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Travel health Kenya and East Africa

Travel health depends on your predeparture preparations,your daily health care while travelling and how you handle any medical problem that arises.While the potential dangers can seem quite frightening,in reality few travellers experience anything more than an upset stomach.Rural clinics are common in Kenya and there are small hospitals across the country,but most are not recommended as the risk of picking up something worse than you came in with are high.Private hospitals are invariably better than government hospitals and there are some good Saudi Arabian-built hospitals on the coast.English is usually spoken.Pharmacies are very common in Kenya ,and most sell antimalarial drugs and many generic medicines.Be careful of the expiry dates on medicines sold in Kenya.If you stick to bottled water(widely available,but make sure the seal is intact),are careful with what you eat and wash your hands before eating,you should be able to avoid most of the orally transmitted diseases.Always wash fruit and vegetables with bottled water before eating and avoid salads,except in upmarket restaurants

Malaria Dengue Fever Yellow Fever Filariasis Typhus Sleeping Sickness Cuts&Scratches Bees,Spiders&Scorpions Snakes Bedbugs&Lice Leeches&Ticks Immunisations Sunburn Prickly Heat Heat Exhaustion  Heat Stroke Fungal Infections Hypothermia Altitude Sickness Motion Sickness Diarrhoea Giardiasis Dysentery Cholera Viral Gastroenteritis Hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E  Typhoid Worms Tetanus Rabies Tuberculosisis(TB) Bilharzia Diphtheria  Sexually Transmitted Disease(STD)   HIV and AIDS Health Directories


 


Immunisations

Plan at least six weeks ahead for getting your vaccinations: some of them require more than one injection,while some vaccinations should should not be given together.Note that some vaccinations should not be given during pregnancy or to people with allergies.Discuss with your doctor or GP(General Practioner).Currently yellow fever is the only vaccine that is subject to international health regulations.You will need a yellow fever certificate if you are coming to Kenya from countires where the disease is endemic,or heading elsewhere after Kenya,which has yellow fever as well, so it makes a lot of sense to get one before leaving your home country.Occasionally,travellers face bureaucratic problems at Kenya's landborders regarding the need for a cholera vaccination,even though all countries have dropped it as a health requirement for travel.If you are planning a cross Africa trip it is wise to get a cholera vaccination certificate from a doctor.This is not necessary if you are flying into Kenya.Vaccinations you should consider for this trip include the following.Carry proof of your vaccinations.

Diphteria and Tetanus

Vaccinations for Dipheteria and Tetanus are usually combined and are recommended for everyone.After an initial course of three injections ( usually given in childhood ), boosters are are necesary every 10 years.

Polio

Everyone should keep up to date with this vaccination,which is normally given in childhood.A booster evry ten years maintains immunity.

Hepatitis A

 


Vaccine for Hepatitis A provides long term immunity (possibly more than 10 years ) after an initial injection and a booster at six to twelve months.Alternatively ,an injection of gamma globulin can provide short term protection against Hepatitis A - two to six months depending on the dose given.It is not a vaccine,but it is a ready made antibody collected from blood donations.It is reasonably effective and,unlike the vaccine,it is protective immediately,but because it is a blood product,there are current concerns about its long-term safety. Hepatitis A vaccine is also available in a combined form with Hepatitis B vaccine.Three injections over a six months period are required,the first two providing substantial protection against Hepatitis A.

Hepatitis B

The traveller who should consider vaccination against hepatitis B include those on a long trip,or where sexual contact or needle sharing is a possibility.Vaccination involves three injections,with a booster at 12 months.More rapid course are available if nescessary.

Typhoid

Vaccination against typoid is recommended if you are travelling for more than a couple of weeks.It is now available either as an injection or as capsules to be taken orally.

 

Cholera

The current injectable vaccine against cholera is poorly protective and has many side effects,so it is not generally recommended for travellers.

Meningococcal Meningitis

Immunisation is recommended if going to Kenya for several months,especially if working among the local population in schools or hospitals or spending time in the far north of Kenya.A single injection gives good protection against the major epidemic forms of the disease for three years.Protection may be less effective in children under two years.

