FOOD & DRINK

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish.

All travellers should bring along an antibiotic and an anti-diarrhoea drug to be started promptly if significant diarrhoea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. If diarrhoea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhoea persists for more than 72 hours, medical attention should be sought.

PROTECTION AGAINST INSECTS

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 20-35% DEET to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be reapplied more frequently. Do not use either DEET on children less than two years of age. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

INSURANCE

Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of pounds. Take all documents with you in your hand luggage. Before departure, determine whether your insurance will make payments directly to providers or reimburse you later for overseas health expenditures.

MEDICAL KITS & MEDICATION

Pack a personal first aid/medical kit, customised for your trip. Take appropriate measures to prevent motion sickness and jet lag. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

Bring adequate supplies of all medications in their original containers, clearly labelled. Carry a signed, dated letter from your GP describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a GP letter documenting their medical necessity. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

RABIES

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately.

AMBULANCE

For a public ambulance call 119

PHARMACIES

The supply of medications at local pharmacies is limited and the quality is unreliable. There is no enforcement of pharmacy regulations.

TRAVELLING WITH CHILDREN

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed. All children should be up-to-date on routine childhood immunizations. When travelling with young children, be particularly careful about what you allow them to eat and drink because diarrhoea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

TRAVEL & PREGNANCY

International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labour. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.

Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary. In general, pregnant women should avoid travelling to countries which do not have modern facilities for the management of premature labour and other complications of pregnancy. As a rule, pregnant women should avoid visiting areas where malaria occurs. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.

Strict attention to food and water precautions is especially important for the pregnant traveller because some infections, such as listeriosis, have grave consequences for the developing foetus. Additionally, many of the medications used to treat travellers' diarrhoea may not be given during pregnancy.