Managing your health on a Uganda trip

The most important Up-to-date health advisory and recommendations for travelling to Uganda can be easily gotten from the CDC, embassy, or consulate. Generally, common health issues that you may encounter on your safari trip to Uganda are mostly predictable and can be easily avoided. Multiple vaccinations and malaria prophylaxis may be required, so make sure you talk to a competent health consultant for safari health advisory before you travel.

People new to exotic travel often worry about tropical diseases, but it’s the accidents that are most likely to carry you off. Road accidents are prevalent in many parts of Uganda, so be aware and do what you can to reduce risks: try to travel during daylight hours, always wear a seatbelt, and refuse to be driven by anyone who has been drinking. Listen to local advice about areas where violent crime is rife too. Also, be interested in national health advisory information by your embassy.

Coronavirus (Covid-19) travel advisory

Keep your mask on when travellin in Uganda. Coronavirus (Covid-19) travel health advisory.
Keep your mask on when travellin in Uganda.

Uganda, like all nations worldwide, is struggling with coronavirus. Since Covid-19 reached the country in Murch 2020, the GoU and MoH have been at the forefront of protecting all within the boundaries. Currently, the death rate is less than 1%, with a relatively low infection rate than other African destinations.

Domestic travel is relatively navigable, and international travel resumed on October 1, 2020, after six months of total lockdown. The Covid task force has set a stringent measure to keep the virus at bay while the MoH, AUTO, UWA, UTB, and all travel stakeholders are issuing travel guidelines to keep all safe yet allowing ease of travel. Ensure you keep up with these guidelines, check with your consulate for the latest travel health advisory, and get travel insurance that would cover Covid health exposure.

And most of all, protect yourself from coronavirus. Wear and keep your facemask on when in contact with people, keep more than a meter of physical distance, don’t shake hands (its Ugandan culture to greet shaking hands, so don’t be tempted), carry a portable hand sanitizer bottle and wipes to disinfect contact points in your hotel room.

Uganda Covid-19 entry requirements

On arrival, tourists and business visitors will need to provide a negative COVID-19 test dated no more than 72 hours before their arrival into Uganda. The same applies to the outbound (test can be done at several hospitals in Kampala & Entebbe with results given within 8-24 hours). Your driver or tour operator will have to ensure that you proceed directly to your place of stay and do not mix with Ugandans.

There will be no requirement to self-isolate. However, if found with coronavirus symptoms, you’ll be isolated, handed over to health officials, and taken to a designated place for treatment.

Ugandan nationals who arrive with a negative COVID-19 test will be allowed to proceed straight to their homes. It is not yet clear whether they will be required to self-isolate at home for 14 days or not.

Vaccines you’ll need for a Uganda trip

Woman receiving a vaccination shot: Vaccines you'll need for a Uganda trip, travel health advisory
Woman receiving a vaccine shot. Coronavirus vaccine will be required when availed.

Almost all immigration health advisory emphasizes that to ensure a healthy trip to Uganda, one requires checks on their immunization status: it is wise to be up to date on routine vaccines, tetanus, polio, diphtheria (now given as an all-in-one vaccine, Revaxis, that lasts for ten years), hepatitis A and the novel coronavirus (Covid-19) when the vaccine is availed.

Generally, the Yellow Fever vaccination is mandatory for travel into Uganda, not to protect you but to protect Ugandans you’ll get into contact with. Malaria is deadly and prevalent in many areas in Uganda, so it’s up to you to protect yourself. And Covid-19, well, you know how everyone is watching out for that. Those are the three major diseases you should watch out for on your trip to Uganda. Otherwise, there are more vaccinations to look out for; see next.

Yellow Fever

Proof of vaccination against yellow fever is needed to enter Uganda if you are coming from another yellow fever endemic area.

The World Health Organization (WHO) advisory insists that a Yellow Fever Vaccine should be gotten before traveling to Uganda by any traveler older than nine months. However, proof of entry is only officially required for those over one year of age. If the vaccine is not suitable for you, then obtain an exemption certificate from your GP or a travel clinic because you’ll be held back at entry points.

Malaria

In addition to health advisory for various vaccinations recommended above, travelers must be properly protected against malaria. All areas of Uganda are marked for a high risk of malaria-transmitting mosquitos.

Ideally, you should visit your own doctor or a specialist travel clinic to discuss your requirements, if possible, at least eight weeks before you plan to travel. Several travelers report that antimalarial drugs (and other medicines) in Kampala are far cheaper than in the UK or US. However, you will still need to start the course of antimalarial tablets before you leave home.

