Time Zone: 0 hours. No daylight savings time 2008.
Tel. Country Code: 223
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
• U.S. Embassy
ACI 2000 at Rue 243
Tel:  270-2300
Fax:  270-2340
• Canadian Embassy
route de Koulikoro
BRITISH EMBASSY LIAISON OFFICE
Bureau De Liaison de l'Ambassade de Grande Bretagne
Enceinte de l'Ambassade du Canada
Route de Koulikoro
Main switchboard:  2021 3412
Tel:  2021 3412
Mobile: 00 223 6674 8208
Consular emergency:  7640 0808
HIV Test: Not required.
Required Vaccinations: ellow fever vaccination is required upon arrival from all countries if the traveler is >1 year of age. Yellow fever vaccination is recommended by the CDC for all travelers >9 months old.
Passport/Visa: A passport and visa are required. All travelers must have international vaccination cards with a current yellow fever immunization. Travelers should obtain the latest visa information and entry requirements from the Republic of Mali Embassy at 2130 R Street NW, Washington, DC 20008, telephone (202) 332-2249. Inquiries should be made at the nearest Malian embassy or consulate. Visit the Embassy of Mali web site at http://www.maliembassy.us/ for the most current visa information.
Vaccinations: Recommended and Routine
Yellow fever vaccination is required upon arrival from all countries if the traveler is >1 year of age. Yellow fever vaccination is recommended by the CDC for all travelers >9 months old.
Hospitals / Doctors
• Medical facilities are very limited and inadequate for dealing with emergencies. Health insurance (including adequate medical evacuation) is therefore essential. Many medicines are unavailable and doctors and hospitals expect immediate cash payment for health care services.
• Point G Hospital, Bamako (550 beds); general medical/surgical facility.
• Centre Medical Interentreprise, Bamako.
Destination Health Info for Travelers
AIDS/HIV: Mali’s HIV epidemic, with an estimated adult prevalence of 1.3 percent based on the 2006 Demographic and Health Survey, is considered to be generalized, although relatively small for the West Africa region. Mali’s first case of HIV was reported in 1985, and for awhile, the epidemic appeared to have stabilized. The most recent data for Mali, collected during a 2006 DHS, indicate a possible decline in the epidemic. Adult national HIV prevalence was estimated at 1.3 percent in 2006, lower than that recorded in a similar survey in 2001, when adult national HIV prevalence was estimated at 1.7 percent (2 percent among women and 1.3 percent among men). Mortality is considered to be a contributing factor to the decline in prevalence. Source: USAID
Note: The HIV prevalence is estimated to be significantly higher in younger sexually-active urban dwellers, as well as commercial sex workers.
• 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.
Note: There is a risk of exposure to unsafe blood and blood products in Mali. Travelers may need to specifically request the use of sterilized equipment.
• 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.
More statistics are available at: http://www.avert.org/subaadults.htm (Africa)
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): There is a low risk of trypanosomiasis in Mali, primarily in the Koulikoro and Sikasso regions. Travelers to these regions should take precautions to prevent tsetse fly bites.
Animal Hazards: Animal hazards include snakes (vipers, cobras), centipedes, scorpions, and black widow spiders; crocodiles and hippopotamuses inhabit the rivers of Mali; lions and panthers are the major terrestrial hazards.
Cholera: This disease is reported active in this country, but the threat to tourists is 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)
Crime/Personal Security: We strongly advise you not to travel to the northern part of Mali, including Timbuktu, Gao and Kidal, and the border areas with Mauritania, Algeria and Niger, because of the risk of banditry, kidnapping and the activities of armed extremist groups.
Dengue Fever: An outbreak of probable dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, was reported in November 2008 from the region surrounding Kayes, Mali.
Dengue fever is a mosquito-transmitted, flu-like viral illness. 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 found at: http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf
Filariasis: Lymphatic filariasis is reported in southern areas. Travelers should take measures to prevent insect (mosquito) bites.
Food & Water Safety: All water should be regarded as being potentially contaminated. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Milk is unpasteurised and should be boiled. Powdered or tinned milk is available and is advised, but make sure that it is reconstituted with pure water. Avoid dairy products which are likely to have been made from unboiled milk. Only eat well cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially 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, but the levels are unclear. Anti-HEV markers are as high as 24% in the nearby Central African Republic. Sporadic cases may occur but go underdiagnosed or underreported. 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%. 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, with a prevalence of 4% in the blood donor 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 50; all travelers with chronic disease or a weakened immune system; travelers of any age wishing to decrease the risk of this illness; pregnant women after the first trimester.