Yellow Fever

A yellow fever vaccine is now the only vaccine that is a legal requirement for entry into certain countries,usually only enforced when coming from an infected area.Vaccination is recommended for travel in areas where the disease is endemic,which includes Kenya and most of its neighbours.You may have to go to a special yellow fever vaccination centre.

Rabies

Vaccination should be considered by those who will spend a month or longer in Kenya,especially if cycling,handling animals,caving or travelling to remote areas,and for children(who may not report a bite).Pretravel rabies vaccination involves having three injections over 21 to 28 days.If someone who has been vaccinated is bitten or scratched by an animal,they will require two booster injections of vaccine,those not vaccinated require more.

Tuberculosis

The risk of TB to travellers is usually very low,unless you will be living with or closely associated with local people.Vaccination against TB ( BCG ) is recommended for children and young adults living in these areas for three months or more.

Malaria

Malaria is now present across Kenya,even in Nairobi,and epidemics are common.Antimalarial drugs do not prevent you from being infected but kill the malaria parasites during a stage in their development and significantly reduce the risk of becoming very ill or dying.Expert advice on medication should be sought,as there are many factors to consider,including the risk of exposure to malaria-carrying mosquitos,the side effect of medication,your medical history and whether you are a child or an adult or pregnant.You may like to carry a treatment dose of medication for use if symptoms occur . More about malaria under Insect-born-disease below .

Health and Travel Insurance

Make sure that you have adequate health insurance. It is important to be covered for emergency medical air evacuation with an organisation such as AMREF ( African Medical and Research Foundation ) . You can get more information about AMREF at http://uk.amref.org They are famous for the Flying Doctor's Society of Africa .They operate a 24-hours air-ambulance service out of Nairobi's Wilson Airport.It will get you wherever you are to the nearest decent hospital(often Nairobi or sometimes Mombasa ) Tourist cover costs USD 25 for two months within 500 km of Nairobi and USD within 1000 km .

A travel-insurance policy to cover theft,loss and medical problems is a very sensible precaution.The policies handled by STA Travel or other student organisations are usually good value.Some policies offer lower and higher medical-expense options,but the higher ones are chiefly for countries such as the USA that have extremely high medical costs.Medical cover is the most vital element of any policy,but make sure you check the small print !

Malaria This serious disease is spread by mosquito bites.Symptoms include headaces,fever,chills and sweating which may subside and recure.Without treatment malaria can develop more serious,potentially fatal effects.It is extremely important to take malarial prophylaxis.Antimalarial drugs do not prevent from being infected but kill the parasites during a stage in their development.There are a number of different types of malaria.The most common one is falciparum malaria.This is responsible for the very serious cerebral malaria.Falciparum is the predominant form in many malaria prone areas in the world.Contrary to popular belief cerebral malaria is not a new strain.The problem in recent years has been the emergence of increasing resistance to commonly used antimalarial drugs like chloroquine,maloprim and proguanil.Newer drugs such as mefloquine(Lariam) and doxycycline(Vibramycin,Doryx) are often recommended for chloroquine and multi drug resistant areas.Expert advice should be sought,as there are many factors to consider when deciding on the type of antimalarial medication,including the area to be visited,the risk of exposure to malaria carrying mosquitos,your medical history,and your age and pregnancy status.It is also important to discuss the side effect profile of the medication,so you can work out some level of risk versus benefit ratio.It is also very important to be sure of the correct dosage of the medication prescripted to you.Some people have inadvertently taken weekly medication(Chloroquine) on a daily basis,with disastertrous effects.While discussing dosages for prevention of malaria,it is often advisable to include the dosages required for treatment,especially if your trip is through a high risk area that would isolate you from medical care.Primary prevention must always be in the form of mosquito-avoidance measures.The mosquitoes that transmit malaria bite from dusk to dawn and during this period the traveller is adviced to wear light coloured clothing,wear long pants and long sleeved shirts,avoid highly scented perfumes or aftershave,to use a mosquito net(it may be worth taking your own),use mosquito repellents containing the compound DEET on exposed areas.The overuse of DEET may be harmful,especially to children,but its use is considered preferable to being bitten by a disease transmitting mosquitos.While no antimalarial is 100% effective,taking the most appropriate drug significantly reduces the risk of contracting the disease.Nobody should ever die from malaria.It can be diagnosed by a simple blood test.Symptoms range from fever,chills and sweating,headache and abdominal pains to a vague feeling of ill health,so seek examination immediately if there is any suggestion of malaria.Contrary to popular belief,once a person contracts malaria he or she does not have it for life.Two species of the parasite may lie dormant in the liver but they can also be eradicated using a specific medication.Malaria is curable,as long as the person seeks medical help when symptoms occur.Anti malarial drugs are available in pharmacies in every bigger town in Kenya .back to the top

