Malaria is present throughout Malawi, year-round, at all altitudes below about 1,500 m. It should be taken seriously. Take antimalarial prophylaxis — atovaquone/proguanil (Malarone), doxycycline, or mefloquine — and start it before you arrive. Use DEET-based repellent, sleep under a treated net, and cover up at dusk and dawn. Malaria risk is higher during and after the rainy season (November–April).
Vaccinations recommended before travel include hepatitis A, typhoid, tetanus/diphtheria, polio, and hepatitis B. Rabies vaccination is worth considering if you'll be spending time in rural areas, working with animals, or doing activities where bites are possible. Consult a travel health clinic at least 6 weeks before departure.
Cholera outbreaks have been ongoing in Malawi in recent years, affecting particularly the lakeshore areas. The oral cholera vaccine is advisable. Wash hands frequently, drink only bottled or purified water, and avoid raw vegetables and seafood from street vendors.
Water: Do not drink tap water. Use bottled, boiled, or filtered water for drinking and brushing teeth. Be cautious with ice.
Bilharzia (schistosomiasis) is present in Lake Malawi and most freshwater bodies. This is one of Malawi's most relevant health risks for travellers who swim in the lake. Avoid wading or swimming in shallow, reedy areas where snails breed. Swimming further from shore in open water carries lower but not zero risk. Get tested after returning home if you spent time in the lake.
Medical care: Lilongwe and Blantyre have private clinics and hospitals that can handle most non-emergency conditions. Outside the main cities, medical facilities are basic. Serious illness or injury is likely to require evacuation to South Africa. Travel insurance with comprehensive medical evacuation cover is essential.
Sun: The sun at altitude (and on the lake's reflective surface) is intense. Wear sunscreen, a hat, and stay hydrated.