Insects: All travelers should take measures to prevent both daytime and nighttime insect 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 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 disease-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
Leishmaniasis: Risk of cutaneous leishmaniasis occurs primarily in rural areas of the southern and central Sahel. Current incidence and distribution data are not available, but sporadic cases have been reported from semi-desert regions, with a major focus in the Nioro District of Kayes Region. Visceral leishmaniasis (kala azar) is currently not reported.
• The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils (such as found in the floors of rain forests), animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET (or 20% picaridin) repellent to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.
Malaria: Risk is present year-round countrywide, including urban areas. Risk is increased during and immediately following the rainy season (June–October). The highest risk of malaria occurs in southern Mali, particularly in the southern savanna and central Sahel zones. There is less risk in the northern Saharan region. Falciparum malaria accounts for approximately 85% of cases; P. malariae causes most other cases. Chloroquine-resistant falciparum malaria is prevalent, and mefloquine resistance has recently been reported.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), or doxycycline 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 Malipage 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 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.
Meningitis: The southern half of Mali lies within the sub-Saharan meningitis belt. Periodic epidemics occur within this country, usually during the dry season (November through June). The most recent was reported in March 2007.
Most infections are caused by Group A organisms, but Type C also occurs.
As of February 2008, >300 cases of meningococcal meningitis were recorded in the African meningitis belt. Burkina Faso reported the most cases. Outbreaks were also reported in Democratic Republic of the Congo, Central African Republic and Uganda. Other countries reporting meningitis activity included Benin, Cote d¡¦Ivoire, Ethiopia, Ghana, Mali, Niger and Togo. (Source: World Health Organization 22 February 2008)
• Meningitis vaccine is recommended for all travelers staying longer than 1 month during dry season, December to June, and should be considered for shorter stays during dry season if prolonged contact with the local populace is anticipated. The vaccine is also recommended for all health care workers and all travelers into epidemic regions at any time of year.
Onchocerciasis: Highly endemic foci are found in the Sikasso and Kayes Regions along rivers where blackflies breed. Travelers should take measures to prevent insect (blackfly) bites.
Other Diseases/Hazards: Anthrax (reported from Kati and Koulikoro Provinces), brucellosis (from consumption of raw dairy products)
• Dracunculiasis (endemic at low levels)
• Ehrlichiosis (tick-borne; a single case was reported in 1992 in a Canadian traveler)
• Lassa fever (acquired by contact with the excreta of infected rodents, but may also be transmitted person-to-person)
• Relapsing fever (tick-borne and louse-borne)
• Rift Valley Fever
Poliomyelitis (Polio): A case of polio was reported in Mali in January 2009. The total number of cases for 2009 from eight countries (Benin, Burkina Faso, Côte dIvoire, Guinea, Liberia, Mali, Niger and Togo) is 82. The most recent case (from Guinea) had onset of paralysis on 24 June.
All travelers should be fully immunized. You should receive a one-time booster dose of IPV polio vaccine if it is more than 10 years since you received your last polio vaccine.
Rabies: Human rabies is reported country-wide. Although rabies is rare among tourists—there is risk. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals. All animal bites or scratches, especially from a dog, should be taken seriously and immediate medical attention sought.
• Rabies vaccine is recommended for travel longer than 3 months, for shorter stays for travelers who plan to venture off the usual tourist routes where they may be more exposed to the stray dog population, or when travelers desire extra protection.
Schistosomiasis: Prevalence is particularly high in irrigated areas. Urinary schistosomiasis occurs throughout southern Mali, primarily in the upper reaches of the Niger River and the upper basin of the Senegal River. Intestinal schistosomiasis is almost as extensively distributed. A new focus of disease has recently been reported from the Bandiagara and Bankas Districts where the Dogon tribe is located.
• 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. Surface water is almost always contaminated and ground water from deep wells commonly brackish. Piped water supplies are either untreated and often contaminated. Water- and food-borne diseases are prevalent with sporadic outbreaks of diarrheal diseases occurring, especially during the rainy season.
• 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 and undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• 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 medical advice if you have severe or bloody diarrhea, diarrhea associated with fever and abdominal pain, or dehydration.
Tuberculosis: Tuberculosis is highly endemic in Mali 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 fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (with the exception of short-term visitors who restrict their meals to hotels) 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: In 2005, >50 suspected cases of yellow fever including 23 deaths were reported in the Bafoulabe district of Kayes region of Mali. A mass vaccination campaign was launched to control the outbreak. (Source: World Health Organization 28 November 2005)
Yellow fever vaccination is required upon arrival from all countries if the traveler is >1 year of age. Yellow fever vaccination is recommended by the CDC for all travelers >9 months old.