If you stay up to date with your vaccinations and take basic preventive measures, you’d be unlucky to succumb to most of the health hazards covered here. The exception is malaria, which is a real risk throughout much of East Africa.
Checking insurance quotes…
Before You Go
Check whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. Most doctors in East Africa expect cash payment.
Ensure that your travel insurance will cover any emergency transport required to get you at least as far as Nairobi (Kenya), or, preferably, home, by air and with a medical attendant if necessary. Consider temporary membership with the African Medical & Research Foundation, which offers air evacuation in medical emergencies for most of East Africa.
Predeparture planning will save you trouble later.
- Get a check-up from your dentist and doctor if you have any regular medication or chronic illness (eg high blood pressure or asthma).
- Organise spare contact lenses and glasses (and take your optical prescription with you).
- Get a first-aid and medical kit together and arrange necessary vaccinations.
- Get an International Certificate of Vaccination (‘yellow booklet’) listing vaccinations you have received.
- Carry medications in their original (labelled) containers. If carrying syringes or needles, have a physician’s letter documenting their medical necessity.
The World Health Organization (www.who.int/en) recommends that all travellers be covered for diphtheria, tetanus, measles, mumps, rubella and polio, as well as for hepatitis B, regardless of their destination.
According to the Centers for Disease Control & Prevention (www.cdc.gov), the following vaccinations are recommended for East Africa: hepatitis A, hepatitis B, meningococcal meningitis, rabies and typhoid, and boosters for tetanus, diphtheria, polio and measles.
It is also advisable to be vaccinated against yellow fever (required for all visitors to Rwanda and the DRC). If travelling overland between Kenya and Tanzania, for example, you will be asked for proof of yellow fever vaccination.
In East Africa
Availability & Cost of Health Care
Health care services can be excellent, especially in major cities, but as a general rule privately run hospitals and clinics offer better care than state-run hospitals. However, private hospitals can be expensive – a major reason why we recommend taking out travel insurance before travelling.
With basic preventive measures, it’s unlikely that you’ll succumb to any of the infectious diseases present in East Africa.
This disease is spread by flukes (minute worms) that are carried by a species of freshwater snail. Don’t paddle or swim in any freshwater lakes or slow-running rivers anywhere in East Africa unless you have reliable confirmation that they are bilharzia-free. A blood test can detect antibodies if you might have been exposed, and treatment is possible in specialist travel clinics. If not treated the infection can cause kidney failure or permanent bowel damage.
Cholera is spread via contaminated drinking water. The main symptom is profuse watery diarrhoea, which causes debilitation if fluids are not replaced quickly. An oral cholera vaccine is available but is not particularly effective. Pay close attention to good drinking water and avoid potentially contaminated food. Treatment is by fluid replacement (orally or via a drip), but sometimes antibiotics are needed. Self-treatment is not advised.
Mini-epidemics of this mosquito-borne disease crop up with some regularity in Tanzania, notably in Dar es Salaam. Symptoms include high fever, severe headache and body ache (dengue used to be known as breakbone fever). Some people develop a rash and experience diarrhoea. There is no vaccine, only prevention. The dengue-carrying Aedes aegypti mosquito is active day and night, so use DEET-mosquito repellent periodically throughout the day. See a doctor to be diagnosed and monitored (dengue testing is available in Dar es Salaam). There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging. Severe dengue is a potentially fatal complication.
Found throughout East Africa, diphtheria is spread through close respiratory contact. Vaccination is recommended for those likely to be in close contact with the local population in infected areas and is more important for long stays than for short-term trips.
Tiny worms migrating in the lymphatic system cause filariasis. The bite from an infected mosquito spreads the infection. Symptoms include localised itching and swelling of the legs and/or genitalia. Treatment is available.
Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice, and although rarely fatal, it can cause prolonged lethargy and delayed recovery. If you’ve had hepatitis A, don’t drink alcohol for up to six months afterwards; once you’ve recovered, there won’t be long-term problems. Early symptoms include dark urine and a yellow colour to the whites of the eyes, sometimes with fever and abdominal pain. Hepatitis A vaccine (Avaxim, VAQTA, Havrix) gives protection for up to a year; a booster after a year gives 10-year protection. Hepatitis A and typhoid vaccines can also be given as a single-dose vaccine (hepatyrix or viatim).
Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse. It can also be spread from an infected mother to the baby during childbirth. It affects the liver, causing jaundice and occasionally liver failure. Most people recover completely, but some might be chronic carriers of the virus, which could lead eventually to cirrhosis or liver cancer. Those visiting high-risk areas for long periods or those with increased social or occupational risk should be immunised.