Dengue Fever There is no prophylactic available for this mosquito spread disease.The main prevention is to avoid mosquito bites.A sudden onset of fever,headaches and severe joint joint and muscle pains are the first signs before a rush starts on the trunk of the body and spreads to the limbs and face.After a further few days,the fever will subside and recovery will begin.Serious complications are not common but full recovery can take up to a month or more. back to the top

Yellow Fever This disease is endemic in many African countries between 15' north and 15' south of the equator,but not including Kenya.This viral disease is transmitted to humans by mosquitoes.The initial symptoms are fever,headache,abdominal pain and vomiting.There may appear to be a brief recovery before the disease progresses to more severe complications,including liver failure.There is no medical treatment apart from keeping the fever down and avoiding dehydration,but yellow fever vaccination gives good protection for 10 years.Vaccination is an entry requirement for some countries,predominantly for those travellers coming from an infected area. back to the top

Filariasis This is a mosquito transmitted parasitic infection which is found in many parts of Africa,including Kenya.There is a range of possible manifestations of the infection,depending on which filarial parasite species has caused the infection.These include fever,pain and swelling of the lymph glands,inflammation of lymph drainage areas,swelling of a limb or scrotum,skin rushes and blindness.Treatment is available to eliminate the parasites from the body,but some of the damage they cause may not be reversible.Medical advice should be obtained promptly if the filariasis infection is suspected. back to the top

Typhus Typhus is spread by ticks,mites or lice.It begins with fever,chills,headache and muscle pains followed a few days later by a body rush.There is often a large painful sore at the site of the bite and nearby lymph nodes are swollen and painful.Treatment is with tetracycline,or chloramphenicol under medical supervision.Tick typhus is spread by ticks.Trekkers in southern Africa may be at risk from cattle or wild animal ticks.Seek local advice on areas where ticks pose a danger and always check your skin carefully for ticks after walking in a danger area such as a tropical forest,A strong insect repelent can help,and serious walkers in tick areas should consider having their boots and trousers impregnated with benzyl benzoate and dibutylphthalate. back to the top

HIV (Human Immunodeficiency Virus ) and AIDS (Acquired Immune Deficiency Syndrome

  HIV may develop into AIDS .HIV is a huge problem in Kenya and the statistics are frightening.Not only are the health services being stretched way beyond limits,it is estimated that 50% of Kenyan hospital cases are HIV related,but life expectancy is dropping rapidly,and it has been estimated that in 5 years Kenya will have one million AIDS orphans.Any exposure to blood,blood products or bodilyfluids may put individuals at risk.In many developing countries transmission is predominantly through heterosexual sexual activity.This is quite different from industrialised countries where transmission is mostly through contact between homosexual or bisexual males,or via contaminated needles shared by IV drug users.Apart from abstinence,the most effective preventative is always to practise safe sex using condoms.It is impossible to detect the HIV status of an otherwise healthy looking person without a blood test.HIV can also be spread through infected blood transfusions.Donors in Kenya are not always screened for HIV.It can also be spread by dirty needles,vaccinations,acupuncture,tattoing and ear and nose pearcing can be potentially as dangerous as intravenous drug use if the equipment is not clean.If you do need an injection,ask to see the syringe unwrapped in front of you,or better still,take a needle and syringe pack with you overseas,it is a cheap insurance package against infection with HIV.Fear of HIV infection should never preclude treatment for serious medical conditions.Although there may be a risk of infection,it is very small indeed. back to the top

