Time Zone: +2 hours. No daylight savings timein 2008.
Tel. Country Code: 265
USADirect Tel.: 0
Electrical Standards: Electrical current is 230/50 (volts/hz). United Kingdom Style Adaptor Plug. Grounding Adaptor Plug C.
Travel Advisory - Malawi
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 Malawi
• U.S. Embassy
Area 40, City Center
Tel:  773-166, 773-342 and 773-367
Fax:  265-770-471
• Canadian Embassy
Accord Centre, M Chipembere Highway
Tel:  (1) 845-441, 841-612, or 843-277
Fax:  (1) 843-446
• British High Commission
Telephone:  (1) 772 400
Fax:  (1) 772 657
HIV Test: Not required.
Required Vaccinations: A yellow fever valid vaccination certificate is required from all travelers older than 1 year arriving from infected areas.
Passport/Visa: Malawi is a developing landlocked country in southern Africa. Tourist facilities in major cities and in resort areas are steadily improving, but remain limited. Aging infrastructure and lack of investment have rendered electricity, water supply, and telecommunications unreliable in rural areas.
ENTRY/EXIT REQUIREMENTS: A passport, return ticket, and adequate funds are required. U.S. citizens traveling to Malawi for tourism, transit or business for 30 days or less can obtain a visa at the airports or border points of entry. The 30-day visa may be extended up to an additional 60 days by the Malawi Department of Immigration prior to expiration. There is no guarantee your request will be granted.â€¨Americans wishing to volunteer, study, conduct research or business for more than 90 days in Malawi are responsible for requesting the correct type of visa from the Malawian Embassy or Consulate, prior to traveling to Malawi. Malawian immigration authorities have fined, arrested, and deported American citizens who entered Malawi with a tourist visa and conducted other business or volunteer services. Persons that overstay their visa expiration date even unknowingly have been fined, arrested and deported. â€¨There is an airport departure tax, which is payable only in U.S. dollars, for all non-Malawians. For the most current visa information, contact the Embassy of Malawi at 1029 Vermont Avenue NW, Washington, DC 20005; telephone  (202) 721-0270.
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 at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and 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): Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.
Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never 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: Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection.
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.
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL and Boostrix are new tetanus-diphtheria-pertussis (Tdap) vaccines that not only boost immunity against diphtheria and tetanus, but have the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccines can be administered in place of the Td vaccine when a booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to hotels or resorts.
Yellow Fever: Travelers >1 year of age entering the country from an endemic area are required to present a certificate of immunization against yellow fever.
Hospitals / Doctors
Medical care is substandard throughout the country, even in the best private medical facilities. Medical facilities are rudimentary and most local medical providers do not speak fluent English.
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 - the equivalent drugs may not be available; may be counterfeit; or be of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage, including air ambulance medevac. In the event of a serious illness or injury that can't be treated locally, every effort should be made to arrange medical evacuation to South Africa.
The U.S Embassy maintains a list of hospitals and doctors at: http://lilongwe.usembassy.gov/doctors.html
The Medical Aid Society to Malawi has a list of hospitals at: http://www.masmmw.com/providers_four.htm
Lilongwe Central Hospital
Tel:  (1) 754 725
General medical/surgical facility.
• Adventist Health Centre
Tel:  (1) 731 819
• Blantyre Adventist Hospital
Tel:  620 488
Mwaiwathu Private Hospital
Often used by expatriates. High degree of sanitation and cleanliness.
• Medical Rescue Services Clinic
Tel:  731 807
• Queen Elizabeth Central Hospital
Tel:  (1) 674 333
General medical/surgical facility.
• Likuni Mission Hospital
200 beds. Recommended as one of the better local hospitals.
Destination Health Info for Travelers
AIDS/HIV: The majority of HIV infections in Malawi occur through heterosexual sex. There is a high prevalence of HIV amongst certain labor groups in Malawi, including commercial sex workers, truck drivers, fishermen and other mobile groups whose movement between areas facilitates the spread of HIV infection. There is no available information about the number of infections transmitted through sex between men, but the number is thought to be relatively low. HIV prevalence is almost twice as high in urban areas as it is in rural areas. There is a higher rate of HIV prevalence amongst women than amongst men: around 60% of adults living with HIV in Malawi are female. The majority of HIV infections occur amongst young people, particularly those between the ages of 13 and 24.
