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Botswana



Capital: Gaborone

Time Zone: +2 hours.
Tel. Country Code: 267
USADirect Tel.: 0
Electrical Standards: Electrical current 230/50 (volts/hz). United Kingdom Style Adaptor Plug. Grounding Adaptor Plugs C, F.


Travel Advisory - Botswana

Sub-Saharan Africa has the highest incidence of insect-transmitted diseases, such as malaria, and all travelers need products to prevent mosquito and tick bites. I recommend all travelers use a combination of DEET or Picaridin repellent on their skin and Permethrin fabric insecticide on their clothing for greater than 99% protection against mosquito and tick bites.

Dr. Rose Recommends for Travel to Botswana


Resource Links

NaTHNaC
World Health Organization
CDC
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies

• U.S. Embassy
Embassy Drive
Gaborone
Tel: [267] 395-3982
E-mail consulargaboro@state.gov
Website: http://botswana.usembassy.gov/

• Canadian Embassy 
Vision Hire Building
Queens Road
Gaborone
Telephone & Fax: [267] 30-44-11
E-mail: canada.consul@info.bw

• British High Commission
Plot 1079-1084 Main Mall
off Queens Road
Gaborone
Tel: [267]395 2841
Email: bhc@botsnet.bw 
Website: www.britishhighcommission.gov.uk/botswana

Entry Requirements

HIV Test: Not required.

Required Vaccinations: Yellow fever vaccination required for all travelers >1 year of age arriving from any yellow fever endemic zone country in Africa or the Americas.

Passport Information

 A passport with at least six months of validity remaining is required. U.S. citizens are permitted stays up to 90 days without a visa. For additional information on entry requirements, travelers may contact the Embassy of the Republic of Botswana, 1531-1533 New Hampshire Ave, NW, Washington, DC 20036; Telephone (202) 244-4990/1; fax (202) 244-4164; or the Permanent Mission of the Republic of Botswana to the United Nations, 103 E. 37th St., New York, NY 10016; Telephone (212) 889-2277; fax (212) 725-5061. There are also honorary consuls in Los Angeles, San Francisco and Houston. 

Go to the Embassy of Botswana website at http://www.botswanaembassy.org/ for the most current visa information. As a general precaution, all travelers are advised to carry a photocopy of the photo/bio information page of their passport and keep it in a location separate from the passport.
Visitors to Botswana who also intend to visit South Africa should be advised that the passports of all travelers to South Africa must contain at least two blank (unstamped) visa pages each time entry to South Africa is sought; these pages are in addition to the endorsement/amendment pages at the back of the passport. Otherwise, the traveler, even when in possession of a valid South African visa, may be refused entry into South Africa, fined, and returned to their point of origin at the travelers expense.

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all non-immune travelers who might be exposed to infected blood or body fluids from unprotected sex; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from contact with open skin sores. Recommended for any traveler requesting protection against hepatitis B infection. 

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

Meningococcal (Meningitis): Vaccination with a quadrivalent vaccine is advised for those travelers anticipating close contact with the indigenous population. Botswana is below the sub-Saharan meningitis belt.
• Areas in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found at:
http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx#651


Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).

Rabies: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites. Children are considered at higher risk because they tend to play with animals and may not report bites. Pre-exposure vaccination eliminates the need for rabies immune globulin in the event of a high-risk animal bite, but does not eliminate the need for treatment with the vaccine.

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels.

Yellow Fever: Yellow fever vaccination is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones in Africa or the Americas, but is not recommended or required otherwise.

Hospitals / Doctors

Medical facilities in Gaborone are adequate, but available facilities in other areas are limited. Well-equipped emergency rooms and trained physicians are available in the capital but services are rudimentary elsewhere. Professional private emergency rescue services operate air and ground ambulances throughout the country, but care is rendered only after a the ability to pay is established. Response times are often slow in less populated areas. 
Note: Outside of Gaborone, most airports are either not equipped or have frequently malfunctioning night lighting capability, so airborne medical evacuations can usually only be conducted during daylight hours.
• All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country. 
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. In the event of serious medical conditions, every effort should be made to go to Johannesburg, South Africa. 

A list of hospitals, clinics, and doctors is found on the U.S. Embassy website at: 
http://botswana.usembassy.gov/medical_information.html

Facilities used by travelers inclde:

• Avenue Medical Center 
Independence Avenue
Gaborone
Tel: 390-7771

• Botswana Adventist Medical
Gaborone
Tel: 395-1515

• Princess Marina Hospital, Gaborone (237 beds); general medical and surgical services.