Sleeping Sickness In parts of tropical Africa,including Kenya,tsetse flies can carry trypanosomiasis or sleeping sickness.They pass it on by biting large,warm blooded animals and are responsible for the lack of horses and cows in some areas.The tsetse fly is about twice the size of a housefly and recognisable by the scissorlike way it folds its wing when at rest.Only a small porportion of tsetse flies carry the disease but it is best to try to avoid being bitten.There is no immunisation.The flies are attracted to large moving objects such as safari buses,to perfume and aftershave,and to colours like dark blue.Swelling at the site of the bite,five or more days later,is the first sign of infection.This is followed within two or three weeks by fever.The illness is serious but responds well to medical attention. back to the top

Giardiasis The parasite causing this intestinal disorder is present in contaminated water.The symptoms are stomach cramps,nausea,a bloated stomach,watery,foul smelling diarrhoea and frequent gas.Giardiasis can appear several weeks after you have been exposed to the parasite.The symptoms may disappear for a few days and then return,this can go on for several weeks.Tinidazole,known as Fasgyn or metronidazol are the recommended drugs for treatment.Either can be used in a single treatment dose. back to the top

Dysentery This serious illness is caused by contaminated food or water and it is characterised by severe diarrhoea,often with blood or mucos in the stool.There are two kinds of dysenery.Bacillary dysentery is characterised  by a high fever and rapid onset,headache,vomiting and stomach pains are also symptoms.It generally does not last longer than a week,but it is highly contagious.Amoebic dysenetery is often more gradual in the onset of symptoms,with cramping abdominal pain and vomiting less likely,fever may not be present.It is not a self limiting disease,it wll persist until treated and can recur and cause long term health problems.A stool test is nescessary to diagnose which kind of dysentery you have ,so you should seek medical help urgently.In case of an emergency the drugs norfloxacin or ciprofloxacin can be used as presumptive treatment for bacillary dysentry and metronidazole for amoebic dysentery. back to the top

Cholera Cholera vaccination is not very effective.The bacteria responsible for this is waterborne,so attention to the rules of eating and drinking should protect the traveller.Outbreaks of cholera are generally widely reported,so you can avoid such problem areas.The disease is characterised by a sudden onset of acute diarrhoea with rice water stools,vomiting,muscular cramps and extreme weakness.You need medical help,but treat for dehydration,which can be extreme,and if there is an appreciable delay in getting to hospital the begin taking tetracycline.The adult dose is 250mg four times daily.It is not recommended for children under 8 years nor for pregnant women.An alternative drug is ampicillin.Remember that while antbiotics might kill the bacteria,it is a toxin produced by the bacteria which causes the massive fluid loss.Fluid replacement is by far the most important aspect of treatment. back to the top

Viral Gastroenteritis This is caused not by a bacteria but,as the name suggests,by a virus.It is characterised by stomach cramps,diarrhoea,and sometimes by vomiting and a slight fever.All you can do is rest and drink lots of fluids. back to the top

Hepatitis Hepatitis is a general term for inflammation of the liver.There are many causes of this condition:drugs,alcohol and infections. back to the top

Hepatitis A This is quite a common disease in Kenya.The symptoms are fever,chills,headache,fatigue,feelings of weakness and aches and pains,followed by loss of appetite,nausea,vomiting,abdominal pains,dark urine,light coloured faeces,jaundiced skin and the whites of the eye may turn yellow.You should seek medical advice,but in general there is not much you can do apart from resting,drinking lots of fluids,eating lightly and avoiding fatty foods.People who have hepatitis must forego alcohol for six months after the illness,as hepatitis attacks the liver and it needs that amount of time to recover.The routes of transmission are via contaminated water,shellfish contaminated by sewerage,or foodstuffs sold by food  handlers with poor standard of hygiene. back to the top

Hepatitis E This is a recently discovered virus,of which little yet is known.It appears to be rather common in developing countries,generally causing mild hepatitis,although in can be very serious in pregnant women.Care with water supplies is the only current prevention,as there are no specific vaccines for this type of hepatitis.At present it does not appear to be too great risk for travellers. back to the top