Immunization against cholera is no longer required for Uganda.

Meningococcus and rabies

Ministry of Health advisory recommends immunizations against meningococcus and rabies. Meningococcal disease has a high mortality rate in teens and young adults if untreated but is vaccine-preventable. While best known as a cause of meningitis, it can also result in sepsis, an even more damaging and dangerous condition.

CDC travel health advisory recommends Meningococcal Vaccines for preteens, teens, and certain other people. If your teenager missed getting MenACWY, ask their doctor about getting it now at least 30 days before you travel to Uganda. Meningitis vaccine (containing strains A, C, W, and Y, will usually be recommended for trips of more than four weeks.

Vaccinations for rabies are ideally advised for everyone visiting Uganda but are especially important for travelers visiting more remote areas, especially if you are more than 24 hours from medical help and definitely if you will be working with animals.

Rabies can spread to people and pets if they are bitten or scratched by a rabid animal. In Uganda, rabies is mostly found in wild animals like bats and dogs. However, some domestic dogs (especially in villages) still carry rabies, and dog bites cause most rabies deaths in people worldwide.

Talk to your doctor about your Uganda travel plans. If your activities bring you into contact with animals such as dogs, cats, bats, or other carnivores, you should consider pre-exposure rabies vaccination, a 3-shot series (days 0, 7, and 21 or 28) given before travel. Even if you receive pre-exposure vaccination, you should still get immediate medical treatment if you are bitten or scratched by an animal.

Hepatitis A vaccine (Havrix Monodose or Avaxim)

Travelers are more likely to get infected with hepatitis A if they visit rural areas, trek in backcountry areas, or frequently eat or drink in settings of poor sanitation. However, even travelers who stay in urban areas, resorts, or luxury hotels, who wash their hands regularly, and choose food and drinks carefully have been infected when visiting regions where hepatitis A is common.

Uganda health advisory recommends Hepatitis A vaccine for all travellers into the country. The vaccine is given in two or three doses. If your plans don’t allow you to get all doses before your safari trip, get at least 1 dose as soon as possible before you travel.

Travelers allergic to a vaccine component or 6 months of age or younger should receive a single dose of immune globulin, which provides effective protection for up to 2 months, depending on the dosage given. Talk to your travel doctor to see if this is the best option for you.

Hepatitis B vaccination

Hepatitis B vaccination should be considered for longer trips (two months or more) or those working with children or situations where contact with blood is likely. Three injections are needed for the best protection and can be given over a three-week period if time is short. Longer schedules give more sustained protection and are therefore preferred if time allows.

Hepatitis A vaccine can also be given as a combination with Hepatitis B as Twinrix’. However, two doses are needed at least seven days apart to be effective for the hepatitis A component, and three doses are needed for hepatitis B. Both these schedules can only be used on those aged 16 or over.

Typhoid vaccines

Health advisory recommends Typhoid vaccination for people traveling to Uganda. Oral vaccines can be given to people at least 6 years old. It consists of four pills taken every other day and should be finished at least 1 week before travel. An injectable vaccine can be given to people at least 2 years old and should be given at least 2 weeks before your trip to Uganda.

Typhoid vaccines are not 100% effective. Always practice safe eating and drinking habits to help prevent infection.

Typhoid vaccines lose effectiveness over time. The injectable vaccine requires a booster every 2 years, and the oral vaccine requires a booster every 5 years. If you were vaccinated in the past, ask your doctor if it is time for a booster vaccination. Taking antibiotics will not prevent typhoid fever; they only help treat it.

Tuberculosis (TB)

The risk of contracting Tuberculosis in Uganda is generally low for most tourist travelers. Those anticipating possible prolonged exposure to TB environments (such as working in hospitals, prisons, or homeless shelters) or those who will be staying for years in an endemic region should have a 2-step tuberculin skin test (TST) or a single interferon-γ release assay (IGRA) before travelling to Uganda. If the pre-departure test is negative, a single TST or IGRA should be repeated 8–10 weeks upon return.

For more up-to-date health advisory for travelers to Uganda with recommendations for vaccines and medications, visit the official CDC link for Uganda.

Protection from the sun

Protection from the sun while on a savannah safari trip to Uganda, travel health advisory
Keep the savannah sun’s UV rays off of your skin

Give some thought to packing sun cream. The incidence of skin cancer is rocketing as Caucasians travel more and spend more time exposing themselves to the sun.

