Africa South of Sahara

Madagascar

Madagascar is a developing island nation off the east coast of Africa. The primary language is French. Antananarivo, the capital, enjoys a temperate climate, but the island has a wide range of microclimates ranging from rain forests in the northeast to desert in the southwest. Facilities for tourism are available, but they vary in quality.

CRIME: The major concerns for visitors to Antananarivo are street crime and theft from residences and vehicles. Although not generally violent, incidents involving violence by assailants, particularly when the victim resists, are on the rise.

MEDICAL FACILITIES: There are foreign physicians in Antananarivo representing a broad range of specialties. The hospital infrastructure, however, is minimal and does not meet basic sanitary norms. A Seventh Day Adventist dental clinic offers emergency procedures and is similar to western facilities in both procedures and cleanliness. There are also competent laboratory and X-ray facilities.

More than 25 mill. people are infected by HIV in the subsaharian Africa.

Arthropodborne diseases are a great problem in this region af Africa.

We recommend:

• Usage of long-sleeved shirt and long pants to wear whenever possible while outside, to prevent illnesses carried by insects
• Usage of insect repellent containing DEET (diethylmethyltoluamide), in 30%–35% strength for adults and 6%–10% for children. Unless you are staying in air-conditioned or well-screened housing
• Usage of a bed net impregnated with the insecticide permethrin.
• Staying and sleeping in air-conditioned houses

Arthropod borne diseases:

• Malaria
• Filariasis
• Leishamaniasis
• Relapsing fever
• Epidemic typhusr

Water- and foodborne diseases:

• Cholera
• Amoebiasis
• Hepatitis A
• Hepatitis E
• Typhoid fever
• Giardiasis
• ETEC E.coli

Other diseases:

• Hepatitis B
• Trachoma
• HIV
• Poliomyelitis
• Schistosomiasis (Bilharziasis)
• Meningitis

Vaccinations recommended:

• Yellow fever when entering from a yellow fever endemic region
• Hepatitis A or Immune Globulin (IG)
• Hepatitis B or Immune Globulin
• Meningitis
• Typhoid fever - vaccination is particularly important because of the presence of S. typhi strains resistant to multiple antibiotics in this region
• Rabies - if risk for contact with wild or domestic animals
• A booster for tetanus/diphtheria - if not covered which indicates not vaccinated within th last 10 years.

Stay healthy:

• Wash hands often with soap and water;
• Drink only boiled water, or water and carbonated (bubbly) drinks in cans;
• Avoid tap water, fountain drinks, and ice cubes;
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it;
• Protect yourself from insects by remaining in well-screened areas, using repellents (applied sparingly at 4-hour intervals) and permethrin-impregnated mosquito nets, and wearing long-sleeved shirts and long pants from dusk through dawn;
• Prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot;
• Do not travel at night;
• Trafic accidents are frequent, be careful;
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases;
• Don't eat food purchased from street vendors;
• Use mefloquine as malaria prophylaxis.(Chloroquine resistance)

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