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Bangladesh

Health & safety

Before you go

Further reading

Lonely Planet’s Healthy Travel – Asia & India is a handy pocket size and packed with useful information including pretrip planning, emergency first aid, immunisation and disease information, and what to do if you get sick on the road. Other recommended references include Traveller’s Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills – check out the website ­ (www.travellingwell.com.au).

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Insurance

Even if you are fit and healthy, don’t travel without health insurance – accidents do happen. Declare any existing medical conditions you have – the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared. You may require extra cover for adventure activities such as scuba diving. If your health insurance doesn’t cover you for medical expenses abroad, consider getting extra insurance. If you’re uninsured, emergency evacuation is expensive.

Find out in advance if your insurance plan will make payments directly to providers, or whether the company will reimburse you later for your overseas health expenditures. (In many countries, including Bangladesh, doctors expect payment in cash.) Some insurance policies offer lower and higher medical-expense options; the higher ones are primarily for countries that have extremely high medical costs, such as the USA. You may prefer a policy that pays doctors or hospitals directly rather than you having to pay on the spot and make a claim later. If you have to claim later, make sure you keep all documentation. Some policies ask you to call back (reverse charges) to a centre in your home country, where an immediate assessment of your problem is made.

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Medical checklist

Recommended items for a personal medical kit:

antibacterial cream, eg ­Muciprocin

antibiotic for skin infections, eg Amoxicillin/Clavulanate or Cephalexin

antibiotics for diarrhoea, eg Norfloxacin or Ciprofloxacin; for bacterial diarrhoea, Azithromycin; for giardia or amoebic dysentery, Tinidazole

antifungal cream, eg ­Clotrimazole

antihistamine – there are many options, eg Cetrizine for daytime and Promethazine for night

antiseptic, eg Betadine

antispasmodic for stomach cramps, eg Buscopa

contraceptive method

decongestant, eg ­Pseudoephedrine

DEET-based insect repellent

diarrhoea treatment – consider an oral rehydration solution (eg Gastrolyte), diarrhoea ‘stopper’ (eg Loperamide) and antinausea medication (eg ­Prochlorperazine)

first-aid items such as scissors, elastoplasts, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers

Ibuprofen or another ­anti-inflammatory

indigestion tablets, such as Quick Eze or Mylanta

iodine tablets to purify water (unless you are pregnant or have a thyroid problem)

laxative, eg Coloxyl

migraine medicine – take your personal medicine

paracetamol

permethrin to impregnate clothing and mosquito nets

steroid cream for allergic/itchy rashes, eg 1% to 2% hydrocortisone

sunscreen and hat

throat lozenges

thrush (vaginal yeast infection) treatment, eg Clotrimazole pessaries or Diflucan tablet

Ural or equivalent, if you’re prone to urine infections.

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Pack medications in their original, clearly labelled, containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is very useful. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity. If you have a heart condition, bring a copy of your ECG taken just prior to travelling.

If you take any regular medication, bring double your needs in case of loss or theft. In most South Asian countries, including Bangladesh, you can buy many medications over the counter without a doctor’s prescription, but it can be difficult to find some of the newer drugs, particularly the latest antidepressant drugs, blood-pressure medications and contraceptive pills, in particular outside Dhaka.

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Vaccinations

Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and will be able to give specific recommendations for you and your trip. The doctors will take into account factors such as your vaccination history, the length of your trip, activities you may be undertaking and underlying medical conditions, such as pregnancy.

Most vaccines don’t produce immunity until at least two weeks after they’re given, so visit a doctor four to eight weeks before your planned departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as ‘the yellow booklet’), which will list all the vaccinations you’ve received.

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Recommended vaccinations

The World Health Organisation (WHO) recommends the following vaccinations for travellers to South Asia:

Adult diphtheria & tetanus Single booster recommended if none in the previous 10 years. Side effects include sore arm and fever.

Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection. Mild side effects such as headache and sore arm occur in 5% to 10% of people.

Hepatitis B Now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually headache and sore arm. In 95% of people, lifetime protection results.

Measles, mumps & rubella Two doses of MMR are required unless you have had the diseases. Occasionally a rash and flulike illness can develop a week after receiving the vaccine. Many young adults require a booster.

Polio In 2003 polio was still present in Nepal, India and Pakistan, but it has been eradicated in Bangladesh. Only one booster is required for an adult for lifetime protection. Inactivated polio vaccine is safe during pregnancy.

Typhoid Recommended for all travellers to Bangladesh, even if you only visit urban areas. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available, however the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur.

Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

These immunisations are recommended for long-term travellers (more than one month) or those at special risk:

Japanese B Encephalitis Three injections in all. Booster recommended after two years. Sore arm and headache are the most common side effects. Rarely, an allergic reaction comprising hives and swelling can occur up to 10 days after any of the three doses.

Meningitis Single injection. There are two types of vaccination: the quadravalent vaccine gives two to three years’ protection; meningitis group C vaccine gives around 10 years’ protection. Recommended for long-term backpackers aged under 25.

Rabies Three injections in all. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally headache and sore arm.

Tuberculosis A complex issue. Long-term adult travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Only one vaccine given in a lifetime.

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Required vaccinations

The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering Bangladesh. If you are travelling to Bangladesh from Africa or South America, you should check to see if you will require proof of vaccination.

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Dangers & annoyances

Bangladesh generally receives a rough ride in the Western press and many people regard it as a dangerously unstable country. The truth couldn’t be further away from this and by and large Bangladesh is overwhelmingly friendly and hospitable. The biggest annoyance you will probably have to face is unabating friendliness – interested crowds are everywhere and questions about your nationality, religion and marital status never cease.

Having said that, there are some very rare but very real dangers in Bangladesh; foreigners have been robbed, raped and kidnapped.

Pickpocketing on crowded buses is not as endemic as in some other Asian countries, but armed robbery on buses, particularly at night and using crude weapons such as knives, acid bulbs and home-made shotguns, does take place. Try to travel in daylight hours only. A number of foreigners have been mugged, often at gunpoint, in the Gulshan area of Dhaka – be careful after dark. There have also been reports of theft committed by both touts and officials at both Dhaka and Sylhet airports. Keep a very close eye on your passport and other papers here. Rickshaws and taxis present all manner of theft and mugging opportunities, and women especially should be extremely careful of any taxi containing a driver and his ‘friend’.

We have had some rare reports of harassment of foreigners in the form of pushing, stone throwing and spitting, but such incidents are very uncommon.

There are also ripples of terrorist activity, targeted assassinations, politically motivated attacks and, sometimes, violent religious rivalry. The latest attack at the time of writing was in May 2007, when bombs exploded at train stations in Dhaka, Sylhet and Chittagong though there were no fatalities. There have been a number of similar attacks in recent years that have seen four people killed. However, between late November and early December 2005 a number of bomb attacks took place across the country that left 23 people dead and 144 injured. Foreigners have never been targeted in these incidents, but many travel advisories warn foreign nationals to stay away from large gatherings to cut down on the ‘wrong place, wrong time’ possibility.

Foreigners are more likely to get tangled up in a hartal (strike). These frequently turn violent and many people have been killed or seriously injured as a result. The National Day of Mourning (21 February) is a potentially chaotic day. Major riots, affecting many towns, took place in August 2007 resulting in deaths and many injuries. A curfew was enforced in many problem areas including Dhaka. This has since been lifted but at the time of writing a state of emergency, originally imposed in January 2007, was still being enforced. However, it has to be said that this will have no effect on your travel plans and most foreigners aren’t even aware of it.

The Chittagong Hill Tracts is the only part of the country where you need really worry for your safety, and even here the problem areas are out of bounds to foreign tourists.