Hepatitis B This is also a very common disease,with almost 300 million chronic carriers in the world.Hepatitis B,which used to be called serum hepatitis,is spread through contact with infected blood,blood products or bodily fluids,for example through sexual contacts,unsterilised needles and blood transfusions,or via small breaks in the skin.Other risk situations include having a shave or tattoo in a local shop,or having your body pierced.The symptoms of type B are much the same as type A except that they are more severe and may lead to irreparable liver damage or even liver cancer.There is no treatment for hepatitis B. back to the top

Hepatitis C This is another recently defined virus.It is a concern because it seems to lead to liver disease more rapidly than Hepatitis B.The virus is spread by contact with blood,usually via contaminated transfusions or shared needles.Avoiding these is the only means of prevention,as there is no available vaccine. back to the top

Hepatitis D Often referred to as the Delta virus,this infection only occurs in chronic carriers of hepatitis B.It is transmitted by blood and bodily fluids.Again there is no vaccine for the virus,so avoidance is the best prevention.The risk to travellers is certainly limited. back to the top

Typhoid Typhoid fever is yet another gut infection that travels the faecal oral route,it is contaminated water and food that are responsible.Vaccination against typhoid is not totally effective  and it is a dangerous infection,medical help must be sought. In its early stages typhoid resembles many other illnesses,sufferers may feel they have a bad cold or flu on the way,as early symptoms are a headache,a sore throat,and a fever which rises a little each day until it is 40 C or more.The victum's is often slow relative to the degree of fever present and gets slower as the fever rises,unlike a normal fever where the pulse increases.There may also be vomiting,diarrhoea or constipation.In the second week the high fever and slow pulse continue and a few pink spots may appear on the body.Other symptoms are trembling,delirium,weakness,weight loss and dehydration.If there are no further complications,the fever and other symptoms will slowly diminish during the third week.However you must get medical help before this because typhoid is very infectious and because pneumonia(acute infection of the lungs) and peritonitis(perforation of the bowel) are common life threatening complications.The fever should be treated by keeping the victim cool and dehydration should also be watched for.The drug of choice is ciprofloxacin at a dose of one gram daily for 14 days.It is quite expensive and may not be available.The alternative,chloramphenicol,has been the mainstay for many years.However it can have dangerous side effects and another option is Ampicillin.People who are allergic to penicillin should not be given ampicillin. back to the top

Worms  These parasites are most common in rural,tropical areas and a stool test when you return home is not a bad idea.They can be present on unwashed vegetables or in undercooked meat and you can pick them up through your skin by walking bare feet.Infestations may not show up for some time,and atlthough they are generally not serious,if left untreated they can cause severe health problems.A stool test is nescessary to diagnose the problem and medication is often available over the counter. back to the top

Tetanus This potentially fatal disease is found worldwide,occurring more commonly in undeveloped tropical areas.It is difficult to treat but preventable with immunisation.Tetanus occurs when a wound becomes infected by a germ which lives in soil and in the faeces of horses and other animals,so clean all cuts,punctures or animal bites.Tetanus is also known as lockjaw,and the first symptom may be discomfort in swallowing,or stiffening of the jaw and neck,this is followed by painful convulsions of the jaw and the whole body. back to the top

Rabies Rabies is a fatal viral infection found in many countries,including Kenya,and is caused by a bite or scratch from an infected animal.Dogs are noted carriers as are monkeys and cats.Any bite,scratch or even lick from a warm blooded,furry animal should be cleaned immediately and thoroughly.Scrub with soap and running water,and then clean with an alcohol or iodine solution.If there is any possibility that the animal is infected medical help should be sought immediately to prevent the onset of symptoms and death.In a person not immunised against rabies this involves having five injections of vaccine and one  of immunoglobulin over 28 days starting as soon as possible after the exposure.Even if the animal is not rabid,all bites should be treated seriously as they can become infected or can result in tetanus. back to the top

Meningococcal Meningitis This is a bacterial infection of the lining of the brain.Sub Saharan Africa is considered the meningitis belt and the meningitis season falls at the time most people would be attempting the overland trip across the Sahara,the northern winter before the rains come.This very serious disease attacks the brain and ca be fatal.A scattered,blotchy rash,fever,severe headache,sensitivity to light and neck stiffness which prevents forward bending of the head are the first symptoms.Death can occur within a few hours,so immediate treatment is important.Treatment is large doses of penicillin given intravenously. back to the top

