Health & insurance
As long as you stay up to date with your vaccinations and take some basic preventive measures, you’d have to be pretty unlucky to succumb to any serious health hazards while in Madagascar.
Before You Go
Get a check-up with your dentist and your doctor six to eight weeks before coming to Madagascar to ensure you are up to date with immunisations, to discuss malaria prophylaxis, and to make sure tooth decay won’t turn into an abscess while you’re away.
Find out in advance whether your insurance plan will make payments directly to providers or will reimburse you later for overseas health expenditures (most medical facilities and doctors in Madagascar expect payment upfront).
It’s vital to ensure that your travel insurance will cover the emergency transport required to get you to a good hospital – in South Africa or Réunion, or all the way home – by air and with a medical attendant if necessary. Not all insurance plans cover this, so check the contract carefully.
It’s a good idea to carry a medical and first-aid kit with you. Following is a list of items you should consider packing. Contact lens wearers should also make sure they have spares and plenty of lens solution.
- Adhesive or paper tape
- Antibacterial ointment for cuts and abrasions
- Antibiotics (if travelling off the beaten track)
- Antidiarrhoeal drugs (eg loperamide)
- Antihistamines (for hay fever and allergic reactions)
- Anti-inflammatory drugs (eg ibuprofen)
- Antimalaria pills
- Bandages, gauze and gauze rolls
- Insect repellent for the skin
- Insect spray for clothing, tents and bed nets
- Iodine tablets (for water purification)
- Oral rehydration salts
- Paracetamol (acetaminophen) or aspirin
- Scissors, tweezers and safety pins
- Steroid cream or hydrocortisone cream (for rashes)
- Sunblock (very difficult to find in Madagascar)
- Syringes and sterile needles (if travelling off the beaten track)
- Tampons (hard to find outside of the capital)
It’s a good idea to consult your government’s travel health website before departure, if one is available. The following websites can help:
United Kingdom (www.fitfortravel.nhs.uk)
United States (www.cdc.gov/travel)
World Health Organisation (WHO) (www.who.int)
The World Health Organization (www.who.int) recommends the following vaccinations as routine (many are administered as part of standard childhood immunisation programs in developed countries, but adults may need a booster):
- BCG (tuberculosis)
- Diphtheria, tetanus and pertussis (DTP)
- Haemophilus influenzae type b (HIB) – this is the leading cause of bacterial meningitis
- Hepatitis B
- Measles, mumps and rubella (MMR)
- Pneumococcal disease
Madagascar had a very serious measles epidemic in 2018–19; vaccination is therefore highly advisable.
Vaccinations for the following are also recommended for Madagascar:
- Hepatitis A
Rabies is endemic in Madagascar, but vaccination is only recommended for visitors who will be spending extensive periods of time in remote areas.
Many vaccines don’t ensure immunity until two weeks after they are given, so visit a doctor four to eight weeks before departure.
Ask your doctor for an International Certificate of Vaccination or Prophylaxis (otherwise known as ICVP or ‘the yellow card’), listing all the vaccinations you’ve received.
Availability & Cost of Health Care
Pharmacies For minor problems such as cuts, bites, upset stomachs or colds, pharmacies should be your first port of call in Madagascar. Pharmacists are, on the whole, well trained. Pharmacies are clean and well stocked, and there is an efficient on-call rotation in most towns and cities (generally displayed in the window). Most drugs and bandages cost the same or a little less than in developed countries (generic drugs are used more widely).
Medical centres & hospitals For more serious conditions, you will need to go to a medical centre or a hospital. Public hospitals are, on the whole, poorly equipped and underfunded, but they are sometimes the only option available (note that patients often have to buy medicine, sterile dressings, intravenous fluids etc from the local pharmacy). There are good medical centres in touristy areas such as Nosy Be, and good private facilities in Antananarivo. For anything serious, however, you will need to be evacuated to Réunion (a French territory) or South Africa.
Dentists There are dentists across Madagascar, and their standard of care varies.
Health care standards vary a lot from one practitioner to another and from one hospital to the next: standards are pretty good in Antananarivo, but patchy outside the capital. If you find yourself in need of medical assistance, contact your embassy or consulate for a list of recommended practitioners or establishments in your area. Your insurance company may also have advice.
Despite the intimidating list of infectious diseases in Madagascar, most are extremely rare among travellers. However, if you do experience unusual symptoms for more than three days, seek medical advice.
Spread through Contaminated drinking water.
Symptoms & effects Profuse watery diarrhoea, which causes debilitation if fluids are not replaced quickly.
