Africa certainly has an impressive selection of tropical and other diseases, but you’re much more likely to get a bout of diarrhoea, a cold or an infected mosquito bite than anything exotic. If you stay up-to-date with your vaccinations and take some basic preventive measures, you’d be pretty unlucky to succumb to most of the other health hazards on offer. When it comes to injuries (as opposed to illness), the most likely reason for needing medical help in Kenya is as a result of road accidents.
Checking insurance quotes…
Before You Go
It’s tempting to leave all the preparations to the last minute – don’t! Many vaccines don’t take effect until two weeks after you’ve been immunised, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (known in some countries as the yellow booklet), which will list all the vaccinations you’ve received. This is mandatory for the African countries that require proof of yellow fever vaccination upon entry, which includes Kenya and its neighbours, but it’s a good idea to carry it anyway wherever you travel.
Fee payment Find out in advance whether your insurance plan will make payments directly to providers or will reimburse you later for overseas health expenditures (many doctors expect payment in cash).
Emergency transport It’s vital to ensure that your travel insurance will cover the emergency transport required to get you to a hospital in a major city, to better medical facilities elsewhere in Africa, or all the way home, by air and with a medical attendant if necessary. Not all insurance covers this, so check the contract carefully.
Medical assistance If you need medical help, your insurance company might be able to locate the nearest hospital or clinic, or you can ask at your hotel. In an emergency, contact your embassy or consulate.
Air evacuation Membership of the African Medical & Research Foundation (AMREF; www.amref.org) provides an air-evacuation service in medical emergencies in Kenya, as well as air-ambulance transfers between medical facilities. Money paid by members for this service goes into providing grassroots medical assistance for local people.
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 Kenya: hepatitis A, hepatitis B, meningococcal meningitis, rabies and typhoid, and boosters for tetanus, diphtheria, polio and measles. It is also necessary to be vaccinated against yellow fever.
It’s a very good idea to carry a medical and first-aid kit with you, to help yourself in the case of minor illness or injury. If you’re travelling through an area where malaria is a problem, particularly an area where falciparum malaria predominates, consider taking a self-diagnostic kit that can identify malaria in the blood from a finger prick.
Following is a list of other items you should consider bringing:
- Acetaminophen (paracetamol) or aspirin
- Acetazolamide (Diamox) for altitude sickness (prescription only)
- Adhesive or paper tape
- Antibacterial ointment (eg Bactroban) for cuts and abrasions (prescription only)
- Antibiotics (prescription only), eg ciprofloxacin (Ciproxin) or norfloxacin (Utinor)
- Antidiarrhoeal drugs (eg loperamide)
- Antihistamines (for hay fever and allergic reactions)
- Anti-inflammatory drugs (eg ibuprofen)
- Antimalaria pills
- Bandages, gauze, gauze rolls
- Insect repellent containing DEET, for the skin
- Iodine tablets (for water purification)
- Oral rehydration salts
- Permethrin-containing insect spray for clothing, tents and bed nets
- Pocket knife
- Scissors, safety pins, tweezers
- Steroid cream or hydrocortisone cream (for allergic rashes)
- Syringes, sterile needles and fluids if travelling to remote areas
Availability & Cost of Health Care
Standards of care Health care in Kenya is varied: it can be excellent in Nairobi, which generally has well-trained doctors and nurses, but is often patchy off the beaten track, even in Mombasa. Medicine and even sterile dressings and intravenous fluids might need to be purchased from a local pharmacy. The standard of dental care is equally variable, and there is an increased risk of hepatitis B and HIV transmission from poorly sterilised equipment.
Hospitals By and large, public hospitals in Kenya offer the cheapest service, but will have the least up-to-date equipment and medications; mission hospitals (where donations are the usual form of payment) often have more reasonable facilities; and private hospitals and clinics are more expensive but tend to have more advanced drugs and equipment and better-trained medical staff.