Tuberculosis(TB) Tuberculosis is a bacterial infection which is widespread in many developing countries.It is usually transmitted from person to person by coughing but may be transmitted through consumption of unpasteurised milk.Milk that has been boiled is safe to drink,and the souring of milk to make cheese or yoghurt also kills the bacilli.Typically many months of contact with the infected person are required before the disease is passed on so it is not considered a serious risk for the traveller.The usual site of the disease is the lungs,although other organs may be involved.Most infected people never develop symptoms.In those who do,especially infants,symptoms may arise within weeks of the infection occurring and may be severe.In most,however,the disease lies dormant for many years until,for some reason infected person becomes physically run down.Symptoms include fever,weight loss,night sweats and coughing.Vaccination against tuberculosis may prevent serious disease so is recommended for young children who are likely to be heavily exposed to infected people. back to the top

Bilharzia Bilharzia is carried in water by minute worms.The larvae infect certain varieties of freshwater snails found in rivers,streams,lakes and particularly behind dams.The worms multiply and are eventually discharged into the water surrounding the snails.The worm enters through the skin,and the first symptom may be a tingling and sometimes a light rash around the area where it entered.They attach themselves to your intestines or bladder,where they produce large number of eggs.Weeks later,when the worm is busy producing eggs,a high fever may develop.A general feeling of being unwell may be the first symptom.Once the disease has established abdominal pain and blood in the urine are other signs.The infection often causes no symptoms until the disease is well established,several months to years after exposure,and damage to internal organs are irreversible.Avoiding swimming or bathing in fresh water where bilharzia is present is the main method of preventing disease.In Kenya,unless you know definitely that water is bilharzia free,assume the worst and be aware that even deep water can be infected.Bilharzia is present in Lake Victoria.If you do get wet,dry off quickly and dry your clothes as well.Seek medical attention if you have been exposed to the disease,even if you do not have any symptoms,and tell the doctor your suspicions,as bilharzia in the early stages can be confused with malaria or typhoid.If you cannot get medical help immediately,praziquantel(Biltricide) is the recommnded treatment.Niridazole is an alternative drug. back to the top

Diphtheria Diphtheria can be a skin infection or a more dangerous throat infection.It is spread by contaminated dust contacting the skin or by the inhalationof infectedcough or sneeze droplets.Frequent washing and keeping the skin dry will help prevent skin infection.The mainstay of the treatment of diphtheria throat infection is an intravenous infusion of diphtheria antitoxin.The antitoxin is produced in horses so may be associated with allergic reactions in some people.Because of this it must be administered under close medical supervision. back to the top

Sexually Transmitted Diseases(STD) Sexual contact with an infected sexual partner spreads these diseases.While abstinence is the only 100% preventative,using condoms is also effective.Gonorrhoea,herpes and syphilis are the most common of these diseases.Sores,blisters or rashes around the genitals,discharges or pain when urinating are common symptoms.Symptoms may be less marked or not observed at all in women.Syphilis symptoms eventually disappear completely but the disease continues and can cause severe problems in later years.The treatment of gonorrhoea and syphilis is with antibiotics.There are numerous other sexually transmitted diseases,for most of which effective treatment is available.However,there is no cure for herpes and there is currently no cure for HIV or AIDS. back to the top

Cuts & Sratches Skin punctures can easily become infected in hot climates and may be difficult to heal.Treat any cut with an antiseptic such as povidone iodine.Where possible avoid bandages which can keep wounds wet.Coral cuts are notoriusly slow to heal and if there are not adequately cleaned,small pieces of coral can became embedded in the wound.Avoid coral cuts by wearing shoes when walking on reefs,and clean any cut thoroughly with sodium peroxide if available. back to the top

Bees,Spiders & Scorpions Bee and wasp stings are usually painful rather than dangerous.Calamine lotion or Stingose spray will give relief and ice packs will reduce the pain and swelling.There are some spiders with dangerous bites but antivenenes are usually available.Scorpion stings are notoriously painful although not fatal in this part of the world.Scorpions often shelter in shoes or clothing. back to the top