Prevention Cholera is usually only a problem during natural or artificial disasters, eg cyclones, war, floods or earthquakes. An oral cholera vaccine is available, but it is not particularly effective. Boil drinking water, or drink bottled water.
Spread through Mosquito bites.
Symptoms & effects Feverish illness with headache and muscle pains similar to those experienced with a bad, prolonged attack of influenza.
Prevention Avoid mosquito bites by covering up and wearing repellent during outbreaks. Seek medical advice if flu-like symptoms persist.
Spread through Close respiratory contact with an infected person.
Symptoms & effects A temperature and a severe sore throat. Sometimes a membrane forms across the throat, and a tracheotomy may be needed to prevent suffocation.
Prevention Vaccination (DTP) is recommended and lasts 10 years.
Spread through Contaminated food (particularly shellfish) and water.
Symptoms & effects Jaundice and prolonged lethargy. First symptoms include dark urine and a yellow colour to the whites of the eyes. Sometimes a fever and abdominal pain might be present.
Prevention Vaccination is available and recommended.
Spread through Infected blood, contaminated needles and sexual intercourse.
Symptoms & effects Jaundice and occasionally liver failure.
Prevention Vaccination is available and recommended.
Spread through Infected blood, contaminated needles and sexual intercourse.
Symptoms & effects Attacks the body’s immune system.
Prevention HIV prevalence in Madagascar is very low (0.2%, similar to Western European countries), so risk to travellers is minimal, but the same precautions apply here as at home: never have unprotected sex and make sure all hospital equipment is sterile.
Spread through Bite of the female Anopheles mosquito.
Symptoms & effects The early stages of malaria include headaches, fever, generalised aches and pains, and malaise, which could be mistaken for flu. Other symptoms can include abdominal pain, diarrhoea and a cough. If not treated, the disease can progress to jaundice, reduced consciousness and coma, followed by death.
Prevention Malaria is present throughout Madagascar, although the risks of contracting the disease are higher on the coast (particularly in the east) than in the highlands. It is recommended that all travellers take prophylaxis: there is a variety of drugs available nowadays, ranging in price, regime and secondary effects. Atovaquone/proguanil (Malarone), doxycycline and mefloquine (Lariam) seem to be the most commonly prescribed – discuss your options with a medical professional. It is essential you seek medical help if you suffer from a persistent high fever during your stay or in the six weeks afterwards, as hospital treatment is essential.
Spread through Bite from infected fleas carried by rodents, handling infected animals (rodents, rabbits and cats in particular), or inhaling droplets from coughs of infected individuals.
Symptoms & effects Pneumonic plague is the most common type of plague in Madagascar. Sufferers will experience shortness of breath, blood-stained sputum and, in the worst cases, septicaemia (blood poisoning) and respiratory failure.
Prevention Plague occurs in small but regular outbreaks in remote areas of Madagascar. There is no vaccine. Travellers are very unlikely to be affected, but as a precaution, never handle animals and use insect sprays to avoid flea bites.
Spread through Contaminated food and water.
Symptoms & effects Polio can be carried asymptomatically (ie showing no symptoms) and can cause a transient fever. In rare cases it causes weakness or paralysis of one or more muscles.
Prevention The vaccine is given in childhood and should be boosted every 10 years.
Spread through Bite or lick on broken skin by an infected animal.
Symptoms & effects Rabies causes acute encephalitis (inflammation of the brain). It is always fatal once the clinical symptoms start, which might be up to several months after an infected bite.
Prevention A preventive vaccine of three injections exists, which gives a person bitten by an infected animal more time to seek medical help. If you have not been vaccinated, you will need a course of five injections within 24 hours of being bitten.
Spread through Flukes (minute worms) that are carried by a species of freshwater snail; the snails shed the flukes in slow-moving or still water. The parasites penetrate human skin during paddling or swimming and migrate to the bladder/bowel.
Symptoms & effects Transient fever and rash, and blood in stools or urine. In chronic cases, schistosomiasis can cause bladder cancer or damage to the intestines.
Prevention Avoid paddling or swimming in suspect freshwater lakes or slow-running rivers. A blood test can detect antibodies if you suspect you have been exposed, and treatment back home is then possible in specialist travel or infectious-disease clinics.
Spread through Close respiratory contact and, occasionally, infected milk or milk products.
Symptoms & effects TB can be asymptomatic, only being picked up on a routine chest X-ray. Alternatively, it can cause a cough, weight loss or fever, sometimes months or even years after exposure.