Drugs Most drugs can be purchased over the counter without a prescription. Many drugs for sale in Kenya might be ineffective; they might be counterfeit or might not have been stored in the right conditions. The most common examples of counterfeit drugs are malaria tablets and expensive antibiotics, such as ciprofloxacin. Most drugs are available in Nairobi, but remote villages will be lucky to have a couple of paracetamol tablets. It is strongly recommended that you bring all medication from home.
Contraception The availability and efficacy of condoms cannot be relied upon – bring all the contraception you’ll need. Condoms bought in Kenya might not be of the same quality as in Europe, North America or Australia, and they might have been incorrectly stored.
Blood transfusion There is a high risk of contracting HIV from infected blood if you receive a blood transfusion in Kenya. The Blood Care Foundation (www.bloodcare.org.uk) is a useful source of safe, screened blood, which can be transported to any part of the world within 24 hours.
It’s a formidable list but, as we say, a few precautions go a long way…
This disease is spread by flukes (minute worms) that are carried by a species of freshwater snail. The parasites penetrate human skin as people paddle or swim and then migrate to the bladder or bowel. Paddling or swimming in suspect freshwater lakes or slow-running rivers should be avoided. There may be no symptoms. However, there may be a transient fever and rash, and advanced cases may have blood in the stool or in the urine. A blood test can detect antibodies if you might have been exposed, and treatment is then possible in specialist travel or infectious-disease clinics. If not treated, the infection can cause kidney failure or permanent bowel damage.
Cholera is usually only a problem during natural or other disasters – eg floods, earthquakes or war – although small outbreaks can also occur at other times. Travellers are rarely affected, although there was an outbreak in a Nairobi conference hotel when we were in town. The disease is caused by a bacterium and spread via contaminated drinking water. The main symptom is profuse watery diarrhoea, which causes debilitation if fluids are not replaced quickly. Most cases of cholera can be avoided by drinking only clean water and by avoiding potentially contaminated food. Treatment is by fluid replacement (orally or via a drip), but sometimes antibiotics are needed. Self-treatment is not advised.
Found in all of Africa, diphtheria is spread through close respiratory contact. It usually causes a high temperature and a severe sore throat. A membrane can form across the throat, requiring a tracheotomy to prevent suffocation. Vaccination is recommended for those likely to be in close contact with the locals in infected areas. This is more important for long stays than for short-term trips. The vaccine is given as an injection alone or with tetanus, and lasts 10 years.
Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, it can cause prolonged lethargy. If you’re recovering from hepatitis A, you shouldn’t drink alcohol for up to six months afterwards, but once you’ve recovered, there won’t be any long-term problems. The first symptoms include dark urine and a yellow colour to the whites of the eyes. Sometimes a fever and abdominal pain might be present. Hepatitis A vaccine (Avaxim, Vaqta, Havrix) is given as an injection: a single dose will give protection for up to a year, and a booster after a year gives 10-year protection. Hepatitis A and typhoid vaccines can also be given as a single-dose vaccine, with 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. Hepatitis B affects the liver, which causes jaundice and occasionally liver failure. Most people recover completely, but some people 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. Many countries now give hepatitis B as part of routine childhood vaccinations. It is given singly or can be given at the same time as hepatitis A (hepatyrix).
A course will give protection for at least five years. It can be given over four weeks or six months.
Human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), is an enormous problem in Kenya, where the infection rate is around 6.1% of the adult population. The virus is spread through infected blood and blood products, by sexual intercourse with an infected partner, and from an infected mother to her baby during childbirth or breastfeeding. It can be spread through ‘blood to blood’ contacts, such as with contaminated instruments during medical, dental, acupuncture and other body-piercing procedures, and through sharing intravenous needles. If you think you might have been exposed to HIV, a blood test is necessary; a three-month gap after exposure and before testing is required to allow antibodies to appear in the blood.
Malaria is a major health scourge in Kenya. Infection rates vary with the season (higher in the rainy season) and climate, so check out the situation before departure. The incidence of malarial transmission at altitudes higher than 2000m is rare.