To sum up, the military-backed caretaker government has done much to ease tensions in Bangladesh and improve both the security and corruption situation, and in all honesty the biggest danger you face is from being involved in a road accident. Even so, it pays to keep yourself informed as to what’s going on by regularly consulting travel advisories and newspapers.

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Scams

Tourism has not really established itself in Bangladesh, and neither have tourist-related scams. You might actually be surprised at the sheer honesty of most people. However, as with anywhere in the world, not everyone is a good guy.

The most common scam you will encounter is short-changing for small transactions. The best guard against this is vigilance when you’re receiving change, or a polite query about unlikely restaurant bills. A similar scam is bus boys conveniently ‘forgetting’ to give you your change, even though they have a fistful of taka. Nine times out of 10 you’re more likely to be chased because you’ve forgotten, but keep this at the back of your mind.

Some travellers have reported being approached by dubious charities, initially appearing legitimate. Some professional beggars wave fraudulent or at least out-of-date pharmaceutical prescriptions asking for assistance in purchasing medicine for children.

Finally, there are the usual hassles with rickshaw, baby taxi (mini three-wheeled auto-rickshaws) and taxi drivers, though even here the level of harassment is minimal compared to some nearby countries, and in many towns it’s possible to just hop on a rickshaw without pre-negotiating a price and not suffer the consequences!

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In transit

Jet lag & motion sickness

Jet lag is common when crossing more than five time zones; it results in insomnia, fatigue, malaise or nausea. To avoid jet lag try drinking plenty of fluids (nonalcoholic) and eating light meals. Upon arrival, seek exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.

Antihistamines such as dimenhydrinate (Dramamine), promethazine (Phenergan) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. Their main side effect is drowsiness. A herbal alternative is ginger, which works like a charm for some people.

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While you're there

Air pollution

If you have severe respiratory problems, speak with your doctor before travelling to any heavily polluted urban centres. Dhaka is one of the most polluted cities in the world. This pollution also causes minor respiratory problems such as sinusitis, dry throat and irritated eyes. If troubled by the pollution, leave the city for a few days and get some fresh air.

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Food

Eating in restaurants is the biggest risk factor for contracting traveller’s diarrhoea. Ways to avoid it include eating only freshly cooked food, and avoiding shellfish and food that has been sitting around in buffets. Peel all fruit, cook vegetables, and soak salads in iodine water for at least 20 minutes. Eat in busy restaurants with a high turnover of customers.

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Heat

Parts of Bangladesh are hot and humid throughout the year. For most people it takes at least two weeks to adapt to the hot climate. Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat. Take it easy when you first arrive. Don’t eat salt tablets (they aggravate the gut), but drinking rehydration solution or eating salty food helps. Treat cramps by stopping activity, resting, rehydrating with double-strength rehydration solution, and gently stretching.

Dehydration is the main contributor to heat exhaustion. Symptoms include feeling weak, headache, irritability, nausea or vomiting, sweaty skin, a fast weak pulse and a normal or slightly elevated body temperature. Treatment involves getting out of the heat and/or sun, fanning the victim and applying cool wet cloths to the skin, laying the victim flat with their legs raised, and rehydrating with water containing ¼ teaspoon of salt per litre. Recovery is usually rapid but it is common to feel weak for some days afterwards.

Heatstroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot, dry body with a temperature of over 41°C, dizziness, confusion, loss of coordination, fits and eventually collapse and loss of consciousness. Seek medical help and commence cooling by getting the person out of the heat, removing their clothes, fanning them, and applying cool wet cloths or ice to their body, especially to the groin and armpits.

Prickly heat is a common skin rash in the tropics, caused by sweat being trapped under the skin. The result is an itchy rash of tiny lumps. Treat by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin, so they should be avoided. Locally bought prickly-heat powder can be helpful.

Tropical fatigue is common in long-term expatriates based in the tropics. It’s rarely due to disease and is caused by the climate, inadequate mental rest, excessive alcohol intake and the demands of daily work in a different culture.