Human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), is an enormous problem throughout East Africa. It’s spread through infected blood and blood products, by sexual intercourse with an infected partner and from an infected mother to her baby during childbirth and breastfeeding. It can be spread through ‘blood to blood’ contact, such as with contaminated instruments during medical, dental, acupuncture and other body-piercing procedures, and through sharing used intravenous needles. If you think you might have been infected with HIV, a blood test is necessary.
Malaria is endemic throughout East Africa (except at altitudes higher than 2000m, where risk of transmission is low). The disease is caused by a parasite in the bloodstream spread via the bite of the female Anopheles mosquito. There are several types of malaria, with falciparum malaria the most dangerous type and the predominant form in the region. Infection rates vary with climate and season. Rates are higher during the rainy season, but the risk exists year-round. It is extremely important to take preventive measures, even just for short visits.
There is no vaccination against malaria (yet). However, several different drugs are used for prevention with new ones in the pipeline. Up-to-date advice from a travel-health clinic is essential. The pattern of drug-resistant malaria changes rapidly, so what was advised several years ago might no longer be current.
Antimalarial A to D
A – Awareness of the risk. No medication is totally effective, but protection of up to 95% is achievable with most drugs, as long as other measures have been taken.
B – Bites: avoid at all costs. Sleep in a screened room, use mosquito spray or coils and sleep under a permethrin-impregnated net at night. Cover up at night with long trousers and long sleeves, preferably with permethrin-treated clothing. Apply repellent to all areas of exposed skin in the evenings.
C – Chemical prevention (ie antimalarial drugs) is usually needed in malarial areas. Expert advice is needed as resistance patterns change and new drugs are in development. Most antimalarial drugs need to be started at least a week in advance and continued for four weeks after the last exposure to malaria.
D – Diagnosis. If you have a fever or flu-like illness within a year of travel to a malarial area, malaria is a possibility; immediate medical attention is necessary.
Malaria’s early stages include headaches, fevers, generalised aches and pains, and malaise, which could be mistaken for flu. Other symptoms can include abdominal pain, diarrhoea and a cough. Anyone who develops a fever while in East Africa or within two weeks after departure should assume malarial infection until blood tests prove negative, even if you have been taking antimalarial medication. If not treated, the next stage could develop within 24 hours, particularly if falciparum malaria is the parasite: jaundice, then reduced consciousness and coma (also known as cerebral malaria) followed by death. Treatment in hospital is essential; the death rate might still be as high as 10% even in the best intensive-care facilities.
Side Effects & Risks
Many travellers are under the impression that malaria is a mild illness, that treatment is always easy and successful and that taking antimalarial drugs causes more illness through side effects than actually getting malaria. Unfortunately, this is not true. Side effects of the medication depend on the drug taken. Doxycycline can cause heartburn and indigestion; mefloquine (Lariam) can cause anxiety attacks, insomnia and nightmares and (rarely) severe psychiatric disorders; chloroquine can cause nausea and hair loss; and proguanil can cause mouth ulcers. These side effects are not universal and can be minimised by taking medication correctly, eg with food. Also, some people should not take a particular antimalarial drug – for example, people with epilepsy should avoid mefloquine, and doxycycline should not be taken by pregnant women or children younger than 12.
If you decide against taking antimalarial drugs, you must understand the risks and be obsessive about avoiding mosquito bites. Use nets and insect repellent, and report any fever or flu-like symptoms to a doctor as soon as possible. Malaria in pregnancy frequently results in miscarriage or premature labour and the risks to both mother and foetus during pregnancy are considerable. Travel in East Africa when pregnant should be carefully considered.
Carrying emergency stand-by treatment is essential for travel in remote areas. Seek your doctor’s advice as to recommended medicines and dosages. However, this should be viewed as emergency treatment only and not as routine self-medication, and should only be used if you will be far from medical facilities and have been advised about the symptoms of malaria and how to use the medication. If you resort to emergency self-treatment, seek medical advice as soon as possible to confirm whether the treatment has been successful. In particular, you want to avoid contracting cerebral malaria, which can be fatal within 24 hours. Self-diagnostic kits, which can identify malaria in the blood from a finger prick, are available in the West and are worth buying.
Meningococcal infection is spread through close respiratory contact and is most likely contracted in crowded situations. Infection is uncommon in travellers. Vaccination is particularly recommended for long stays and is especially important towards the end of the dry season. Symptoms include fever, severe headache, neck stiffness and a red rash. Immediate medical treatment is necessary.
The ACWY vaccine is recommended for all travellers in sub-Saharan Africa. This vaccine is different from the meningococcal meningitis C vaccine given to children and adolescents in some countries; it is safe to be given both types of vaccine.
