It’s a formidable list but, a few precautions go a long way…
Malaria is a serious and sometimes fatal disease transmitted by mosquitoes. You cannot be vaccinated against malaria. Malaria risk exists throughout the year in the whole country. There is usually less risk in Nairobi and in the highlands (above 2500m/8200ft) of the Central, Eastern Nyanza, Rift Valley and Western Provinces. Mefloquine, doxycycline or malarone are the recommended prophylaxis.
Malaria precautions are essential in all areas, all year round. Malaria is the most major and common illness to be aware of. It is strongly advised that you take prophylaxis and other precautions to avoid being bitten. Anti-malarial tablets are readily available at all pharmacies. Injections are also available at all hospitals and clinics. Malaria is a major health scourge in Kenya. Infection rates vary with season (higher in the rainy season) and climate, so check out the situation before departure. Every traveller to Africa needs reliable, up to date advice on the risks at his or her own destination. The most suitable choice of medication depends on many individual factors, and travellers need careful, professional advice about the advantages and disadvantages of each option.
Whatever your choice, you must take an anti malarial drug if you are visiting a malarial region, and you must continue taking the drug for the necessary period after your return; you must also still take precautions to reduce the number of insect bites. Visitors to malarial areas are at much greater risk than local people and long term expatriates - from malaria as from several other diseases: do not change or discontinue your malaria medication other than on skilled professional advice. Travellers to very remote places should also consider taking stand-by malaria treatment, for use in an emergency.
Malaria is caused by a parasite in the bloodstream spread via the bite of the female anopheles mosquito. There are several types, falciparum malaria being the most dangerous and the predominant form in Kenya. Unlike most other diseases regularly encountered by travellers, there is no vaccination against malaria (yet). However, 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 pattern of drug-resistant malaria is changing rapidly, so what was advised several years ago might no longer be the case.
Malaria prevention is very important and requires use of medication. As a precautionary measure it is usually advised to take anti-malarial drugs before, during and after your visit. Check with your doctor or nurse about suitable antimalarial tablets. Atovaquone/proguanil OR doxycycline OR mefloquine is usually recommended. If travelling to high risk malarious areas, remote from medical facilities, carrying emergency malaria standby treatment may be considered.
To prevent malaria and other travel-related illnesses it is advisable to do the following:
Visit your health care provider 4-6 weeks before foreign travel for any necessary vaccinations and a prescription for an anti-malarial drug. Many local people and some travellers do not take malaria prophylaxis, but most health professionals recommend you do. Consult your doctor or a specialist travel clinic for the latest advice concerning malaria prophylaxis, as it changes regularly. It is advisable to avoid malarial areas if you are pregnant.
Take your anti-malarial drugs exactly on schedule without missing doses.
Prevent mosquito and other insect bites. Use insect repellant containing 30% DEET, preferably in a slow release form, (e.g. Hour Guard cream from AMWAY, U.S.A) on exposed skin and flying insect spray in the room where you sleep.
Although it is believed that the Anopholes mosquito (the species that carries malaria) hunts only at night, it is advised to cover all exposed areas with an insect repellent at all times. Wear long pants and long-sleeved shirts, especially from dusk to dawn.
Whether you take oral prophylaxis or not, always use mosquito repellent, wear long pants, closed shoes and light long-sleeved shirts at night.
Sleep under a mosquito net in endemic areas that has been dipped in insecticide if you are not living in screened or air-conditioned housing. There are some very good travelling mosquito nets available. If you’re sleeping in a room or tent that doesn’t have a net, spray insect repellent inside, close the area and leave for a few minutes.
If you have been travelling in a malarious area and develop a fever seek medical attention promptly. If you feel achy, have chills and hot flushes, headaches, or a fever either during your trip or up to two weeks afterwards, visit a doctor immediately to be tested for malaria. A malaria test only takes about fifteen minutes and involves a simple finger prick. If your symptoms persist, don’t hesitate in seeking a second opinion. Remember malaria can develop even up to one year after exposure. Treatment is widely available and recovery times are fast, provided that you get diagnosed as soon as you notice any possible symptoms.