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Insect bites & stings

Bedbugs don’t carry disease but their bites are very itchy. They live in the cracks of furniture and walls, and then migrate to the bed at night to feed on you. You can treat the itch with an antihistamine.

Lice inhabit various parts of your body but most commonly your head and pubic area. Transmission is via close contact with an infected person. They can be difficult to treat and you may need numerous applications of an antilice shampoo such as permethrin. Pubic lice are usually contracted from sexual contact.

Ticks are contracted after walking in rural areas. They are commonly found behind the ears, on the belly and in the armpits. If you have had a tick bite and experience symptoms such as a rash at the site of the bite or elsewhere, fever or muscle aches, you should see a doctor. Doxycycline prevents tick-borne diseases.

Leeches are found in humid rainforest areas. They do not transmit any disease but their bites are often intensely itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection.

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Skin problems

Fungal rashes are common in humid climates. There are two common fungal rashes that affect travellers. The first occurs in moist areas that get less air, such as the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as Clotrimazole or Lamisil. Tinea versicolor is also common – this fungus causes small, light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.

Cuts and scratches become easily infected in humid climates. Take meticulous care of any cuts and scratches to prevent complications such as abscesses. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection (increasing pain and redness), see a doctor. Divers and surfers should be particularly careful with coral cuts as they become easily infected.

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Sunburn

Even on a cloudy day sunburn can occur rapidly. Always use a strong sunscreen (at least factor 30), making sure to reapply after a swim, and always wear a wide-brimmed hat and sunglasses outdoors. Avoid lying in the sun during the hottest part of the day (10am to 2pm). If you become sunburnt, stay out of the sun until you have recovered, apply cool compresses and take painkillers for the discomfort. One percent hydrocortisone cream applied twice daily is also helpful.

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Coughs, colds & chest infections

Respiratory infections are common in Bangladesh. This usually starts as a virus and is exacerbated by environmental conditions such as pollution in the cities, or cold and altitude in the mountains. Commonly a secondary bacterial infection will intervene – marked by fever, chest pain and coughing up discoloured or blood-tinged sputum. If you have the symptoms of an infection, seek medical advice or commence a general antibiotic.

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Dengue fever

This mosquito-borne disease is becoming increasingly problematic in the tropical world, especially in the cities. As there is no vaccine available it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue bites day and night, so use insect avoidance measures at all times. Symptoms include high fever, severe headache and body ache (dengue was previously known as ‘breakbone fever’). Some people develop a rash and experience diarrhoea. There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging. See a doctor to be diagnosed and monitored.

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Hepatitis A

A problem throughout the region, this food- and waterborne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment for hepatitis A, you just need to allow time for the liver to heal. All travellers heading to South Asia should be vaccinated against hepatitis A.

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Hepatitis B

The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of South Asia up to 20% of the population are carriers of hepatitis B, and usually are unaware of this. In Bangladesh the number of carriers is just below 10%. The long-term consequences can include liver cancer and cirrhosis.

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Hepatitis E

Transmitted through contaminated food and water, hepatitis E has similar symptoms to hepatitis A, but is far less common. It is a severe problem in pregnant women and can result in the death of both mother and baby. There is currently no vaccine, and prevention is by following safe eating and drinking guidelines.

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HIV

HIV is spread via contaminated body fluids. Avoid unsafe sex, unsterile needles (including those in medical facilities) and procedures such as tattoos. The rate of HIV infection in South Asia is growing more rapidly than anywhere else in the world.

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Influenza

Present year-round in the tropics, influenza (flu) symptoms include high fever, muscle aches, runny nose, cough and sore throat. It can be very severe in people over the age of 65 or in those with underlying medical conditions such as heart disease or diabetes – vaccination is recommended for these individuals. There is no specific treatment, just rest and paracetamol.