Destination Health Info for Travelers

A Country Profile: Botswana is a land-locked nation in south central Africa, located on South Africa’s northern border. Botswana is about the size of Texas but has a population of only 1.6 million. The small population is a result of Botswana’s aridity; two-thirds of the nation is taken up by the Kalahari Desert, and only 5 percent of Botswana’s land is arable.
The presence of diamonds and other mineral resources has made Botswana wealthy relative to other African nations. The per capita GNI of more than $3,000 is deceptive, however, as wealth is unevenly distributed, and a quarter of the working age population is unemployed.
• Botswana has been devastated by HIV/AIDS. Reversing the trend of rapid population growth seen in most African nations, AIDS is expected to result in Botswana’s population falling by a quarter by 2025. Botswana’s HIV prevalence rate is the second highest in the world, superceded only by that of Swaziland.
• TB prevalence in Botswana is currently 231 per 100,000, with a death rate of about 43 per 100,000. One of the goals of the BOTUSA Project, a joint venture of the Botswana Ministry of health and the CDC, is to address the growing problem of TB in Botswana.
• Malaria is endemic in the northern parts of Botswana, including Kasane and Francistown, but generally not in the south. WHO reports that in 2000 the malaria death rate for children ages 0-4 was 72 per 100,000.

AIDS/HIV: Botswana is among the countries hardest hit by HIV/AIDS. In 2006, there were an estimated 270,000 people living with HIV, giving Botswana an adult HIV prevalence rate of 24.1%, the second highest in the world after Swaziland. (An earlier UNAIDS estimate of 37.3% prevalence in Botswana is now thought to have been too high.) Heterosexual contact is the predominate mode of transmission. Due to the AIDS epidemic life expectancy at birth has been reduced from 67 to 47 years. 
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids of another person or their blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.

Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if Medevac or air ambulance services are required.
Health insurance is essential.

African Sleeping Sickness (Trypanosomiasis): Recent incidence data are not available. Sporadic cases have been reported in the northern areas, including cases among foreign visitors to the Okavango swamps in the northwest district of Ngamiland. Travelers at most risk are those on safari and game-viewing holiday. Travelers to urban areas are at very low risk. The tsetse fly comes out in the early morning and the late afternoon. Insect repellent applied to the skin does not prevent tsetse fly bites, so travelers should wear protective clothing and sleep under a bed net.
Initial symptoms: The bite of tsetse fly can be painful and may develop into a raised red sore, called a chancre. The initial sore may subside or develop into an expanding red, tender, swollen area, followed by a generalized illness with fever, myalgia, abdominal discomfort, diarrhea, vomiting, headache, rigors, and sweats. 
Read more: http://www.phac-aspc.gc.ca/tmp-pmv/info/af_trypan-eng.php

Animal Hazards: Animal hazards include snakes (vipers, cobras), centipedes, scorpions, and black widow spiders.

Cholera: Cases of cholera may occur sporadically, but the threat to tourists is very low. No outbreaks are currently reported. Cholera vaccine is usually recommended only for people, such as relief workers or health care personnel, who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who don’t have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)

Dengue Fever: Dengue is known or presumed to occur in this country. Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in parts of Africa. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases. 
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear. 
• There is no vaccination or medication to prevent or treat dengue.
A dengue fever map is at:http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf

Gnathostomiasis: Gnathostomiasis is a nematode infection caused by the late third-stage larva (L3) of the helminth Gnathostoma spp. A foodborne zoonosis, it is endemic where people eat raw or undercooked fish that harbor the infectious L3.
In 2008, two outbreaks of the parasitic disease gnathostomiasis were reported from the Okavango Delta. Humans become infected by eating undercooked or raw freshwater fish such as bream, catfish, snake-headed fish, sleeper perch, Nile tilapia, butterfish, or eel; frogs; snakes; chickens; snails; or pigsfish or poultry containing third-stage larvae, or reportedly by drinking water containing infective second-stage larvae. 
Studies in the 1990s confirmed the efficacy of a 21-day course of albendazole, 400 mg 2x/d and ivermectin, 0.2 mg/kg immediately or for 2 consecutive days.
Read more: http://www.medscape.com/viewarticle/590049

Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Hepatitis A is transmitted through contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation. 
• Hepatitis E is endemic at a high level with outbreaks reported in north-central areas. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 10% to 12%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at an unclear level in the general population. (The prevalence of hepatitis C antibody in neighboring South Africa is 1.7%.) Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C — an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Influenza: Influenza is transmitted year-round in the tropics. Influenza vaccine is advised for all travelers over 6 months of age.

Leishmaniasis: Very low risk. Sporadic cases have been reported in the medical literature.