Malaria can affect people in several ways. The early stages include headaches, fevers, generalised aches and pains, and malaise, often mistaken for flu. Other symptoms can include abdominal pain, diarrhoea and a cough. Anyone who develops a fever while in a malarial area should assume malarial infection until a blood test proves negative, even if you’ve been taking antimalarial medication. If not treated, the next stage can develop within 24 hours, particularly if falciparum malaria is the parasite: jaundice, reduced consciousness and coma (known as cerebral malaria), followed by death. Treatment in hospital is essential, and if patients enter this late stage of the disease the death rate may 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, that treatment is always easy and successful, and that taking antimalarial drugs causes more illness through side effects than actually getting malaria. Unfortunately this is not true. Side effects of the medication depend on the drug being taken. Doxycycline can cause heartburn and indigestion; mefloquine (Larium) can cause anxiety attacks, insomnia and nightmares, and (rarely) severe psychiatric disorders; chloroquine can cause nausea and hair loss; and proguanil can cause mouth ulcers. These side effects are not universal, and can be minimised by taking medication correctly, such as with food. Also, some people should not take a particular antimalarial drug, eg people with epilepsy should avoid mefloquine, and doxycycline should not be taken by pregnant women or children younger than 12.
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. Some people advocate homeopathic preparations against malaria, such as Demal200, but as yet there is no conclusive evidence that this is effective, and many homeopaths do not recommend their use. Malaria in pregnancy frequently results in miscarriage or premature labour and the risks to both mother and foetus during pregnancy are considerable. Travel in Kenya when pregnant should be carefully considered.
Adults who have survived childhood malaria develop a resistance and usually only develop mild cases of malaria if it recurs; most Western travellers have no resistance at all. Resistance wanes after 18 months of nonexposure, so even if you have had malaria in the past, you might no longer be resistant.
If you are going to be in remote areas or far from major towns, consider taking a stand-by treatment. Emergency stand-by treatments should be seen as emergency treatment aimed at saving the patient’s life and not as routine way of self-medicating. It should be used only if you will be far from medical facilities and have been advised about the symptoms of malaria and how to use the medication. Medical advice should be sought as soon as possible to confirm whether the treatment has been successful. The type of stand-by treatment used will depend on local conditions, such as drug resistance, and on what antimalarial drugs were being used before stand-by treatment. This is worthwhile because you want to avoid contracting a particularly serious form such as cerebral malaria, which can be fatal within 24 hours. Self-diagnostic kits, which can identify malaria in the blood from a finger prick, are also available in the West.
This disease is spread by flukes (minute worms) that are carried by a species of freshwater snail. The flukes are carried inside the snail, which then sheds them into slow-moving or still water. The parasites penetrate human skin as people paddle or swim 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 may be no symptoms. However, there may be a transient fever and rash, and advanced cases may have blood in the stool or in the urine. A blood test can detect antibodies if you might 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 directly.
Cholera is usually only a problem during natural or other disasters, e.g. war, floods or earthquakes, although small outbreaks can also occur at other times. Travellers are rarely affected. The disease is caused by a bacteria and spread via contaminated drinking water. The main symptom is profuse watery diarrhoea, which causes debilitation if fluids are not replaced quickly. An oral cholera vaccine is available in the USA, but it is not particularly effective. Most cases of cholera can be avoided by drinking only clean water and by avoiding potentially contaminated food. Treatment is by fluid replacement (orally or via a drip), but sometimes antibiotics are needed. Self-treatment is not advised.
Found in all of Africa, diphtheria is spread through close respiratory contact. It usually causes a high temperature and a severe sore throat. A membrane can form across the throat, requiring a tracheostomy to prevent suffocation. Vaccination is recommended for those likely to be in close contact with the locals in infected areas. This is more important for long stays than for short-term trips. The vaccine is given as an injection alone or with tetanus, and lasts 10 years.