HIV prevalence rates vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in South Africa and Zambia around 15-20% of adults are infected with HIV. In four southern African countries, the national adult HIV prevalence rate now exceeds 20%. These countries are Botswana (24.1%), Lesotho (23.2%), Swaziland (33.4%) and Zimbabwe (20.1%).
The HIV prevalence rate in Malawi is estimated at 14.7% (Source: Avert.org)
• 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.
African Sleeping Sickness (Trypanosomiasis): Trypansomiasis (sleeping sickness) is endemic throughout the country, especially in the Kasungu and Vwaza Game Reserves, near the Luangwa Valley of Zambia. Trypanosomiasis was recently confirmed in a British soldier who acquired the infection on a field exercise in the Kasunga National Park. This is the 5th case of trypanosomiasis in travelers to this area in 2007.
• Travelers should take precautions against insect (tsetse fly) bites.
Animal Hazards: Animal hazards include snakes (vipers, cobras), centipedes, scorpions, and black widow spiders.
Cholera: An outbreak of cholera in Blantyre, Chikwawa, Chiradzulu, Mulanje, Nkhotakota, Nsanje and Thyolo started in November 2007. The threat to tourists, however, is considered very low. Cholera vaccine is recommended only for 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 do not 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)
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 may be endemic but levels are unclear. Transmission of HEV occurs primarily through contaminated drinking water. In developing countries, prevention of HEV relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 8% to 10%. 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 in the general population. 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. The flu vaccine is recommended for all travelers over age 6 months.
Insects: All travelers should take measures to prevent both daytime and nighttime insect bites. Insect-bite prevention measures include a DEET-containing repellent applied to exposed skin, insecticide (permethrin) spray applied to clothing and gear, and use of a permthrin-treated bednet at night while sleeping.
Malaria: Risk is present year-round throughout this country, including urban areas. Malaria risk is highest along the shores of Lake Malawi, where the risk is highest at the end of the rainy season, November through April. Falciparum malaria accounts for approximately 90% of
cases. The rest of the cases of malaria are due to the P. ovale and P. malariae species, rarely P. vivax.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine is recommended.
A malaria map is located on the Fit for Travel website, 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 Malawi page on the Destinations menu or A-Z Index.
Malaria is transmitted via the bite of an infected 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 mosquito bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellent (20% formulation) is now recommended by the CDC as an acceptable alternative to DEET 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.
Meningitis (Meningococcal): Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.
• Areas in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found at: http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx#651
Onchocerciasis: A focus of disease activity may exist in the southern Thyolo highlands. Travelers to this area should take measures to prevent insect (blackfly) bites.
Other Diseases/Hazards: African tick typhus, African tick-bite fever, brucellosis (from consumption of raw dairy products), dengue (low risk), echinococcosis, filariasis (may occur along the lower Shire River and along the shores of Lake Malawi), leishmaniasis (risk undetermined; sporadic cases may occur), leptospirosis, meningitis, plague, rabies (transmitted by dogs, hyenas, and jackals), toxoplasmosis, syphilis, tuberculosis (a major health problem), trypanosomiasis (reported from the Kasungu and Vwaza Game Reserves, near the Luangwa Valley of Zambia), trachoma, typhoid fever, and intestinal helminths (very common).
Plague: An outbreak of bubonic plague reported in 1997 in southern Malawi with eight cases identified.
Poliomyelitis (Polio): Immunization is recommended, due to the persistence of polio in sub-Saharan Africa. A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never 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: Sporadic cases of human rabies are reported countrywide. All animal bites or scratches, especially from a dog, should be taken seriously, and immediate medical attention sought. Access to rabies vaccine or rabies immune globulin may require emergency travel to another country.
Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. 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, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status. Note: If adequate rabies treatment is not available locally, medical evacuation is advised to a facility that can provide treatment.
Schistosomiasis: Risk areas are distributed countrywide with an intense focus along the shores of Lake Malawi, as well as the Shire River.
Schistosomiasis is a parasitic flatworm infection of the intestinal or urinary system caused by one of several species of Schistosoma. Schistosomiasis is transmitted through exposure to contaminated water while 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: High risk. There are water treatment systems in some major urban areas, but even treated water should be considered potentially contaminated. Travelers should observe all food and drink safety precautions. A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of acute diarrhea. Diarrhea not responding to treatment with an antibiotic, or chronic diarrhea, may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
Tuberculosis: Tuberculosis is highly endemic in Malawi with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (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, prolonged contact with the local population. 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 unvaccinated 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: A yellow fever vaccination certificate is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones. Vaccination is not recommended or required otherwise.