Rabies is spread by receiving the bites or licks of an infected animal on broken skin. It is always fatal once the clinical symptoms start (which might be months after an infected bite), so postbite vaccination should be given as soon as possible. Postbite vaccination (whether or not you’ve been vaccinated before the bite) prevents the virus from spreading to the central nervous system. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of postbite vaccine is not available. Three preventive injections are needed over a month. If you haven’t been vaccinated you will need a course of five injections starting 24 hours or as soon as possible after being exposed. If you have been vaccinated, you will need fewer postbite injections, and have more time to seek medical help.
Rift Valley Fever
This fever is spread occasionally via mosquito bites. The symptoms are of a fever and flu-like illness; and the good news is it’s rarely fatal.
Trypanosomiasis (Sleeping Sickness)
Spread via the bite of the tsetse fly, it causes headache, fever and eventually coma. If you have headache and fever symptoms and have negative malaria tests, have yourself evaluated by a reputable clinic, where you should also be able to obtain treatment.
TB is spread through close respiratory contact and occasionally through infected milk or milk products. The BCG vaccine is recommended for those likely to be mixing closely with the local population, although it only provides moderate protection. It’s more important for long stays than for short-term visits. Inoculation with the BCG vaccine is not available in all countries, but it is given routinely to many children in developing nations. It is a live vaccine and should not be given to pregnant women or immunocompromised individuals.
TB can be asymptomatic, only being picked up on a routine chest X-ray. Alternatively, it can cause a cough, weight loss or fever, months or even years after exposure.
This is spread through food or water contaminated by infected human faeces. The first symptom is usually a fever or a pink rash on the abdomen. Sometimes septicaemia (blood poisoning) can occur. A typhoid vaccine (typhim Vi, typherix) will give protection for three years. In some countries, the oral vaccine Vivotif is also available. Antibiotics are usually given as treatment, and death is rare unless septicaemia occurs.
Tanzania, Kenya, Uganda and Burundi no longer officially require you to carry a certificate of yellow fever vaccination unless you’re arriving from an infected area (which includes from anywhere in East Africa). However, it’s still sometimes asked for at some borders, and is a requirement in some neighbouring countries, including Rwanda. The vaccine is recommended for most visitors to Africa by the Centers for Disease Control & Prevention (www.cdc.gov). Also, there is always the possibility that a traveller without a legally required, up-to-date certificate will be vaccinated and detained in isolation at the port of arrival for up to 10 days, or possibly even repatriated.
Yellow fever is spread by infected mosquitoes. Symptoms range from a flu-like illness to severe hepatitis (liver inflammation), jaundice and death. The yellow fever vaccination must be given at a designated clinic and is valid for 10 years. It is a live vaccine and must not be given to immunocompromised or pregnant travellers.
Diarrhoea is the most common travel-related illness. Sometimes dietary changes, such as increased spices or oils, are the cause. To help prevent diarrhoea: avoid tap water unless you’re sure it’s safe to drink; only eat fresh fruits or vegetables if cooked or peeled; and be wary of dairy products that might contain unpasteurised milk. Although freshly cooked food can often be a safe option, plates or serving utensils might be dirty, so be selective when eating food from street vendors (make sure that cooked food is piping hot all the way through).
If you develop diarrhoea, be sure to drink plenty of fluids, preferably lots of an oral rehydration solution containing water, and some salt and sugar. A few loose stools don’t require treatment, but if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinoline drug, such as ciprofloxacin or norfloxacin) and an antidiarrhoeal agent (such as loperamide) if you are not within easy reach of a toilet. If diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention.
Contracted by consuming contaminated food and water, amoebic dysentery causes blood and mucus in the faeces. It can be relatively mild and tends to come on gradually, but seek medical advice if you think you have the illness, as it won’t clear up without treatment (which is with specific antibiotics).
This, like amoebic dysentery, is also caused by ingesting contaminated food or water. The illness usually appears a week or more after you have been exposed to the offending parasite. Giardiasis might cause only a short-lived bout of typical traveller’s diarrhoea, but it can also cause persistent diarrhoea. Ideally, seek medical advice if you suspect you have giardiasis, but if you're in a remote area you could start a course of antibiotics, with medical follow-up when feasible.
The lack of oxygen at high altitudes (over 2500m) affects most people to some extent. Symptoms of Acute Mountain Sickness (AMS) usually develop in the first 24 hours at altitude, but may be delayed up to three weeks. Mild symptoms are headache, lethargy, dizziness, difficulty sleeping and loss of appetite. Severe symptoms are breathlessness, a dry, irritated cough (followed by the production of pink, frothy sputum), severe headache, lack of coordination, confusion, vomiting, irrational behaviour, drowsiness and unconsciousness. There’s no rule as to what is too high: AMS can be fatal at 3000m, but 3500m to 4500m is the usual range when it can cause problems. Symptoms should never be ignored; trekkers die every year on East Africa’s mountains, notably Mt Kilimanjaro.