Tiny worms migrating in the lymphatic system cause filariasis. The bite from an infected mosquito spreads the infection. Symptoms include localised itching and swelling of the legs and/or genitalia. Treatment is available.
Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, it can cause prolonged lethargy. If you’re recovering from hepatitis A, you shouldn’t drink alcohol for up to six months afterwards, but once you’ve recovered, there won’t be any long-term problems. The first symptoms include dark urine and a yellow colour to the whites of the eyes. Sometimes a fever and abdominal pain might be present. Hepatitis A vaccine (Avaxim, Vaqta, Havrix) is given as an injection: a single dose will give protection for up to a year, and a booster after a year gives 10-year protection. Hepatitis A and typhoid vaccines can also be given as a single-dose vaccine, with hepatyrix or viatim.
Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse. It can also be spread from an infected mother to the baby during childbirth. Hepatitis B affects the liver, which causes jaundice and occasionally liver failure. Most people recover completely, but some people might be chronic carriers of the virus, which could lead eventually to cirrhosis or liver cancer. Those visiting high-risk areas for long periods or those with increased social or occupational risk should be immunised. Many countries now give hepatitis B as part of routine childhood vaccinations. It is given singly or can be given at the same time as hepatitis A (hepatyrix).
A course will give protection for at least five years. It can be given over four weeks or six months.
Human Immunodeficiency Virus (HIV), the virus that causes Acquired IDeficiency Syndrome (AIDS), is an enormous problem in Kenya. The virus is spread through infected blood and blood products, by sexual intercourse with an infected partner, and from an infected mother to her baby during childbirth or breastfeeding. It can be spread through ‘blood to blood’ contacts, such as with contaminated instruments during medical, dental, acupuncture and other body-piercing procedures, and through sharing intravenous needles. At present there is no cure; medication that might keep the disease under control is available, but these drugs are too expensive for the overwhelming majority of Africans, and are not readily available for travellers either. If you think you might have been exposed to HIV, a blood test is necessary; a three-month gap after exposure and before testing is required to allow antibodies to appear in the blood.
Estimates of the incidence of infection differ widely. The United Nations Development Program (UNDP) claimed in 2006 that more than 16 percent of adults in Kenya are HIV-infected, whereas the Joint United Nations Programme on HIV/AIDS (UNAIDS) cites the much lower figure of 6.7 percent. Despite politically charged disputes over the numbers, however, the Kenyan government recently declared HIV/AIDS a national disaster. In 2004 the Kenyan Ministry of Health announced that HIV/AIDS had surpassed malaria and tuberculosis as the leading disease killer in the country. Due largely to AIDS, life expectancy in Kenya has dropped by about a decade and is estimated at between 47 and 55 years. Since 1984 more than 1.5 million Kenyans have died because of HIV/AIDS. More than 3 million Kenyans are HIV positive. More than 70 people a day die of HIV-related illnesses. The prevalence rate for women is nearly twice that for men. The rate of orphanhood stands at about 11 percent.
There is a risk of contracting HIV/AIDS if the necessary precautions are not taken. It is advisable to take a kit of sterilized syringe needles for any possible injections needed, as well as drip needles for emergencies.
Meningococcal infection is spread through close respiratory contact and is more likely to be contracted 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 in sub-Saharan Africa. 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.
Polio is generally spread through contaminated food and water. It is one of the vaccines given in childhood in the West and should be boosted every 10 years, either orally (a drop on the tongue) or as an injection. Polio can be carried asymptomatically (ie showing no symptoms) and could cause a transient fever. In rare cases it causes weakness or paralysis of one or more muscles, which might be permanent.
Rabies is spread by the bites or licks of an infected animal on broken skin. It is always fatal once the clinical symptoms start (which might be up to several months after an infected bite), so postbite vaccination should be taken as soon as possible. Postbite vaccination (whether or not you’ve been vaccinated before the bite) prevents the virus from spreading to the central nervous system. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of post-bite vaccine is not available within 24 hours. To prevent the disease, three injections are needed over a month. If you have not been vaccinated and receive a bite, you will need a course of five injections starting 24 hours or as soon as possible after the injury. If you have been vaccinated, you will need fewer postbite injections, and have more time to seek medical help.