Malaria: An outbreak of malaria was reported in April 2008 from the Bobirwa area, at the eastern tip of Botswana close to Zimbabwe and South Africa. Malaria is moderately endemic October to mid-April in northern areas, including the Boteti, Chobe, Ngamiland, Okavango, and Tutume districts/subdivisions. Limited transmission occurs in the southeastern border with South Africa, extending along the Molopo River bordering South Africa. Gaborone is essentially risk free, except in years with very heavy rainfall. 
• Prophylaxis with atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), or primaquine (G6PD test rquired) is recommended.

A malaria map is located on the Fit for Travel website (www.fitfortravel.nhs.uk), which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Botswana page on the Destinations menu or A-Z Index.

Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies. 
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
• Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.

Other Disease/Outbreaks: African tick typhus (contracted from dog ticks, often in urban areas)
• African tick-bite fever (transmitted by cattle ticks)
• Arboviral fevers (mosquito-transmitted; West Nile and Rift Valley fever may occur; explosive urban outbreaks of chikungunya fever have occurred, but human cases are primarily reported from rural areas)
• Brucellosis (from contaminated meat or unpasteurized dairy products)
• Leptospirosis
• Rift Valley Fever
• Tick-borne relapsing fever
• Flea- and louse-borne typhus

Plague: An outbreak in Central District, near Lake Xau, was reported in 1989–1990, with 164 human cases and 12 fatalities. Doxycycline prophylaxis is recommended only if travelers expect to have on-going, close contact with rodents (e.g., field biologists). 

Rabies: Human cases of rabies occur in this country. All travelers should avoid contact with animals, especially dogs and monkeys. No one should pet or pick up stray animals. Dogs are the primary source of human infection. Rabid jackals are also a potential threat, especially in the rural eastern areas. 
Pre-exposure rabies vaccine is recommended for travel longer than 3 months, for shorter stays in rural when travelers plan to venture off the usual tourist routes and where they may be more exposed to the stray dog population; when travelers desire extra protection; or when they will not be able to get immediate medical care.
• All animal bite wounds, especially from a dog, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment, regardless of your vaccination status. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine.
• Even if rabies vaccine was administered before travel, a 2-dose booster series of vaccine is needed after the bite of a rabid animal.

Road Safety: Driving outside of large towns is dangerous. Major roads are in good condition, but the combination of long, tedious stretches of 2-lane highways, high speed limits (120kph), and the occasional presence of large animals on roads (particularly in the Okavango Delta) makes fatal accidents not infrequent. Driving at night on rural highways particularly hazardous and is strongly discouraged.
Desert conditions in remote areas are harsh. Travel to these areas should not be undertaken without a guide and a four-wheel-drive vehicle equipped with provisions, fuel, and water. Contact Medical Rescue International if you want assistance in a planning a trip, or if you need emergency help.

• Medical Rescue International
Plot 20623 Block 3
Broadhurst Industrial
Gaborone
Emergency: [267] 390-1601
Admin: [267] 390-3066
Fax: ([267] 390-2117
Email: enquiries@mri.co.bwis (available for assistance or planning)
Internet: http://www.mri.co.bw/

Schistosomiasis: Risk areas of urinary schistosomiasis are widely distributed along the eastern border from Francistown to Lobatse, with scattered foci in the north. Risk areas for intestinal schistosomiasis are confined to the Okavango Delta marshlands in the northwest district of Ngamiland and the northeastern Chobe drainage system, including the Kasane vicinity.
• Schistosomiasis is transmitted through exposure to freshwater streams, rivers or lakes during activities such as wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection. All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, or streams. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: Water from deep boreholes may be unpalatable due to high salinity. Indiscriminate disposal of human waste causes serious contamination of ground water in many villages, and in some towns. Piped water is available many communities but many water treatment and distribution systems are poorly maintained and may be contaminated. 
Water- and food-borne diseases are a risk in this country. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%. 
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis. 
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.

Tuberculosis (TB): Tuberculosis is a significant health problem in Botswana and cases of extremely drug-resistant (XBR) disease are reported. XDR-TB is defined as resistance to three or more second-line antibiotics for TB. The condition remains treatable with other types of medications, but those are less effective, costlier and toxic.
• This country has a TB prevalence of over 100 cases per 100,000 population, the highest WHO risk category. TB is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact with an infected individual. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.

Typhoid Fever: Typhoid vaccine is recommended by the CDC for all people traveling to or working in sub-Saharan Africa, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.

Yellow Fever: There is no risk of yellow fever in Botswana, but a yellow fever vaccination certificate is required for travelers >1 year of age arriving from yellow fever infected area