Malaria is everywhere and prophylaxis is not optional. Medical facilities outside Dar es Salaam are limited, so evacuation cover is the part of the insurance that matters.
- Malaria is present across almost all of Tanzania, Zanzibar and the parks included, below about 1,800 metres. Take prophylaxis prescribed by a travel clinic, and avoid bites as well.
- Any fever within a year of coming home is malaria until a test says otherwise. Tell the doctor where you have been.
- Allow 6 to 8 weeks for a travel clinic: yellow fever, hepatitis A and typhoid are the usual list, with rabies worth discussing for remote travel.
- Insurance must cover medical evacuation. In the parks there is nothing, the plan for anything serious is a flight out, and AMREF Flying Doctors membership is cheap and widely used.
- On Kilimanjaro, choose a route of 7 days or more. The 5-day Marangu has the worst summit success and the worst safety record, and descent is the only cure for altitude sickness.
Malaria
Take this seriously. It is the single most important health decision of the trip.
- Malaria is present across almost all of Tanzania, including Zanzibar and the safari parks, at altitudes below about 1,800 metres.
- Take prophylaxis, prescribed by a travel clinic. Which one depends on your trip and your health, so ask 6 to 8 weeks before you go.
- Prophylaxis is not complete protection. Bite avoidance is the other half: repellent with DEET, long sleeves and trousers after dusk, a net over the bed, and permethrin-treated clothing if you are camping.
- The mosquito that carries malaria bites from dusk to dawn. The daytime ones carry dengue instead.
- Any fever within a year of coming home is malaria until a test says otherwise. Tell the doctor where you have been.
Before you go
- Yellow fever vaccination is required if you are arriving from a risk country and recommended more widely.
- Hepatitis A and typhoid are routine recommendations, and rabies is worth discussing if you are going remote.
- Check tetanus, polio and MMR are current.
- Allow 6 to 8 weeks for a travel clinic appointment and the course to take effect.
Medical care and insurance
- Facilities are limited, especially outside Dar es Salaam. Aga Khan and the Nairobi hospitals are the regional standard.
- Arusha has adequate private clinics for ordinary problems.
- In the parks there is nothing. The plan for anything serious is a flight out.
- Insurance must cover medical evacuation. AMREF Flying Doctors membership is cheap, widely used in East Africa and worth buying on top of a normal policy.
- You pay first and claim later almost everywhere. Keep every receipt.
Kilimanjaro
- Altitude sickness is the reason people fail on Kilimanjaro, and occasionally the reason they die.
- Choose a route of 7 days or more. The 5-day Marangu has the worst summit success rate and the worst safety record, for exactly this reason.
- Ascend slowly, drink constantly, and tell your guide the truth about headaches and nausea.
- Diamox is worth discussing with a doctor before you go.
- Descent is the only cure. A good operator carries oxygen and a stretcher and will turn you around; a cheap one may not.
Food, water and the sun
- Do not drink tap water. Bottled or filtered only, and be careful with ice outside good hotels.
- Peel it, boil it, or leave it for fruit and salad away from established places.
- Stomach upsets are near universal. Carry rehydration salts and something to stop it for a travel day.
- The equatorial sun is brutal, on the plains and on the water alike. High-factor sunscreen, a hat, and long sleeves in the middle of the day.
- Bilharzia is present in lakes including parts of Lake Victoria and Lake Tanganyika. Ask locally before swimming; the sea and chlorinated pools are fine.
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