Keep out of the sun during the middle of the day and, if you must expose yourself to the sun, build up gradually from 20 minutes per day. Be especially careful of exposure in the middle of the day and the sun reflected off water, and wear a T-shirt and lots of waterproof sun cream (at least SPF30) when swimming.

Sun exposure ages the skin, makes people prematurely wrinkly; and increases the risk of skin cancer. Cover up with long, loose clothes and wear a hat when you can.

The glare and the dust can be hard on the eyes, too, so bring UV-protecting sunglasses and, perhaps, a soothing eyebath.

Protection against Malaria in Uganda

Beds with mosquito nets are a standard in Ugandan hotels & lodges. Travel health advisory for protection against Malaria in Uganda
Beds with mosquito nets are a standard in Ugandan hotels & lodges.

Along with road accidents, malaria poses the single biggest serious threat to travelers’ health in most parts of tropical Africa, Uganda included. It is unwise to travel in malarial parts of Africa whilst pregnant or with children: the risk of malaria in many parts is considerable. These travelers are likely to succumb rapidly to the disease.

The Anopheles mosquito that transmits the parasite is most commonly found near marshes and still water, where it breeds, and the parasite is most abundant at low altitudes. The risk of malaria above 1,800m above sea level is low.

Parts of Uganda lying at an altitude of 2,000m or higher (a category that includes only high mountains such as the Bwindi, Rwenzoris, and Elgon) are regarded as free of malaria.

In mid-latitude locations, malaria is largely but not entirely seasonal, with the highest transmission risk occurring during the rainy season (March to May and October to December).

Moist and low-lying areas such as the Nile at Murchison Falls are a high risk throughout the year, but the danger is greatest during the rainy season.

This localized breakdown might influence what foreigners working in Uganda do about malaria prevention. Still, all travelers to Uganda must assume that they will be exposed to malaria and take health advisory precautions throughout their trip.

Malaria prevention

There is no vaccine against malaria that gives enough protection to be useful for Africa safari travelers, but there are other ways to avoid it; since most of Africa is a very high risk for malaria, travelers must plan their malaria protection properly. Seek current advice on the best antimalarials to take: usually Atovaquone-proguanil, doxycycline, mefloquine, or tafenoquine.

If mefloquine (Lariam) is suggested, start this two-and-a-half-week (three doses) before departure to check that it suits you; stop it immediately if it seems to cause depression or anxiety, visual or hearing disturbances, severe headaches, fits, or changes in heart rhythm.

Side effects such as nightmares or dizziness are not medical reasons for stopping unless they are sufficiently debilitating or annoying. Anyone who has been treated for depression or psychiatric problems has diabetes controlled by oral therapy or who is epileptic (or who has suffered fits in the past) or has a close blood relative who has epilepsy should probably avoid mefloquine.

In the past, doctors were nervous about prescribing mefloquine to pregnant women; however, experience has shown that it is relatively safe and certainly safer than the risk of malaria. It is now an option at some stages. However, there are other issues and if you are traveling to Uganda whilst pregnant, seek expert advice before departure.

Malarone (proguanil and atovaquone) is as effective as mefloquine. It has the advantage of having few side effects and only be continued for one week after returning. However, it is expensive, and because of this, it tends to be reserved for shorter trips. Malarone may not be suitable for everybody, so advice should be taken from a doctor.

Another alternative is the antibiotic doxycycline (100mg daily). Good for last-minute travelers because the drug is started 1–2 days before travel like Malarone. Unlike mefloquine, it may also be used in travelers with epilepsy, although certain antiepileptic medication may make it less effective. In perhaps 1-3% of people, there is the possibility of allergic skin reactions developing in sunlight; the drug should be stopped if this happens.

Women using oral contraceptives should use an additional protection method for the first four weeks when using doxycycline. It is also unsuitable in pregnancy or for children under 12 years.

Chloroquine and proguanil are no longer considered effective enough to travel to Uganda but may be considered a last resort if nothing else is deemed suitable.

Find other malaria drug recommendations from the CDC health advisory Yellowbook.

All tablets should be taken with or after the evening meal, washed down with plenty of fluid, and, except Malarone, continued for four weeks after leaving.

Despite all these precautions, it is important to be aware that no antimalarial drug is 100% protective, although those on prophylactics who are unlucky enough to catch malaria are less likely to get rapidly into serious trouble.