Malaria is caused by a parasite in the bloodstream spread via the bite of the female anopheles mosquito. There are several types, falciparum malaria being the most dangerous and the predominant form in Kenya. Unlike most other diseases regularly encountered by travellers, there is no vaccination against malaria (yet). However, several different drugs are used to prevent malaria and new ones are in the pipeline. Up-to-date advice from a travel-health clinic is essential, as some medication is more suitable for some travellers than others. The pattern of drug-resistant malaria is changing rapidly, so what was advised several years ago might no longer be the case.
The 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 a mosquito spray or coils; sleep under a permethrin-impregnated net at night. Cover up at night with long trousers and long sleeves, preferably with permethrin-treated clothing. Apply appropriate repellent to all areas of exposed skin in the evenings.
C – Chemical prevention (ie antimalarial drugs) is usually needed in malaria-infected areas. Expert advice is needed as the resistance patterns of the parasite can change, and new drugs are in development. Not all antimalarial drugs are suitable for everyone. Most antimalarial drugs need to be started at least a week in advance and continued for four weeks after the last possible exposure to malaria.
D – Diagnosis. If you have a fever or flu-like illness within a year of travel to a malaria-infected area, malaria is a possibility, and immediate medical attention is necessary.
Malaria can affect people in several ways. Anyone who develops a fever while in a malarial area should assume malarial infection until a blood test proves negative, even if you’ve been taking antimalarial medication.
- The early stages include headaches, fevers, generalised aches and pains, and malaise, often mistaken for flu. Other symptoms can include abdominal pain, diarrhoea and a cough.
- If not treated, the next stage can develop within 24 hours, particularly if falciparum malaria is the parasite: jaundice, reduced consciousness and coma (known as cerebral malaria), followed by death.
- Treatment in hospital is essential, and if patients enter the late stage of the disease the death rate may 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 being taken. These side effects are not universal, and can be minimised by taking medication correctly, such as with food.
- Doxycycline can cause heartburn, sunburn and indigestion.
- Mefloquine (Larium) can cause anxiety attacks, insomnia and nightmares, and (rarely) severe psychiatric disorders.
- Chloroquine can cause nausea and hair loss.
- Proguanil can cause mouth ulcers.
If you decide that you really do not wish to take 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.
Some people advocate homeopathic preparations against malaria, such as Demal200, but as yet there is no conclusive evidence that this is effective, and many homeopaths do not recommend their use.
Some people should not take a particular antimalarial drug; eg people with epilepsy should avoid mefloquine, and doxycycline should not be taken by pregnant women or children younger than 12 years. Malaria in pregnancy frequently results in miscarriage or premature labour and the risks to both mother and foetus during pregnancy are considerable. Travel in Kenya when pregnant should be carefully considered.
If you’re going to be in remote areas or far from major towns, consider carrying with you a stand-by treatment. Emergency stand-by treatments should be seen as emergency treatment aimed at saving the patient’s life and not as a routine way of self-medicating. It should be used only if you will be far from medical facilities and have been advised about the symptoms of malaria and how to use the medication. Medical advice should be sought as soon as possible to confirm whether the treatment has been successful.
The type of stand-by treatment used will depend on local conditions, such as drug resistance, and on what antimalarial drugs were being used before stand-by treatment. This is worthwhile because you want to avoid contracting a particularly serious form, such as cerebral malaria, which can be fatal within 24 hours. Self-diagnostic kits, which can identify malaria in the blood from a finger prick, are also available in the West.
Dengue Fever (Break-Bone Fever)
Dengue fever, spread through the bite of mosquitoes, causes a feverish illness with headache and muscle pains similar to those experienced with a bad, prolonged attack of influenza. There might be a rash. Mosquito bites should be avoided whenever possible. This disease is present in Kenya. Self-treatment consists of paracetamol and rest.
