu

Medical Officer: Maternal Health

Tel: +264-61-255 121/191

Fax: +264-61-204 6202

E-mail: [email protected]

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