In addition to taking antimalarials, it is therefore important to avoid mosquito bites between dusk and dawn. Unfortunately, the occasional traveler prefers to ‘acquire resistance’ to malaria rather than take preventive tablets or who takes homeopathic Prophylactics thinking these are effective against the killer disease. Homeopathy theory dictates treating like with like, so there is no place for prophylaxis or immunization in a good person; bona fide homeopathists do not advocate it.

Travelers to Uganda cannot acquire any effective resistance to malaria. Those who don’t make use of prophylactic drugs risk their life in a manner that is both foolish and unnecessary. Malaria diagnosis and treatment Even those who take their malaria tablets meticulously and do everything possible to avoid mosquito bites may contract a malaria strain that is resistant to prophylactic drugs.

Untreated malaria is likely to be fatal, but even strains resistant to prophylaxis respond well to prompt treatment. Because of this, your immediate priority upon displaying possible malaria symptoms — including a rapid rise in temperature (over 38°C), and any combination of a headache, flu-like aches and pains, a general sense of disorientation, and possibly even nausea and diarrhea — is to establish whether you have malaria, ideally by visiting a clinic.

Diagnosing malaria is not easy, so consulting a doctor is sensible: there are other dangerous causes of fever in Africa, which require different treatments. Even if you test negative, it would be wise to stay within reach of a laboratory until the symptoms clear up and to test again after a day or two if they don’t. It’s worth noting that if you have a fever and the malaria test is negative, you may have typhoid or paratyphoid, which should also receive immediate treatment.

Travelers to remote parts of Uganda — for instance, in the game reserves and most popular hiking areas — would be wise to carry a course of treatment to cure malaria and a rapid test kit. With malaria, it is normal enough to go from feeling healthy to having a high fever in the space of a few hours (and it is possible to die from falciparum malaria within 24 hours of the first symptoms). In such circumstances, assume that you have malaria and act accordingly — whatever risks are attached to taking the dangers of untreated malaria outweigh an unnecessary cure.

Experts differ on the costs and benefits of self-treatment but agree that it leads to overtreatment and many people taking drugs they do not need, yet treatment may save your life. There is also some division about malaria’s best treatment, but either Malarone or Coarthemeter is the current choice treatment. Discuss your trip with a specialist either at home or in Uganda.

Travel clinics and health advisory information

Personal first-aid kit contents

What you should have in your Personal first-aid kit. Travel advisory for travelling to Uganda
Personal first-aid kid, an important item to have on your packing list.

A minimal first-aid kit for your trip to Uganda contains:

  • A good drying antiseptic, e.g., iodine or potassium permanganate (don’t take antiseptic cream)
  • N95 facemask, disinfectant wipes, alcohol-based hand rub, a bottle of sanitizer, or a bar of soap in a plastic box.
  • A few small dressings (Band-Aids)
  • Sunscreen
  • Insect repellent; antimalarial tablets; impregnated bed-net or permethrin spray
  • Aspirin or paracetamol
  • Antifungal cream (e.g., Canesten)
  • Ciprofloxacin or norfloxacin, for severe diarrhea
  • Tinidazole for giardia or amoebic dysentery (see below for regime)
  • Antibiotic eye drops, for sore, ‘gritty,’ stuck-together eyes (conjunctivitis)
  • A pair of fine-pointed tweezers (to remove hairy caterpillar hairs, thorns, splinters, coral, etc.)
  • Condoms or femidoms
  • Malaria diagnostic kits (5) and a digital thermometer (for those going to remote areas)

Medical facilities in Uganda

Medical facilities, Private clinics, hospitals, and pharmacies can be found in most large towns, and doctors generally speak fair to fluent English.

The main hospital is the International Hospital Kampala (Namuwongo; 0312 200400). Private clinics include Case Medical both in Kampala and Entebbe (+256-312 250 700), and IAA which is run by IMC has clinics in major cities around Uganda (+256 772 200400).

Consultation fees and laboratory tests are remarkably inexpensive (averagely UGX 20,000 – less than $10) compared with most Western countries, so if you do fall sick, it would be absurd to let financial considerations dissuade you from seeking medical help. International medical insurance cards are accepted in most modern clinics.

Commonly required medicines such as broad-spectrum antibiotics are widely available and cheap throughout Uganda, as are malaria cures and prophylactics, but wherever possible, take medicines with you. If you are on any medication before departure, or you have specific needs relating to a known medical condition (for instance, if you are allergic to bee stings or you are prone to attacks of asthma), then you are strongly advised to bring any related drugs and devices with you.