Meningococcal infection is spread through close respiratory contact and is more likely to be contracted in crowded situations, such as dormitories, buses and clubs. Infection is uncommon in travellers. Vaccination is recommended for long stays and is especially important towards the end of the dry season. Symptoms include a 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 the bites or licks of an infected animal on broken skin. It is always fatal once the clinical symptoms start (which might be up to several months after an infected bite), so post-bite vaccination should be taken as soon as possible. Post-bite 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 post-bite vaccine is not available within 24 hours. To prevent the disease, three injections are needed over a month. If you have not been vaccinated and receive a bite, you will need a course of five injections starting 24 hours or as soon as possible after the injury. If you have been vaccinated, you will need fewer post-bite injections, and have more time to seek medical help.
Rift Valley Fever
This fever is spread occasionally via mosquito bites and is rarely fatal. The symptoms are a fever and flu-like illness.
This illness is spread through handling food or drinking water that has been contaminated by infected human faeces. The first symptom of infection is usually a fever or a pink rash on the abdomen. Sometimes septicaemia (blood poisoning) can also 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.
You should carry a certificate as evidence of vaccination against yellow fever if you’ve recently been in an infected country, to avoid immigration problems. For a full list of countries where yellow fever exists, visit the website of the World Health Organization (www.who.int) or the Centers for Disease Control & Prevention (www.cdc.gov/travel/blusheet.htm). A traveller without a legally required up-to-date certificate could possibly be vaccinated and detained in isolation at the port of arrival for up to 10 days, or even repatriated.
Yellow fever is spread by infected mosquitoes. Symptoms range from a flu-like illness to severe hepatitis (liver inflammation), jaundice and death. Vaccination must be given at a designated clinic and is valid for 10 years. It’s a live vaccine and must not be given to immunocompromised people or pregnant women. For visitors to Kenya, vaccination is not mandatory (unless you're arriving from a country where yellow fever is present, such as Tanzania and Uganda) but is strongly recommended.
Never drink tap water unless it has been boiled, filtered or chemically disinfected (such as with iodine tablets). Never drink from streams, rivers and lakes. It’s also best to avoid drinking from pumps and wells – some do bring pure water to the surface, but the presence of animals can still contaminate supplies.
Although it’s not inevitable that you will get diarrhoea while travelling in Kenya, it’s certainly possible. Diarrhoea is the most common travel-related illness, and sometimes simply dietary changes, such as increased spices or oils, are the cause.
Prevention To help prevent diarrhoea, avoid tap water. You should also 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 safe, plates or serving utensils might be dirty, so be highly selective when eating food from street vendors (ensure that cooked food is piping hot right through).
Treatment If you develop diarrhoea, drink plenty of fluids, preferably an oral rehydration solution containing water (lots), 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 (eg 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 abdominal pain, seek medical attention.
Contracted by eating 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).
Giardiasis, like amoebic dysentery, is caused by contaminated food or water. The illness usually appears a week or more after exposure to the parasite. It might cause only a short-lived bout of typical traveller's diarrhoea, but may cause persistent diarrhoea. Ideally, seek medical advice if you suspect you have giardiasis, but if you are in a remote area you could start a course of antibiotics.
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: fluid replacement with water and/or fruit juice, and cooling by cold water and fans. The treatment of the salt-loss component consists of consuming salty fluids such as soup, and adding a little more salt to foods than usual.
Heat exhaustion is a precursor to the much more serious condition of heatstroke. In this case there is damage to the sweating mechanism, with an excessive rise in body temperature; irrational and hyperactive behaviour; and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is ideal. Emergency fluid and electrolyte replacement is usually also required by intravenous drip.
Insect Bites & Stings
Mosquitoes might not always carry malaria or dengue fever, but they (and other insects) can cause irritation and infected bites. Use DEET-based insect repellents, which are also effective against sand flies.
Scorpions are frequently found in arid or dry climates. They can cause a painful bite that is sometimes life-threatening. If you are bitten by a scorpion, seek immediate medical assistance.
Basically, avoid getting bitten! Don’t walk barefoot, and don’t stick your hand into holes or cracks. However, 50% of those bitten by venomous snakes are not actually injected with poison (envenomed). If bitten, 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 antivenene can be given if needed. It will also help if you are able to provide doctors with a detailed description of the snake so that they can identify the species and treat you correctly.