Prevention The BCG vaccination is recommended for those mixing closely with locals, although it gives only moderate protection.
Spread through Food or water contaminated by infected human faeces.
Symptoms & effects Usually a fever or a pink rash on the abdomen. Sometimes septicaemia can occur.
Prevention A vaccine is available and gives protection for three years.
Spread through Inhaling droplets coughed or sneezed by an infected person; the disease is highly infectious.
Symptoms & effects Cold-like symptoms (runny nose, sneezing, coughing), sore or red eyes, high fever, blotchy rash that starts on the head or upper neck. Measles can lead to serious complications such as pneumonia or encephalitis.
Prevention A vaccine is available and offers lifelong protection.
Although it’s not inevitable that you will get diarrhoea while travelling in Madagascar, it’s certainly very likely. Diarrhoea is the most common travel-related illness: figures suggest that at least half of all travellers to Africa will get diarrhoea at some stage. Sometimes dietary changes, such as increased spices or oils, are the cause. To avoid diarrhoea, eat fresh fruits and vegetables only if they have been 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 you should be highly selective when eating food from street vendors (and make sure that cooked food is piping hot all the way through).
If you develop diarrhoea, drink plenty of fluids, preferably an oral rehydration solution containing lots of salt and sugar. A few loose stools don’t require treatment, but if you start having more than four or five loose stools a day for more than a couple of days, you could start taking an antibiotic (usually a quinoline drug, such as ciprofloxacin or norfloxacin). 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.
Causes Heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt.
Symptoms & effects Headache, dizziness and tiredness.
Prevention & treatment Aim to drink sufficient water to produce pale, diluted urine. To replace salt loss, drink oral rehydration fluids or plenty of savoury and sweet liquids (soup, fruit juice etc).
Causes Occurs when the body’s heat-regulating mechanism breaks down because of extreme heat, high humidity, dehydration and physical exertion.
Symptoms & effects An excessive rise in body temperature, irrational and hyperactive behaviour and, in the most serious cases, loss of consciousness.
Prevention & treatment Acclimatisation to different climate conditions is the best way to prevent heatstroke. Cool the person down with water and keep them in a cool, dark place. Treatment is similar to that for heat exhaustion, but emergency fluids (intravenous) may be needed for extreme cases.
Insect Bites & Stings
Causes Mosquitoes, fleas, scorpions, bedbugs and spiders.
Symptoms & effects Aside from the fact that some bugs can transmit diseases, insect bites or stings can cause irritation, infections, blisters and pain. Scorpion stings can be very nasty (fever is common), and sometimes fatal in people with heart conditions, so seek medical help if you’re stung.
Prevention & treatment Avoiding getting bitten or stung is obviously the best way to go: wear trousers and long sleeves in the evenings as well as insect repellent. Where sand bugs can be an issue, such as the 'mokafui' at Andilana Beach on Nosy Be, sunscreen with insect repellent is a good idea. In Ankarana, where scorpions are rife, don’t sit on large rocks or logs, and if you camp, check your shoes in the morning and take great care when folding your tent. Antihistamine or steroid creams can help relieve itching from the more benign bites. Painkillers can be effective in dealing with painful bites. If you have a severe allergy (anaphylaxis) to bee or wasp stings, carry an adrenaline injection or similar with you as you won’t find any outside of major cities.
Causes Leeches are a type of worm that feed on the blood of hot-blooded animals (humans included). They're found in hot, humid areas, all along the east coast and particularly in the northeast.
Symptoms & effects Leeches produce an anaesthetic when they bite so you won't feel anything. Bites bleed profusely, however, since leeches use an anticoagulant to get the blood flowing whilst they feed.
Prevention & treatment The best way to prevent being bitten is to cover up and use insect repellent. Leeches are extremely persistent and in some areas, getting bitten is virtually unavoidable. Don't worry if you do get bitten, and don't try to pull the leech off: it'll fall off after 20 to 30 minutes of feeding.
It is not safe to drink water from taps anywhere in Madagascar – including the most expensive hotels. Bottled water (Ar1800 to Ar4000) is available throughout the country. If you can get clear water from a tap or well, water-purifying tablets are a good option.
To save on plastic, consider investing in a portable water filter/steriliser such as SteriPen (about US$100) or LifeStraw (about US$30).
Avoid ice in drinks without first asking if it’s been made from filtered water.
Although Western medicine is available in larger cities and towns, fanafody (traditional medicine or herbal healing) plays an important role in Madagascar, particularly in rural areas where there are few alternatives. Ombiasy (healers) hold considerable social status.