Water sterilization

You can fall ill from drinking contaminated water so try to drink from safe sources, e.g., bottled water (which is readily provided at all facilities and in tour vehicles). If you are away from shops — such as halfway up the Rwenzori — and your bottled water runs out, make tea, pour the remaining boiled water into a clean container and use it for drinking.

Alternatively, water should be passed through a good bacteriological filter or purified with iodine or the less-effective chlorine tablets (eg: Puritabs).

Common medical problems travelling in Uganda

Common medical problems travelling in Uganda

Travelers’ diarrhea

Travelling in Uganda carries a fairly high risk of getting a dose of travelers’ diarrhea; perhaps half of all visitors will suffer, and the newer you are to exotic travel, the more likely you will be to suffer.

By taking precautions against travelers’ diarrhea, you will also avoid typhoid, paratyphoid, cholera, hepatitis, dysentery, worms, etc.

Travelers’ diarrhea and the other fecal-oral diseases come from getting other people’s feces in your mouth. This most often happens from cooks not washing their hands after a trip to the toilet, but even if the restaurant cook does not understand basic hygiene, you will be safe if your food has been properly cooked and arrives piping hot.

The most important prevention strategy is to wash your hands before eating anything. Take your portable hand sanitizer wherever you go around Uganda. You can pick up salmonella and shigella from toilet door handles and possibly banknotes. The maxim to remind you what you can safely eat is:

If you can’t peel it, boil it, cook it then forget it

This means that fruit you have washed and peeled yourself, and hot foods, should be safe but raw foods, cold cooked foods, salads, fruit salads which have been prepared by others, ice cream and ice are all risky, and foods kept lukewarm in hotel buffets are often dangerous.

That said, plenty of travelers and expatriates enjoy fruit and vegetables, so do keep a sense of perspective: food served in a fairly decent hotel in a large town or a place regularly frequented by expatriates is likely to be safe. If you are stuck, see the treatment below.

Treating Traveler’s Diarrhea

It is dehydration that makes you feel awful during a bout of diarrhea, and the most important part of treatment is drinking lots of clear fluids. Sachets of oral rehydration salts give the perfect biochemical mix to replace all that is pouring out of your bottom, but other recipes taste nicer.

Any dilute mixture of sugar and salt in the water will do you good: try Coke or orange squash with a three-finger pinch of salt added to each glass (if you are salt-depleted, you won’t taste the salt).

Otherwise, make a solution of a four-finger scoop of sugar with a three-finger pinch of salt in a 500ml glass. Or add eight level teaspoons of sugar ( 18g) and one level teaspoon of salt (3g) to one liter (five cups) of safe water. A squeeze of lemon or orange juice improves the taste and adds potassium, which is also lost in diarrhea. Drink two large glasses after every bowel action, and more if you are thirsty.

These solutions are still absorbed well if you are vomiting, but you will need to take sips at a time. If you are not eating, you need to drink three liters a day, and based on whatever is pouring into the toilet.

If you feel like eating, take a bland, high carbohydrate diet. Heavy, greasy foods will probably give you cramps. If the diarrhea is bad, or you are passing blood or slime, or you have a fever, you will probably need antibiotics in addition to fluid replacement.

A dose of norfloxacin or ciprofloxacin repeated twice a day until better may be appropriate (if you are planning to take an antibiotic with you, note that both norfloxacin and ciprofloxacin are available only on prescription in the UK). Ciprofloxacin is considered to be less effective in Uganda.

If the diarrhea is greasy and bulky and is accompanied by sulfurous (eggy) burps, one likely cause is giardia. This is best treated with tinidazole (four x 500mg in one dose, repeated three to seven days later if symptoms persist).

Eye problems

Bacterial conjunctivitis (pink eye) is a common infection in Africa; people who wear contact lenses are most open to this irritating problem. The eyes feel sore and gritty, and they will often be stuck together in the mornings. They will need treatment with antibiotic drops or ointment.

Lesser eye irritation should settle with bathing in saltwater and keeping the eyes shaded. If an insect flies into your eye, extract it with great care, ensuring you do not crush or damage it; otherwise, you may get a nastily inflamed eye from toxins secreted by the creature. Small elongated red and black blister beetles carry warning coloration you not to crush them anywhere against the skin.

Heat rush

A fine pimply rash on the trunk is likely to be heat rash; cool showers, dabbing dry, and talc will help. Treat the problem by slowing down to a relaxed schedule, wearing only loose, baggy, 1100%-cotton clothes, and sleeping naked under a fun; if it’s bad, you may need to check into an air-conditioned hotel room for a while.

