Health, vaccinations and medical care in Madagascar

The number

• 117 from a mobile, 17 from a landline, and ask for an ambulance.
• Call your insurer as soon as you are referred to a medical facility, before treatment starts.

What the hospitals can and cannot do

• There are public and private hospitals in Antananarivo, but they can only handle routine operations.
• For complex surgery, patients are flown to Mauritius, South Africa or Reunion. That is the sentence that sets your insurance requirement: cover for treatment, evacuation and repatriation, with accessible funds, not a policy that reimburses you in six weeks.
• The FCDO publishes a list of medical providers in Madagascar with English-speaking staff. Find it before you need it.

Malaria, which is the main one

• NaTHNaC assesses Madagascar as high risk for malaria, and recommends atovaquone/proguanil, or doxycycline, or mefloquine.
• Bites happen between dusk and dawn. Cover up, use repellent, and sleep under a net.
• A fever of 38 C or more more than a week after being in a malaria area, or any malaria-like symptom within a year of getting home, is an emergency. Say where you have been.

The rest of the list

• Dengue and chikungunya are both present, spread by mosquitoes that bite in daylight, so bite avoidance is an all-day job here rather than an evening one.
• Schistosomiasis is a risk: do not wade, swim or bathe in fresh water. Sea water and properly chlorinated pools are fine.
• Rabies is present in domestic animals. Avoid contact with animals, and treat any bite, scratch or lick on broken skin as urgent.
• Measles risk is higher than in the UK. Check your MMR is complete.
• Hepatitis B prevalence is intermediate to high.
• An mpox clade I outbreak is ongoing in the region and is flagged on the country's TravelHealthPro page.
• Altitude illness is a risk in parts of the country. Antananarivo sits high, and the highland routes go higher.

Water and everyday risks

• Tap water is unsafe. Drink boiled or bottled water and avoid ice in drinks.
• Syphilis levels are high and STI risk is correspondingly higher than at home.
• Check vaccine recommendations at least 8 weeks before you travel, and remember the yellow fever certificate is an entry requirement, not only medical advice, if you are arriving from a transmission-risk country.