Snakes  To minimize your chances of being bitten always wear boots,socks and long trousers when walking through undergrowth where snakes may be present.Do not put your hands into holes and crevices and be careful when collecting firewood.Snake bites do not cause instantaneous death and antivenenes are usually available.Keep the victim calm and still,wrap the bitten limb tightly,as you would do with a sprained ankle,and the attach a splint to immobilise it.Then seek medical help,if possible with the dead snake for identification.Do not attempt to catch the snake if there is even a remote possibility of being bitten again.Tourniquets and sucking out the poison are now comprehensively discredited. back to the top

Bedbugs & Lice Bedbugs live in various places,but particularly in dirty mattresses and beddings.Spots of blood on bedclothes or on the wall around the bed can be read as a suggestion to find another hotel.Bedbugs leave itchy bites in neat rows.Calamine lotion or Stingose spray may help.All lice cause itching and discomfort.They make themselves at home in your hair(head lice),your clothing(body lice) or in your pubic hair(crabs).You catch lice through direct contact with infected people or by sharing combs,clothing and the like.Powder or shampoo treatment will kill the lice and infected clothing should then be washed in very hot water. back to the top

Leeches & Ticks Leeches may present in damp forest conditions,they attach themselves to your skin to suck your blood.Trekkers often get them on their legs or in their boots.Salt or a lighted cigarette end will make them fall off.Do not pull them off,as the bite is then more likely to become infected.An insect repellent may keep them away.You should always check your body if you have been walking through a potentially tick infested area as ticks can cause skin infections and other more serious diseases.If a tick is found attached,press down around the tick's head with tweezers,grab the head and gently pull upwards.Avoid pulling the rear of the body as this may squeeze the tick's gut contents through the attached mouth parts into the skin,increasing the risk of infection and disease.Smearing chemicals on the tick will not make it let go and is not recommended. back to the top

Sunburn In the tropics,the desert or at high altitude you can get sunburnt surprisingly quickly,even through cloud.Use a a sunscreen and take extra care to cover areas which do not normally see sun,eg your feet.A hat provides added protection,and you should also use zinc cream or some other barrier cream for your nose and lips.Calamine lotion is good for mild sunburn. back to the top

Prickly heat Prickly heat is an itchy rash caused by excessive perspiration trapped under the skin.It usually strikes people who have just arrived in a hot climate and whose pores have not yet opened suffiently to cope with greater sweating.Keeping cool but bathing often,using a mild talcum powder or even resorting to air conditioning may help until you acclimatise. back to the top

Heat Exhaustion Dehydration or salt deficiency can cause heat exhaustion.Take time to acclimatise to high temperatures and make sure you get sufficient liquids.Wear loose clothing and a broad brimmed hat.Do not do anything too physically demanding.Salt deficiency is characterised by fatigue,lethargy,headaches,giddiness and muscle cramps and in this case salt tablets may help.Vomiting and diarrhoea can deplete your liquid and salt levels.Anhydrotic heat exhaustion,caused by an inability to sweat.is quite rare.Unlike the other forms of heat exhaustion it is likely to strike people who have been in a hot climate for some time,rather than newcomers. back to the top

Heat Stroke This serious condition,which can also be fatal,can occur if the body's heat regulating mechanism breaks down and the body temperature rises to dangerous levels.Long continuous exposure to high temperatures can leave you vulnerable to heat stroke.You should avoid excessive alcohol or strenuous activity when you first arrive in hot climate.The symptoms are feeling unwell,not sweating very much or at all and a high body temperature( 39-41 C ).Where sweating has ceased the skin becomes becomes flushed and red.Severe,throbbing headaches and lack of coordination will also occur,and the sufferer may be confused or aggressive.Eventually the victim will become delirious or convulse.Hospitalisation is essential,but meanwhile get victims out of the sun,remove their clothing,cover them with a wet sheet or towel and then fan continually. back to the top

Fungal Infections Fungal Infections,which occur with greater frequency in hot weather,are more likely to occur on the scalp,between the toes or fingers(athlete's foot),in the groin(jock itch or grotch rot) and on the body(ringworm).You get ringworm,which is a fungal infection not a worm, from infected animals or by walking on damp areas like shower floors.To prevent fungal infections wear loose,comfortable clothes,avoid artificial fibres,wash frequently and dry carefully.If you do get an infection,wash the infected area daily with a disinfectant or medicated soap and water,and rinse and dry well.Apply an antifungal cream or powder like the widely available Tinaderm.Try to expose the infected area to air or sunlight as much as possible and wash all towels and underwear in hot water as well as changing them often. back to the top

Hypothermia Too much cold is just as dangerous as too much heat,particularly if it leads to hypothermia.If you are trekking on Mount Kenya be prepared.Hypothermia occurs when the body loses heat faster than it can produce it and the core temperature of the body falls.It is surprisingly easy to progress from very cold to dangerously cold due to a combination of wind,wet clothing,fatigue and hunger,even if the air temperature is above freezing.It is best to dress in layers,silk,wool and some of the new articficial fibres are all good insulating materials.A hat is important,as a lot of heat is lost through the head.A strong,waterproof outer layer is essential,as keeping dry is vital.Carry basic supplies,including food containing simple sugars to generate heat quickly and lots of fluid to drink.A space blanket is something all travellers in cold environments should carry.Symptoms of hypothermia are exhaustion,numb skin(particularly toes and fingers),shivering,slurred speech,irrational or violent behaviour,lethargy,stumbling,dizzy spells,muscle cramps and violent bursts of energy.Irrationality may take the form of suffers claiming they are warm and trying to take off their clothes.To treat mild mild hypthermia,first get the person out of the wind and rain,remove their clothingif it's wet and replace it with warm,dry clothing.Give them hot liquids,not alcohol,and some high kilojoule,easily digestable food.Do not rub victims,instead allow them to slowly warm themselves.This should be enough to treat early stages of hypothermia.The early recognition and treatment of mild hypothermia is the only way to prevent severe hypothermia which is a critical condition. back to the top

Altitude Sickness Acute Mountain Sichness or AMS occurs at high altitude and can be fatal.(Mount Kenya)The lack of oxygen at high altitudes over 2500 m affects most people to some extend.It may be mild or severe and occurs because less oxygen reaches the muscles and brain at high altitude,requiring the heart and lungs to compensate by working harder.Symptoms usually develop during the first 24 hours at altitude but may be delayed up to three weeks.Symptoms of benign AMS include headache,lethargy,dizziness,difficulty sleeping and loss of appetite.Malignant AMS may develop from benign AMS or without warning and can be fatal.These symptoms include breathlessness,dry cough,severe headache,lack of cordination and balance,confusion,irrational behavior,vomiting,drowsiness and unconsciousness.In benign AMS the treatment is to remain resting at the same altitude until recovery,usually a day or two.Paracetamol or aspirincan be taken for headaches.If symptoms persist or become worse ,however,descent is necessary,even 500 m can help.The treatment of malignant AMS is immediate descent to a lower altitude.There are various drug treatments available but they should never be used to avoid descent or enable further ascent by a person with AMS.A number of measures can be adopted to prevent acute mountain sickness.Ascend slowly,have frequent rest days,spending 2 or 3 nights at each rise of 1000 m.If you reach a high altitude by trekking,acclimatisation takes place gradually and you are less likely to be affected than if you fly direct.The altitude at which a person sleeps is an important factor.It is always wise to sleep at a lower altitude than the greatest height reached during the day.Also,once above 3000m ,care should be taken not to increase the sleeping altitude by more than 300 m per day.Drink extra fluids.The mountain air is dry and cold and moisture is lost as you breathe.Eat light,high carbohydrate meals for more energy.Avoid alcohol,it may increase the risk of dehydration occuring.Avoid sedatives.Avoid the drugs acetazolamide(Diamox) and dexamethason even though they have been recommended for prevention of AMS.They can reduce the symptoms,but they also mask warning signs.Severe and fatal AMS has occured in people taking these drugs.In general they are not recommended for travellers. back to the top

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