Skin infections

Any mosquito bite or small nick in the skin allows bacteria to foil the body’s usually excellent defenses; it will surprise many travelers how quickly skin infections start in warm, humid climates. It is essential to clean and cover even the slightest wound.

Creams are not as effective as a good drying antiseptic such as dilute iodine, potassium permanganate (a few crystals in half a cup of water), or crystal (or gentian) violet. One of these should be available in most towns.

If the wound starts to throb or becomes red and the redness starts to spread, or the wound oozes. Especially if you develop a fever, antibiotics will probably be needed: flucloxacillin (250mg four times a day) or cloxacillin (500mg four times a day). For those allergic to penicillin, erythromycin (500mg twice a day) for five days should help. See your travel advisory doctor if the symptoms do not start to improve within 48 hours.

Fungal infections also get a hold easily in hot, moist climates, so wear 100%-cotton socks and underwear and shower frequently.

An itchy rash in the groin or flaking between the toes is likely to be a fungal infection. This needs treatment with an antifungal cream such as Canesten (clotrimazole); if this is not available, try Whitfield’s ointment (compound benzoic acid ointment) or crystal violet (although this will turn you purple!).

See the CDC health advisory and medical recommendations on skin infections.

Insect-borne diseases

Malaria is by no means the only insect-borne disease to which the traveler may succumb to Uganda. Others include sleeping sickness and river blindness.

Dengue fever is rare in Uganda, but there are many other similar arboviruses. These mosquito-borne diseases may mimic malaria, but there is no prophylactic medication against them. The mosquitoes that carry dengue fever viruses bite during the daytime, so it is worth applying repellent if you see any mosquitoes around.

Symptoms include strong headaches, rashes, and excruciating joint and muscle pains, and high fever. Viral fevers usually last about a week or so and are not usually fatal.

Complete rest and paracetamol are the usual treatment; plenty of fluids also help. Some patients are given an intravenous drip to keep them from dehydrating. It is especially important to protect yourself if you have had dengue fever before since a second infection with a different strain can result in potentially fatal dengue hemorrhagic fever.

Avoiding Insect Bites

As the sun is going down, don long clothes and apply repellent on any exposed flesh. Pack a DEFF-based insect repellent (roll-ons or stick are the least messy preparations for traveling).

You also need either a permethrin-impregnated bed-net or a pet spray so that you can ‘treat’ bed-nets in hotels. Permethrin treatment makes even very tatty nets protective and prevents mosquitoes from biting through the impregnated net when you roll against it; it also deters other biters.

Otherwise, retire to an air-conditioned room or burn mosquito coils (widely available and cheap in Uganda) or sleep under a fan. Coils and fans reduce rather than eliminate bites. Safari Lodges have most of these procedures in place but if you’re not traveling on a planned trip, check out travel clinics. They usually sell a good range of nets, treatment kits, and repellents. 

Aside from avoiding mosquito bites between dusk and dawn, which will protect you from elephantiasis and a range of nasty insect-borne viruses, as well as malaria, it is important to take health advisory precautions against other insect bites. 

It is wise to wear long, loose (preferably 100% cotton) clothes during the day if you are pushing through a scrubby country; this will keep off ticks and tsetse and day-biting Aedes mosquitoes, which may spread viral fevers, including yellow fever. A Tsetse fly bite hurts like a bee sting, and it is said that These flies are attracted to the color blue; locals will advise on where they are a problem and where they transmit sleeping sickness. 

Minute pestilential biting blackflies spread river blindness in some parts of Africa between 90oN and 170oS; the disease is caught close to fast-flowing rivers since flies breed there, and the larvae live in rapids. The flies bite during the day, but long trousers tucked into socks will help keep them off. Citronella-based natural repellents (e.g., Mosi-guard) do not work against them. 

Mosquitoes and many other insects are attracted to light. If you are camping, never put a lamp near the opening of your tent, or you will have a swarm of biters waiting to join you when you retire. In hotel rooms, be aware that the longer your light is on, the greater the number of insects will be sharing your accommodation. 

Tumbu flies or putsi, often called mango flies in Uganda, are a problem where the climate is hot and humid. The adult fly lays her eggs on the soil or on drying laundry, and when the eggs come into contact with human flesh (when you put on clothes or lie on a bed), they hatch and bury themselves under the skin. Here they form a crop of ‘boils’ each with a maggot inside. 

