Health


This section should not be considered comprehensive, and is not intended to replace consultation with a qualified doctor.

When travelling to any foreign country, it's important to check all the latest health-safety information pertaining to your destination. It is HIGHLY advisable to speak to your General Practitioner about any individual or family history risks that may affect your travel (e.g. heart conditions, diabetes, etc.) and to assess the availability and legality of medications abroad.

It is obligatory that you obtain comprehensive travel and medical insurance covering medical evacuation before travelling. You should check for any gaps or situations that are not covered in your policy and be sure that these are not activities you’ll by undertaking while abroad. Healthcare standards, particularly in the rural areas, are generally poor in Malawi.

The country also has a very high HIV/AIDS infection rate. Unprotected sex carries an increased risk of sexually transmitted infections including HIV. Carry condoms with you if there is any possibility you may be sexually active while abroad. If working in a health care setting, or anywhere where there is a risk of exposure to blood or blood products, consider carrying post-exposure prophylaxis for HIV infection - antiretroviral drugs taken after contact with HIV infection that can reduce the chance of becoming HIV positive.

Please refer to Fit For Travel, a service run by the British NHS, for more current information.

DISEASES THAT CAN BE PICKED UP

There are many diseases, prevalent in Malawi, that a traveller should be aware of and take precautions against:

  • Malaria - from mosquitoes bites
  • Salmonella - from food
  • E coli - from food and drinks
  • Hookworm - via skin, bare feet
  • Bilharzia/Schistosomiasis - water-borne, via skin
  • Katayama - fatal form of Bilharzia/Schistosomiasis
  • Cholera - water, and foods washed in infected water
  • Typhoid - from food and water
  • Rabies - from animal bites
  • Hepatitis - A, B, C, E
  • Other worms from undercooked meat

COMMON SENSE

The list above is not exhaustive, and the travelers should exercise common sense to avoid becoming ill or injured while in Malawi. Simple procedures that can keep you healthy are:

  • Avoid putting hands near mouth, eyes and nose. Many diseases are contagious (picked up through touch). These areas above all have, what are termed, mucous membranes, and diseases can pass through these more easily than skin.
  • Use alcohol gel frequently, especially after shaking hands, visiting lavatories, touching door handles, before eating etc. It’s very cheap and can be bought readily in any pharmacy or supermarket.
  • Wear flipflops. Intestinal worms have a variety of ways of being picked up, including via soles of feet. Don't walk in bare feet, and wear flipflops in showers.
  • Avoid insect bites by covering up, especially at night. Many flying insects require blood to reproduce. As they attempt to suck blood, they inject an anti-coagulant in their saliva that prevents the host's blood from clotting. The parasites that cause malaria and other such diseases are to be found in their saliva. Keep covered, especially around dusk. Wear socks and long trousers in the evening. You can also be bitten around the head without realizing.
  • Iron your clothes. Don't put on clothes that have been left to dry, without ironing first, as the tumbu fly lays its eggs on wet cloth and the larvae can burrow under the skin.
  • Stay away from animals. Dogs, cats, monkeys can be carriers of rabies, and other diseases. Hippos, crocodiles must be avoided if near Lake Malawi as they are extremely dangerous.

IMMUNIZATIONS

All routine vaccinations should be up-to-date before you travel - it is essential check with your General Practitioner (GP) or a travel clinic, as well as the organisations you'll be involved with in Malawi, to determine the medical treatment necessary in the specific location of your travels.

The following recommendations outline some of the vaccines you may have to have.

Immunisations against Polio, Tetanus, Diphtheria, Typhoid, Hepatitis A and Rabies are recommended for all travel to Malawi for whatever length of time.

Vaccines for Tuberculosis, Cholera, Hepatitis B, and Meningococcal meningitis are often advised for those visiting for longer than one month, or travelling to remote locations.

Tuberculosis is most commonly transmitted via droplet infection (sneezing or coughing). Immunisation is recommended for all volunteers who will be living in rural communities. Most UK citizens will have received the BCG immunization as children, but make sure to confirm this.

Cholera is spread through contaminated food and water, and is more common in floods and rainy seasons. Vaccination is recommended for volunteers who may be unable to take precautions (e.g. working in remote areas or in refugee camps).

Hepatitis B is a highly infectious virus and transmission often occurs without any obvious route of infection. Blood-to-blood contact, infected needles or sexual transmission carry a high risk of transmission, and it can lead to jaundice and liver failure. All travellers staying for a month or more or working with children or in health care should be immunized

Rabies is endemic in most African countries. The rabies virus is transmitted through the saliva of infected animals and transmitted to humans through bites, scratches or contact of saliva with broken skin and is always fatal once symptoms commence. It is recommended to get vaccinated before departure for all travellers, as treatment and prevention are more complicated without it. All travellers who have possibly been exposed to the rabies virus, whether by bites, scratches or other exposure, should seek medical advice without delay (even if pre-exposure vaccine was received). This also applies to travellers in low risk areas in case other animal-transmitted infections are present, or the animal may have strayed across the border from an endemic country. Those who have already had a rabies course before departure should have two further doses of rabies vaccine. This is a belt and braces policy to further reduce the risk of rabies because it is always fatal once it enters the nervous system. Prevention for those not previously vaccinated is more complex and difficult to obtain in many developing countries. Those going to high risk areas that are remote from medical care should seek vaccination before departure.