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Japanese B encephalitis

This viral disease is transmitted by mosquitoes and is rare in travellers. Like most mosquito-borne diseases it is becoming a more common problem in affected countries. Most cases occur in rural areas and vaccination is recommended for travellers spending more than one month outside of cities. There is no treatment, and a third of infected people will die, while another third will suffer permanent brain damage.

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Malaria

For such a serious and potentially deadly disease, there is an enormous amount of ­misinformation concerning malaria. You must get expert advice as to whether your trip puts you at risk. Outside Dhaka, the risk of contracting malaria far outweighs the risk of any tablet side effects. Remember that malaria can be fatal. Before you travel, seek medical advice on the right medication and dosage for you. Malaria in South Asia, including Bangladesh, is chloroquine resistant.

Malaria is caused by a parasite, transmitted through the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. A diagnosis can only be made by taking a blood sample.

Two strategies should be combined to prevent malaria – mosquito avoidance, and antimalarial medications. Most people who catch malaria are taking inadequate or no antimalarial medication.

Travellers are advised to prevent mosquito bites by taking these steps:

Use a DEET-containing insect repellent on exposed skin. Wash this off at night, as long as you are sleeping under a mosquito net. Natural repellents such as citronella can be effective, but must be applied more frequently than products containing DEET.

Sleep under a mosquito net ­impregnated with permethrin.

Choose accommodation with screens and fans (if not air-conditioned).

Impregnate clothing with permethrin in high-risk areas.

Wear long sleeves and trousers in light colours.

Use mosquito coils.

Spray your room with insect repellent before going out for your evening meal.

There are a variety of medications available:

Doxycycline This daily tablet is a broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of tropical diseases including leptospirosis, tick-borne diseases and typhus. The potential side effects include photosensitivity (a tendency to sunburn), thrush in women, indigestion, heartburn, nausea and interference with the contraceptive pill. More serious side effects include ulceration of the oesophagus – you can help prevent this by taking your tablet with a meal and a large glass of water, and never lying down within half an hour of taking it. It must be taken for four weeks after leaving the risk area.

Lariam (Mefloquine) Lariam has received much bad press, some of it justified, some not. This weekly tablet suits many people. Serious side effects are rare but include depression, anxiety, psychosis and having fits. Anyone with a history of depression, anxiety, other psychological disorders or epilepsy should not take Lariam. It is considered safe in the second and third trimesters of pregnancy. Tablets must be taken for four weeks after leaving the risk area.

Malarone This drug is a combination of Atovaquone and Proguanil. Side effects are uncommon and mild, most commonly nausea and headache. It is the best tablet for scuba divers and for those on short trips to high-risk areas. It must be taken for one week after leaving the risk area.

A final option is to take no preventive medication but to have a supply of emergency medication should you develop the symptoms of malaria. This is less than ideal, and you’ll need to get to a good medical facility within 24 hours of developing a fever. If you choose this option, the most effective and safest treatment is Malarone (four tablets once daily for three days). Other options include Mefloquine and Quinine but the side effects of these drugs at treatment doses make them less desirable. Fansidar is no longer recommended.

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Measles

Measles remains a significant problem in Bangladesh. This highly contagious bacterial infection is spread via coughing and sneezing. Most people born before 1966 are immune as they had the disease in childhood. Measles starts with a high fever and rash, and can be complicated by pneumonia and brain disease. There is no specific treatment.

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Rabies

This is a common problem in South Asia. Around 30, 000 people die from rabies in India alone each year, and there are more than 2000 deaths annually in Bangladesh. This uniformly fatal disease is spread by the bite or lick of an infected animal – most commonly a dog or monkey. You should seek medical advice immediately after any animal bite and commence postexposure treatment. Having pretravel vaccination means the postbite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not prevaccinated, you will need to receive rabies immunoglobulin as soon as possible. This is very difficult to obtain outside Dhaka.

