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Madagascar Travel and Destination Guide
HEALTH
Local Health Conditions
Malaria
Malaria is present throughout Madagascar, particularly in the coastal areas; it is less common in the central highlands and Antananarivo, but outbreaks can occur. 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, falciparum malaria being the most dangerous type. Infection rates vary with the seasons and climate, so check out the situation before departure. 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 early stages of malaria 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 in a malarial area should assume malarial infection until a blood test proves 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, and the death rate might still be as high as 10% even in the best intensive-care facilities.
Many travellers are under the impression that malaria is a mild illness, and that taking antimalarial drugs causes more illness through side effects than actually getting malaria. This is unfortunately not true. 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.
Schistosomiasis (bilharzia)
This disease is spread by flukes (minute worms) that are carried by a species of freshwater snail. The flukes are found inside the snail, which then sheds them into slow-moving or still water. The parasites penetrate human skin during paddling or swimming and then migrate to the bladder or bowel. They are passed out via stool or urine and could contaminate fresh water, where the cycle starts again. Paddling or swimming in suspect freshwater lakes or slow-running rivers should be avoided. There might be no symptoms. There might be a transient fever and rash, and advanced cases might have blood in the stool or in the urine. A blood test can detect antibodies if you suspect you 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. It is not possible for you to infect others. Self-treatment: none.
Hepatitis
Several different viruses cause hepatitis; they differ in the way that they are transmitted. The symptoms in all forms of the illness include fever, chills, headache, fatigue, feelings of weakness and aches and pains, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured faeces, jaundiced (yellow) skin and yellowing of the whites of the eyes.
There are 6 known types of viral hepatitis:A, B, C, D, E and G. G is not dangerous. A and E are passed on by the fecal-oral route of transmission; there is a vaccine. Seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods. A and E cause an acute illness, but you will recover fully from it.
B and D are passed on via blood, saliva, semen and vaginal fluids. They can be passed on by close contact, sexual contact, and blood-to-blood contact. The symptoms of hepatitis B may be more severe than type A and the disease can lead to long-term problems such as chronic liver damage, liver cancer or a long-term carrier state. There is a vaccine.
Hepatitis C is only passed on from blood-to-blood contact. There is no vaccine.
Meningococcal Meningitis
Meningococcal infection is spread through close respiratory contact and is more likely 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 to the region. 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. Self-treatment: none.
Dengue Fever
Dengue fever is spread through mosquito bites. It 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. Self-treatment: paracetamol and rest.
Diarrhoea
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, 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 you should be highly 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 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, 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.
Dangers and Annoyances
Travelling around Madagascar is not inherently dangerous - there isn't a single venomous snake on any of the islands. There is no reason for you to be overly concerned about your personal safety. However, as when travelling anywhere in the world, some common-sense precautions are always warranted.
Some areas along the Malagasy coastlines are subject to danger from sharks and strong currents. Make sure to seek local advice before heading into the water. To avoid stepping on sea urchins or nibbling crabs always wear shoes when walking on the beach or swimming in the water.
In rainforests watch for leeches in muddy areas or during the rainy season. Wear your socks over your trousers (OK, we know how freaking dorky that sounds, but it does work), apply insect repellent, and carry salt to remove any leeches that do get in. Mosquitoes are also ubiquitous - wear insect repellent, especially at dawn and dusk.
If you've travelled in other parts of Africa you will be shocked at how safe Madagascar feels. Pick-pocketing and snatch-and-grab robberies are the most frequent crimes. You can usually avoid any trouble by dressing down (leave the diamonds at home), walking confidently and carrying as few valuables as possible.
A combination of packed and unroadworthy vehicles, reckless drivers and poor-quality roads makes taxi-brousse (bush taxi) travel in Madagascar, and to a lesser extent the Comoros, fairly hazardous. To minimise the risks, try to avoid night travel if possible.
Be wary of organising trips with someone you met at the airport on arrival in Madagascar. It's always best to wait and get a recommendation from your hotel or other travellers first. While most official guides are very competent and well trained, some guides are reluctant to do the full circuit they've been paid for, while others ask for higher fees than those set by the park.
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