Smear a little Vaseline over the hole, and they will push their noses out to breathe. It may be possible to squeeze them out, but it depends if they are ready to do so as the larvae have spines that help them hold on.  In putsi areas, either dry your clothes and sheets within a screened house, dry them in direct sunshine until they are crisp, or iron them. 

Jiggers or sandfleas are another flesh-feaster, which can be best avoided by ‘wearing shoes.’ They latch on if you walk barefoot in contaminated places and set up home under the skin of the loot, usually at the side of a toenail, where they cause painful, boil-like swelling. A Local expert has to pick them out.

Bilharzia

Bilharzia or schistosomiasis is a disease that commonly afflicts the rural poor of the tropics. Two types exist in sub-Saharan Africa — Schistosoma transonic and Schistosoma haematobium.

 It is an unpleasant problem worth avoiding on your Uganda safari trip, though it can be treated if you do get it. This parasite is common in almost all water sources in Uganda, even places advertised as `bilharzia free.’ Lake Bunyonyi is genuinely free of bilharzia.

The riskiest shores will be close to places where infected people use water, wash clothes, etc. It is easier to understand how to diagnose it, treat it, and prevent it if you know a little about the life cycle. Contaminated feces are washed into the lake, the eggs hatch, and the larva infect certain snail species. The snails then produce about 10,000 cercariae a day for the rest of their lives.

The parasites can digest their way through your skin when you wade or bathe in infested fresh water. Winds disperse the snails and cercariae. In particular, the snails can drift a long way, especially on windblown weed, so nowhere is really safe.

However, deep water and running water are safer, while shallow water presents the greatest risk for catching bilharzia. The cercariae penetrate intact skin and find their way to the liver. There male arid females meet and spend the rest of their lives in permanent copulation. No wonder you feel tired! Most finish up in the lower bowel wall, but others can get lost and damage many different organs. Schistosoma haematobium goes mostly to the bladder. 

Although the adults do not cause any harm in themselves, after about four to six weeks, they start to lay eggs, which cause an intense but usually ineffective immune reaction, including fever, cough, abdominal pain, and a fleeting, itching rash called `safari itch.’ 

The absence of early symptoms does not necessarily mean there is no infection. Later symptoms can be more localized and more severe, but the general symptoms settle down fairly quickly, and eventually, you are just tired. ‘Tired all the time’ is one of the most common symptoms among ex-pats in Africa, and bilharzia, giardia, amoeba, and intestinal yeast are the most common culprits. 

Although bilharzia is difficult to diagnose, it can be tested at specialist travel clinics. Ideally, tests need to be done at least six weeks after likely exposure and determine whether you need treatment. Fortunately, it is easy to treat at present. 

Avoiding bilharzia 

If you are bathing, swimming, paddling, or wading in freshwater, which you think may carry a bilharzia risk, try to get out of the water within ten minutes. 

  • Avoid bathing or paddling on shores within 200m of villages or places where people use the water a great deal, especially reedy shores or waterweed areas. 
  • Dry off thoroughly with a towel; rub vigorously. 
  • If your bathing water comes from a risky source, try to ensure that the water is taken from the lake in the early morning and stored snail-free. Otherwise, it should be filtered, or Dettol or Cresol added. 
  • Bathing early in the morning is safer than bathing in the last half of the day. 
  • Cover yourself with DEET insect repellent before swimming: it may offer some protection.

HIV/AIDS health advisory for travelling to Uganda

The risks of sexually transmitted infections are extremely high in Uganda, whether you sleep with fellow travelers or locals. If you must indulge, use condoms or femidoms, which help reduce the risk of transmission. 

If you notice any genital ulcers or discharge, get treatment promptly since these increase the risk of acquiring HIV. If you have unprotected sex, visit a clinic as soon as possible; this should be within 24 hours, or no later than 72 hours, for post-exposure Prophylaxis. It costs US$15.

Meningitis 

This is a particularly nasty disease as it can kill within hours of the first symptoms appearing. The telltale symptoms are a combination of a blinding headache (light sensitivity), a blotchy rash, and a high fever. 

Immunization protects against the most serious bacterial form of meningitis, and the tetravalent vaccine ACWY is recommended for Uganda by UK travel clinics. Although other forms of meningitis exist (usually viral), there are no vaccines for these. 

Local papers normally report localized outbreaks. A severe headache and fever should. Make you run to a doctor immediately. There are also other causes of headache and fever, one of which is typhoid, which occurs in travelers to Uganda. Seek medical help if you are ill for more than a few days. 