Rift Valley Fever
This fever is spread occasionally via mosquito bites and is rarely fatal. The symptoms are of a fever and flu-like illness.
River Blindness (Onchocerciasis)
This is caused by the larvae of a tiny worm, which is spread by the bite of a small fly. The earliest sign of infection is intensely itchy, red, sore eyes. Travellers are rarely severely affected. Treatment should be sought in a specialised clinic.
Sleeping Sickness (Trypanosomiasis)
Sleeping sickness is spread via the bite of the tsetse fly and causes a headache, fever and eventually coma. There is an effective treatment.
TB is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccination is recommended for anyone who is likely to be mixing closely with the local population, although the vaccination gives only moderate protection against TB. It is more important to be vaccinated for long-term stays than for short stays. The BCG vaccine is not available in all countries, but is given routinely to many children in developing countries. The vaccination is usually given in a specialised chest clinic and causes a small permanent scar at the site of injection. It is a live vaccine and should not be given to pregnant women or immunocompromised individuals.
TB can be asymptomatic, only being picked up by a routine chest X-ray. Alternatively, it can cause a cough, weight loss or fever, sometimes months or even years after exposure.
This illness is spread through handling food or drinking water that has been contaminated by infected human faeces. The first symptom of infection is usually a fever or a pink rash on the abdomen. Sometimes septicaemia (blood poisoning) can also occur. A typhoid vaccine (Typhim Vi, Typherix) will give protection for three years. In some countries, the oral vaccine Vivotif is also available. Antibiotics are usually given as treatment, and death is rare unless septicaemia occurs.
It is advised to carry a certificate as evidence of vaccination against yellow fever if you’ve recently been in an infected country, to avoid immigration problems. For a full list of countries where yellow fever is endemic visit the websites of the World Health Organization (www.who.int/wer/) or the Centers for Disease Control and Prevention (www.cdc.gov/travel/blusheet.htm). A traveller without a legally required, up-to-date certificate could possibly be vaccinated and detained in isolation at the port of arrival for up to 10 days, or even repatriated.
It is spread by infected mosquitoes. Symptoms range from a flu-like illness to severe hepatitis (liver inflammation), jaundice and death. Vaccination must be given at a designated clinic and is valid for 10 years. It’s a live vaccine and must not be given to immunocompromised or pregnant women. For visitors to Kenya, vaccination is mandatory.
Although it’s not inevitable that you will get diarrhoea while travelling in Kenya, it’s certainly likely. Diarrhoea is the most common travel-related illness, and sometimes simply dietary changes, such as increased spices or oils, are the cause. To help prevent diarrhoea, avoid tap water. You should also 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 safe, plates or serving utensils might be dirty, so be highly selective when eating food from street vendors (ensure that cooked food is piping hot right through).
If you develop diarrhoea, drink plenty of fluids, preferably an oral rehydration solution containing water (lots), and some salt and sugar. A few loose stools don’t require treatment but, if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinoline drug, such as ciprofloxacin or norfloxacin) and an antidiarrhoeal agent (e.g. 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 abdominal pain, seek medical attention.
Contracted by eating contaminated food and water, amoebic dysentery causes blood and mucus in the faeces. It can be relatively mild and tends to come on gradually, but seek medical advice if you think you have the illness as it won’t clear up without treatment with specific antibiotics.
This, like amoebic dysentery, is caused by contaminated food or water. The illness usually appears a week or more after exposure to the parasite. Giardiasis might cause only a short-lived bout of typical traveller’s diarrhoea, but may cause persistent diarrhoea. Ideally, seek medical advice if you suspect you have giardiasis, but if you are in a remote area you could start a course of antibiotics.
Taken from Relocation Africa's African Relocation Guides.
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