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STDs

Sexually transmitted diseases most common in Bangladesh include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If, after a sexual encounter, you develop any rash, lumps, discharge or pain when passing urine, seek immediate medical attention. If you have been sexually active during your travels, have an STD check on your return home.

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Tuberculosis

While TB is rare in travellers, those who have significant contact with the local population, such as medical and aid workers, and long-term travellers, should take precautions. Vaccination is usually only given to children under the age of five, but adults at risk are recommended to have pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.

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Typhoid

This serious bacterial infection is also spread via food and water. It gives a high and slowly progressive fever and headache, and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for all travellers spending more than a week in South Asia. India and Nepal pose a particularly high risk and have the added problem of significant antibiotic resistance. In Bangladesh the risk is medium level but the infection is also antibiotic resistant. Be aware that vaccination is not 100% effective, so you must still be careful with what you eat and drink.

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Giardiasis

Giardia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardia, but work in Nepal has shown that they are not specific to giardia. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is Tinidazole, with Metronidazole being a second-line option.

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Availability of health care

In general, medical facilities are not up to international standards and serious cases are likely to be evacuated. Facilities are severely limited outside the major cities and, as a result, it can be difficult to find reliable medical care in rural areas. Your embassy and insurance company can be good contacts.

Self-treatment may be appropriate if your problem is minor (eg traveller’s diarrhoea), you are carrying the relevant medication and you cannot attend a recommended clinic. If you think you may have a serious disease, especially malaria, do not waste time – travel to the nearest quality facility to receive attention.

Buying medication over the counter is not recommended, as fake medications and drugs that have been poorly stored or are out-of-date are common.

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Traveller’s diarrhoea

Traveller’s diarrhoea is by far the most common problem affecting travellers – between 30% and 70% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, traveller’s diarrhoea is caused by a bacteria, and therefore responds promptly to treatment with antibiotics. Treatment with antibiotics will depend on your situation – how sick you are, how quickly you need to get better, where you are etc.

Traveller’s diarrhoea is defined as the passage of more than three watery bowel actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or generally feeling unwell.

Treatment consists of staying well hydrated; rehydration solutions such as Gastrolyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.

Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It can be helpful, for example if you have to go on a long bus ride. Don’t take Loperamide if you have a fever, or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic.

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Amoebic dysentery

Amoebic dysentery is rare in travellers but is often misdiagnosed by poor-quality labs in South Asia. Symptoms are similar to bacterial diarrhoea, ie fever, bloody diarrhoea and generally feeling unwell. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs: Tinidazole or Metronidazole to kill the parasite in your gut, and then a second drug to kill the cysts. If left untreated, complications such as liver or gut abscesses can occur. Bacterial dysentery is more common.

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Women’s health

Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 and 28 weeks), when the risk of pregnancy-related problems is at its lowest and pregnant women generally feel at their best. During the first trimester there is a risk of miscarriage, and in the third trimester complications such as premature labour and high blood pressure are possible. It’s wise to travel with a companion. Always carry a list of quality medical facilities available at your destination and ensure you continue your standard antenatal care at these facilities. Avoid rural travel in areas with poor transportation and medical facilities. Most of all, ensure your travel insurance covers all pregnancy-related possibilities, including premature labour.

Malaria is a high-risk disease in pregnancy. WHO recommends that pregnant women do not travel to areas with Chloroquine-resistant malaria. None of the more effective antimalarial drugs are completely safe in pregnancy.

Hepatitis E is a particular problem for pregnant women – if it is contracted in the third trimester, 30% of women and their babies will die.

Traveller’s diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many of the drugs used to treat various diarrhoea bugs are not recommended in pregnancy. Azithromycin is considered safe.

In the urban areas of Bangladesh, supplies of sanitary products are readily available. Birth-control options may be limited so bring adequate supplies of your own form of contraception. Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as Clotrimazole. A practical alternative is a single tablet of Fluconazole (Diflucan). Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.

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