Catching Rabies in Uganda

To avoid catching rabies, avoid stray dogs when walking around Uganda
To avoid catching rabies, avoid stray dogs when walking around Uganda

All mammals carry rabies (beware the village dogs and small monkeys) and pass it on to man through a bite, scratch, or a lick of an open wound. 

You must always assume any animal is rabid and seek medical help as soon as possible. Meanwhile, scrub the wound with soap under a running tap or while pouring water from a jug. 

Find a reasonably learned source of water (but at this stage, the water quality is not important), then pour on a strong iodine or alcohol solution olgin, whisky, or rum. This helps stop the rabies virus from entering the body and guard against wound infections, including tetanus. 

Pre-exposure vaccination for rabies is ideally advised for everyone. Still, it is particularly important if you intend to have contact with animals and/or are likely to be more than 24 hours away from medical help. Ideally, three doses should be taken over a minimum of 21 days, though even taking one or two doses of vaccine is better than none at all. Contrary to popular belief, these vaccinations are relatively painless. 

If you are bitten, scratched, or licked over an open wound by a sick animal, then post-exposure prophylaxis should be given as soon as possible. However, it is never too late to seek help, as rabies’ incubation period can be very long. Those who have not been immunized will need a full course of injections. 

The vast majority of travel health advisors, including WHO, recommend rabies immunoglobulin (RIG). Still, this product is expensive (around US$800) and may be hard to come by — another reason why pre-exposure vaccination should be encouraged.

 Tell the doctor if you have had a pre-exposure vaccine, as this should change the treatment you receive. And remember that, if you do contract rabies, mortality is 100% and death from rabies is probably one of the worst ways to go. 

Tickbite fever 

African ticks are not the rampant disease transmitters in the Americas, but they may spread tick bite fever and a few dangerous rarities in Uganda. Tickbite fever is a flu-like illness that can easily be treated with doxycycline, but as there can be some serious complications, it is important to visit a doctor. 

Ticks should ideally be removed as soon as possible, as leaving ticks on the body increases the chance of infection. They should be removed with special tick tweezers that can be bought in good travel shops. Failing that, you can use your fingernails by grasping the tick as close to your body as possible and pulling steadily and firmly away at right angles to your skin. The tick will then come away complete as long as you do not jerk or twist. If possible, douse the wound with alcohol (any spirit will do) or iodine. 

Irritants (e.g., Olbas oil) or lit cigarettes are discouraged since they can cause the ticks to regurgitate and therefore increase the risk of disease. It is best to get a traveling companion to check you for ticks and if you are travelling with small children, remember to check their heads, particularly behind the ears. 

Spreading redness around the bite and/or fever and/or aching joints after a tick bite implies that you have an infection that requires antibiotic treatment, so seek advice.

Snakebite 

Snakes rarely attack unless provoked, and bites in travelers are unusual. You are less likely to get bitten if you wear stout shoes and long trousers when in the bush. Most snakes are harmless, and even venomous species will dispense venom in only about half of their bites. 

If bitten, you are unlikely to have received venom; keeping this fact in mind may help you stay calm. Many so-called first-aid techniques do more harm than good: cutting into the wound is harmful; tourniquets are dangerous; suction and electrical inactivation devices do not work. The only treatment is antivenom. 

In case of a bite that you fear may have been from a venomous snake: 

  • Try to keep calm — no venom has likely been dispensed. 
  • Prevent movement of the bitten limb by applying a splint 
  • Keep the bitten limb BELOW heart height to slow the spread of any ven.
  • If you have a crêpe bandage, wrap it around the whole limb (e.g., all the way from the toes to the thigh), as tight as you would for a sprained ankle or a muscle pull. 
  • Evacuate to a hospital that has antivenom. 

And remember:

  • NEVER give aspirin; you may take paracetamol, which is safe 
  • NEVER cut or suck the wound 
  • DO NOT apply potassium permanganate

If the offending snake can be captured without risk of someone else being bitten, take this to show the doctor — but beware since even a decapitated head can bite.

Up to date health advisory for travelling to Uganda

Stay in the know, find relevant health advisory information on travelling to Uganda at your embassy or consulate. Engage your travel doctor for advice before you start planning. That will help you have workable dates for your trip itinerary. Most importantly, if you’re going on a guided planned trip, talk to your trip manager about your health. It will be great for them to help you avoid places that would threaten your health. Check out these official links for more accurate health information: