Your doctor or travel clinic is your best first source of advice and probable supplier of jabs and prescriptions. Ensure you consult them at least four weeks prior to your departure from home so that you have enough time for vaccinations and/or a course of malariaprophylactics. If you’re going to Kenya for longer than a short holiday, get a thorough dental checkup before leaving home.
Sexually transmitted diseases, including HIV, are rife. Using a condom will help to protect you from this and other STDs, including hepatitis B, which is quite widespread and can lead to chronic liver disease. One of the biggest hazards is the fierce UV radiation of the equatorial sun. Brightness rather than heat is the damaging element, so wear a hat and use high-factor sunblock, especially in your first two weeks.
Inoculations
For arrivals by air direct from Europe and North America, Kenya has no required inoculations. Entering overland from Uganda or Tanzania, though (or flying via another African country), you may well be required to show an International Vaccination Certificate (IVC) for yellow fever on arrival. You may also be required to show an IVC for yellow fever when returning home from a country that requires one (such as Uganda or Tanzania). Effective protection takes some time to develop after vaccination, so plan ahead and start organizing your jabs at least four weeks before departure. A yellow fever certificate only becomes valid ten days after you’ve had the jab, but is then valid for ten years.
You should ensure that you are up to date with your childhood tetanus and polio protection: boosters are necessary every ten years and it’s as well to check before travelling.
Although not necessary for an ordinary safari-and-beach holiday, if you’re going to be exposed to unhygienic conditions – particularly if working locally or travelling extensively – doctors recommend jabs for typhoid, hepatitis A and hepatitis B (or a combined vaccination course).
Malaria
Malaria is endemic in tropical Africa. It’s caused by a parasite called Plasmodium, carried in the saliva of the female Anopheles mosquito. Anopheles prefers to bite in the evening, and can be distinguished by the eager, head-down position as she settles to bite. Anopheles is rarely found above 1500m, which means Nairobi and much of central Kenya are naturally malaria-free, but infected humans are vectors for the disease, meaning that an uninfected Anopheles mosquito that bites an infected person can pass malaria on to someone else, so you should assume the whole country is risky. Research has spotlighted a number of areas as having relatively high levels of malaria transmission, including the far south coast, around Shimoni, and the Lake Victoria shoreline and the plains inland from it. It can’t be stressed enough, however, that you can catch malaria virtually anywhere in Kenya.
Though not infectious, the disease can be very dangerous and sometimes fatal if not treated quickly. The destruction of red blood cells by the Plasmodium falciparum parasite can lead to cerebral malaria (blocking of the brain capillaries), which can cause a swelling of the brain and induce coma.
Wherever you travel, mosquito bites are almost a certainty and protection against malaria is essential. The best and most obvious method is to reduce your risk of being bitten. Keep your arms, legs and feet covered as much as possible after dusk (long, light-coloured sleeves and trousers are best), and cover exposed skin with a strong repellent. Deet-based repellents (“deet” is the insecticide diethyltoluamide) are best; citronella oil is considered much less effective, and has the disadvantage that elephants are attracted to the smell, and have been known to break into cars and tents to get at it. Sleep under a mosquito net (if you’re using your own, you might want to impregnate it with Deet) and burn mosquito coils, or mosquito-repellent tablets on a plug-in electric burner, both readily available in Kenya. Electronic buzzers have been shown not to work.
However much you can avoid being bitten, most medical professionals consider it essential to take anti-malaria tablets. The commonly recommended preventatives are the weekly mefloquine (sold as Lariam), which has a poor record for side effects, the antibiotic doxycycline, taken daily, and atovaquone-with-proguanil, taken daily (sold as Malarone), which, while expensive, has few, if any, side effects and can be started just two days before you leave. Your doctor or travel clinic may be able to advise further on which of these pills is the best one for you, and what the various side effects can be. It’s important to maintain a careful routine and cover the period before and after your trip with doses.
If you do get a dose of malaria, you’ll know about it: the fever, shivering and headaches are something like severe flu and come in unpleasant waves, making you pour with sweat for half an hour and then shiver uncontrollably. Typically, the time between being infected and when symptoms start (incubation period) is seven to eighteen days, but it can be up to several weeks. If you suspect anything, even after returning home, seek medical attention immediately. You will be rapidly tested and sold the appropriate treatment. If you are in Kenya and can’t get to a doctor, seeing a pharmacist is a good plan B.
If you’re visiting Kenya for an extended period, it makes sense to buy further supplies of anti-malarial tablets there. They’re all available over the counter and can be much cheaper than at home – a box of one hundred doxycycline, for example, costs less than Ksh1000.
Waterborne diseases
Serious stomach upsets don’t afflict a large proportion of travellers. That said, Kenya’s once fairly safe tap water is increasingly unfit to drink and the supply can be particularly suspect during periods of drought or heavy flooding. Where there is no mains supply, be very cautious of rain- or well-water. To purify water intended for drinking, use purifying tablets or, better, iodine (six drops per litre of water, then wait for half an hour), or boil it (if at high altitude, for thirty minutes).
If your stay in Kenya is short, you might as well stick to bottled water, which is widely available. For longer stays, think of re-educating your stomach; it’s virtually impossible to travel around the country without exposing yourself to strange bugs from time to time. Take it easy at first, don’t overdo the fruit (and wash it in clean water), don’t keep food too long, and be wary of salads. It is also wise to eat food that is freshly cooked and piping hot, even at buffets in safari lodges and beach resorts.
Should you go down with diarrhoea, it will probably sort itself out without treatment within 48 hours. In the meantime, and especially with children, for whom it may be more serious, it’s essential to replace the fluids and salts lost, so drink lots of water with oral rehydration salts (if you can’t get them from pharmacies, use half a teaspoon of salt and eight teaspoons of sugar in a litre of water). It’s a good idea to avoid greasy food, heavy spices, caffeine and most fruit and dairy products. Plain rice or ugali with boiled vegetables is the best diet. Drugs like Lomotil and Imodium simply plug you up, undermining the body’s efforts to rid itself of infection, though they can be useful if you have to travel.
Avoid jumping for antibiotics at the first sign of trouble: they annihilate what’s nicely known as your “gut flora” and will not work on viruses. But if your diarrhoea continues for more than five days, seek medical help. You should be aware of the fact that diarrhoea reduces the efficacy of malaria and contraceptive pills as they may pass straight through your system without being absorbed.
Bilharzia (medical name schistosomiasis) is transmitted by tiny worm-like flukes that live in freshwater snails and burrow into animal or human skin to multiply in the bloodstream. The snails only favour stagnant water and the chances of picking up the disease are small. The usual recommendation is never to swim in, wash with, or even touch, lake water that can’t be vouched for as schistosome-free. The stagnant and weed-infested parts of Kenyan lakes and rivers often harbour bilharzia, but the danger of crocodile attack means you’re unlikely to want any close contact with most inland waters in any case. If you suffer serious fatigue and pass blood, which are the first symptoms of bilharzia, see a doctor: it’s quickly curable with the right medication.