Some vaccinations are administered over an extended period of time (from one to three months) because they have several doses and therefore it is worth planning your immunizations enough in advance before your departure.

MALARIA

Malaria is widespread in Malawi and present all year long. You should seek advice about suitable anti-malarial tablets before travelling. Speak to your travel clinic, general practitioner, or coordinating volunteer organisation about which anti-malarial treatments are suitable to you and possible reimbursement of cost from your organisation.

Malaria can still occur despite appropriate prevention, and therefore you should promptly seek medical care in the event of a fever or flu-like illness in the first year following your return from travelling to a malaria risk country.

The best procedures for avoiding infection are:

  • Taking malarial propholaxis (anti-malarials) prior to, during and after your visit: There are a number of malarial propholaxis: Larium, Doxycycline and Malarone, all have some side-effects. Your practice nurse should be able to advise on the most up to date requirements, and the cost. Take extra tablets with you in case you are sick i.e. vomiting, and lose protection for even a day. Ensure that they are taken at the prescribed time, roughly at the same time every day, if they are to be taken daily. Continue to take them on your return; you must finish the course. It may seem you have not been bitten, but you could have been. Not everyone reacts to the insect's saliva in the same way; some develop large red spots, some have no reaction at all. The incubation period for some diseases can be several weeks, so you won't know you've been infected until as much as eight weeks after the event. If you have been sick, and have vomited, you may have lost some or all of the potency of the anti-malarial. Ask the pharmacist to advise on this i.e. taking a second dose in a single day.
  • Keep covered, especially towards dusk.
  • Sleep under treated mosquito nets when possible
  • Take a good insect repellent, preferably with DEET.

YELLOW FEVER

A yellow fever vaccination certificate is required from travellers coming from areas with risk of yellow fever transmission and for travellers having transited more than 12 hours through the airport of a country with risk of yellow fever transmission.

Click here to print out a copy of the letter to show airport staff that the Government of Malawi which recognises you do not need a yellow fever certificate unless you are coming from areas with risk of yellow fever transmission or having transited more than 12 hours through the airport of a country with risk of yellow fever transmission.


TRAVEL CLINICS
MASTA is a network of 51 travel clinics in the UK. Some of the clinics in Scotland include:

Ark Occupational Health
213 George Street
Aberdeen
AB25 1HY

Davidsons Mains Medical Centre
5 Quality Street
Edinburgh
EH4 5BP

Other travel clinics:
Adventure & Tourism Travel Clinic 
TrExMed Travel Clinic Edinburgh 
Health Link 360 
The Travel Clinic (Glasgow) 4 Arran Court, Glasgow Airport, PA3 2ST
The Travel Clinic (Ayrshire) Ayrshire Central Hospital, Irvine, Ayrshire

SWIMMING
Health experts strongly advise against any skin contact with fresh water in Malawi e.g. ponds, lakes and rivers. Swim only in protected chlorinated swimming pools, not Lake Malawi. Avoid drinking infected water. Wear protective footwear when walking in soil, especially if it is damp or water logged. Water for washing can be treated by heating water to 50 degrees C for five minutes or leaving to stand for 48 hours.

If travellers are concerned that they may have been exposed to bilharzia (schistosomiasis), they should seek medical help on their return. Those who have been knowingly exposed can be screened by having a blood test after return but if there are no symptoms this should be delayed for 6 weeks after the last possible exposure so as to allow the time for the development of antibodies.

For more current information on any of the above, please refer to Fit For Travel a service run by the British NHS.

FOOD AND WATER

Be wary of water. Tap water may be untreated, especially outside the city, so only used bottled water for drinking and brushing teeth. Some water sources for washing hands in certain buildings may also not be treated, so it's best to use alcohol gel after washing.

Be careful of what and where you eat. Beware of roadside food stalls (even if the food is safe the implements such as skewers may not be), and food provided by cheap lodges ($5/night). Outbreaks of gastro-intestinal infections and cholera occur (spread through contaminated food or water), especially during the rainy season (December to March). Typhoid and Hepatitis A are spread through contaminated food and water. Avoid salads, rice, uncooked produce, as we are unsure of where they have come from. Some grow produce in untreated sewage. Don't eat pre-peeled fruits. Unpeeled fruits will also harbor bacteria, so care must be taken when peeling, to prevent transferring the organisms from the skin into the flesh. If fruits could be blanched in boiling water for 20 seconds, most pathogenic organisms would be killed.

IF YOU ARE ILL

If your do find yourself ill, you should make note of:

  • What you have eaten from the day before
  • When you ate
  • Was there anything unusual - taste, smell, texture, animals, insects present 
  • Were you bitten, did you touch any animals
  • Are any others complaining of the same symptoms
  • Onset of symptoms - how long after you ate did you feel unwell
  • What are the symptoms
  • Drink plenty of fluids; sweet drinks like coke and orange juice are high in sugar and will provide energy. A pinch of salt will also provide you with the necessary salt you may lose in sweat. You need to keep hydrated.
  • Take Imodium/Boots version, paracetamol, bandages, mosquito net, alcohol gel, Diarrholyte, a safari pack if one is available.
  • Blood transfusion packs can also be bought.