Treat mild symptoms by resting at the same altitude until you have recovered, usually a day or two. Paracetamol or aspirin can be taken for headaches. If symptoms persist or grow worse, however, immediate descent is necessary; even 500m can help. Drug treatments should never be used to avoid descent or to enable further ascent. Diamox (acetazolamide) reduces the headache of AMS and helps the body acclimatise to the lack of oxygen. It is only available on prescription.
Suggestions for preventing AMS:
- Ascend slowly. On Mt Kilimanjaro, this means choosing one of the longer routes (eg Machame) that allow for a more gradual ascent. On Mt Kenya, it means spending at least three nights on the ascent.
- Sleep at a lower altitude than the greatest height reached during the day if possible (‘climb high, sleep low’).
- Drink extra fluids. Monitor hydration by ensuring that urine is clear and plentiful.
- Eat light, high-carbohydrate meals for more energy.
- Avoid alcohol, sedatives and tobacco.
This condition occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt, and is particularly common in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty – aim to drink sufficient water to produce pale, diluted urine. Self-treatment requires fluid replacement with water and/or fruit juice, and cooling by cold water and fans. Treatment of the salt-loss component consists of consuming salty fluids, as in soup, and adding a little more table salt to foods than usual.
Insect Bites & Stings
Mosquitoes might not always carry malaria or dengue fever, but they (and other insects) can cause irritation and infected bites. To avoid these, take the same precautions as you would for avoiding malaria. Use DEET-based insect repellents. Excellent clothing treatments are also available, and mosquitoes that land on the treated clothing will die.
Bee and wasp stings cause real problems only to those who have a severe allergy to the stings (anaphylaxis). If you are one of these people, carry an ‘epipen’ – an adrenaline (epinephrine) injection, which you can give yourself. This could save your life.
Scorpions are frequently found in arid or dry climates. They can cause a painful sting that is sometimes life threatening. If stung by a scorpion, seek immediate medical assistance.
Bed bugs are often found in hostels and cheap hotels. They lead to very itchy, lumpy bites. Spraying the mattress with crawling insect killer after changing bedding will get rid of them.
Scabies is also frequently found in cheap accommodation. These tiny mites live in the skin, particularly between the fingers. They cause an intensely itchy rash. The itch is easily treated with malathion and permethrin lotion from a pharmacy; other members of the household also need treatment to avoid spreading scabies, even if they do not show any symptoms.
Tsetse flies can be unwelcome safari companions in some areas, delivering painful, swelling bites. To minimise the nuisance, wear thick, long-sleeved shirts and trousers in khaki or other drab shades, and avoid bright, contrasting and very dark clothing. The flies are also attracted by heat (eg the heat of a running car motor), so if you’re idling, keep the windows rolled up.
Avoid getting bitten! Do not walk barefoot, or stick your hand into holes or cracks. However, 50% of those bitten by venomous snakes are not actually injected with poison (envenomed). If you are bitten by a snake, do not panic. Immobilise the bitten limb with a splint (such as a stick) and apply a bandage over the site, with firm pressure, similar to bandaging a sprain. Do not apply a tourniquet, or cut or suck the bite. Get medical help as soon as possible so antivenom can be given if needed. Try to note the snake’s appearance to help in treatment.
Don’t drink tap water in East Africa unless it has been boiled, filtered or chemically disinfected (such as with iodine tablets). Never drink from streams, rivers and lakes. Also avoid drinking from pumps and wells; some do bring pure water to the surface, but the presence of animals can contaminate supplies. With bottled water, check that the bottles are properly sealed, and haven’t just been refilled with ordinary tap water.
Good, Western-style medical care is available in Nairobi (which is the main medical hub for the region and the main regional destination for medical evacuations), and to a lesser extent in Dar es Salaam. Elsewhere, reasonable to good care is available in larger towns, and in some mission stations, though availability is patchy off the beaten track. Private or mission-run clinics and hospitals are generally better equipped than government ones. If you fall ill in an unfamiliar area, ask staff at top-end hotels or resident expatriates where the best nearby medical facilities are; in an emergency, contact your embassy. Most towns have at least one clinic where you can get an inexpensive malaria test and, if necessary, treatment. With dental treatment, there is often an increased risk of hepatitis B and HIV transmission via poorly sterilised equipment.
Most drugs can be purchased over the counter in East Africa, without a prescription. However, there are often problems with ineffectiveness, eg if the drugs are counterfeit, or if they have been improperly stored. Most drugs are available in capital cities, but almost none in remote villages. Bring all drugs for chronic diseases from home.