Health & Safety in Madagascar
Vaccinations
Mandatory
Yellow fever vaccination is mandatory if you are arriving from or have transited through a country where yellow fever is endemic (most of sub-Saharan Africa and parts of South America). You will need to show your International Certificate of Vaccination (yellow card) at immigration. Without it, you may be denied entry or vaccinated on the spot.
Strongly recommended
- Hepatitis A — transmitted through contaminated food and water. Essential for all travellers.
- Typhoid — also food/water-borne. Recommended especially if visiting rural areas.
- Hepatitis B — transmitted through blood and bodily fluids. Recommended for longer stays.
- Tetanus-Diphtheria — ensure your routine boosters are up to date.
- Rabies — recommended if you plan to spend time in rural areas or around animals. Rabies is present in Madagascar.
Visit a travel health clinic at least 4–6 weeks before departure. Some vaccinations require multiple doses spaced over weeks.
Malaria & Mosquitoes
Malaria is present throughout Madagascar, including in urban areas. It is transmitted by Anopheles mosquitoes that bite mainly between dusk and dawn. The predominant strain is Plasmodium falciparum, the most dangerous form.
- Antimalarial prophylaxis — consult your doctor. Common options include Malarone (atovaquone-proguanil), doxycycline, or mefloquine.
- Mosquito repellent — use DEET-based repellent (30–50%) on exposed skin, especially at dusk and dawn.
- Sleep under a mosquito net — most hotels provide them, but carry a compact net as backup.
- Wear long sleeves and trousers at dusk and dawn.
- Use air conditioning or fans — mosquitoes are less active in cooled rooms.
Other mosquito-borne diseases present in Madagascar include dengue fever and chikungunya. The same protective measures apply. There is no prophylaxis for dengue — prevention is purely about avoiding bites.
Water & Food Safety
Tap water is not safe to drink in Madagascar. Always drink bottled or purified water. Ice in drinks should be avoided unless you are certain it was made from purified water. Eat freshly cooked food, peel fruit yourself, and avoid raw vegetables in places with questionable hygiene.
Medical Facilities
Medical facilities in Antananarivo are adequate for basic care but limited compared to Western standards. Outside the capital, medical infrastructure is very basic. Carry a well-stocked first aid kit and any prescription medications you need.
Comprehensive travel insurance with medical evacuation coverage is essential. In serious cases, medical evacuation to Réunion, South Africa, or Europe may be necessary. Ensure your policy covers emergency air evacuation.
Sun & Heat
Madagascar is close to the equator. UV radiation is intense, even on cloudy days. Use high-SPF sunscreen, wear a hat, and stay hydrated. Heat exhaustion and dehydration are common risks, especially during the hot season (November–April).
General Safety
Madagascar is generally a safe destination, but like anywhere, common sense applies. Petty theft can occur in crowded areas and markets, especially in Antananarivo. Avoid walking alone at night in urban areas. Keep valuables in a hotel safe and carry only what you need.
- Avoid displaying expensive jewellery, cameras, or electronics in crowded areas
- Use official taxis or trusted transport services
- Be cautious with ATMs — use those inside banks or shopping centres
- Carry a photocopy of your passport, keep the original in the hotel safe