Health, malaria and getting care in Ghana

What actually goes wrong on a Ghana trip

Most visitors to Ghana have no health problem at all, and of those who do, the overwhelming majority are dealing with an upset stomach, sunburn, dehydration or a heat headache rather than anything dramatic. The serious risk worth planning around is malaria. The most common cause of serious injury is the road.

That ordering matters, because people arrive frightened of the wrong things. Nobody needs to worry about the diseases that make international news; they need to worry about drinking enough water in Accra in March, about what they ate at a roadside stop at three in the afternoon, and about whether the vehicle they are in has working seatbelts.

The other thing to hold onto is that Ghana is not a country without medicine. There are teaching hospitals, well-equipped private clinics, pharmacies on more or less every high street, and doctors who see more malaria in a month than a European GP will see in a career. What is different is how care is paid for and how you find it, and that is the part worth understanding before you need it.

Everything below assumes an ordinary trip of a week or three. If you are coming to stay, arriving with a pre-existing condition, or travelling with a small child, talk to a travel medicine clinic well before you fly rather than reading anything online, including this.

What to sort out before you fly

Two things must be done before departure and cannot be fixed on arrival: a yellow fever vaccination certificate, which Ghana requires for entry, and a travel clinic appointment for malaria prophylaxis and any vaccines you need topped up. Start both at least six to eight weeks out.

Yellow fever is the one with legal teeth. The certificate is checked at Kotoka on arrival, and the requirement applies to travellers arriving from anywhere, not only from other yellow fever countries. The vaccine needs time to take effect before it counts, which is why leaving it to the last fortnight causes problems. We go through the certificate, where to get it and what happens if you turn up without one in our guide to the yellow fever certificate for Ghana.

Beyond that, a travel clinic will usually talk to you about hepatitis A, typhoid, tetanus and, depending on your plans and how long you are staying, rabies, meningococcal disease and hepatitis B. Rabies is the one visitors dismiss and should not: dogs are everywhere, monkeys at some sites are habituated to people, and post-exposure treatment is far simpler if you have had the pre-exposure course.

The third thing to arrange is insurance that actually covers you, including medical evacuation, because the cost of an air ambulance out of West Africa is not something you want to discover at the time. Read what your policy excludes — motorbike riding and some adventure activities are common exclusions — and carry the policy number somewhere that is not only your phone. Our guide to travel insurance for Ghana covers what to look for.

Malaria: what you are actually dealing with

Malaria is present throughout Ghana, all year, in every region including central Accra, and the predominant parasite here is the one capable of killing an adult within days if untreated. That is the honest framing, and it is why prophylaxis is not optional caution for a two-week trip.

It is transmitted by Anopheles mosquitoes, which bite between dusk and dawn. This is the most useful single fact in the whole subject, because it tells you when to protect yourself. The mosquitoes biting your ankles at lunchtime on a beach at Kokrobite are a nuisance; the ones in your room at one in the morning are the problem.

Risk is higher during and just after the rains, when standing water multiplies breeding sites, and it is higher in rural areas than in air-conditioned parts of Accra. But higher and lower are the only honest words here. There is no zero-risk month and no zero-risk region, and people do contract malaria in Osu and East Legon.

Ghanaians themselves live with a degree of partial immunity built up from repeated childhood exposure, which is why a Ghanaian colleague may treat malaria as a bad week while it puts a visitor in hospital. If you grew up in Ghana and have been abroad for years, that immunity fades — returning diaspora travellers are not protected by having been born here, and this catches people out badly.

Prevention people actually stick to

The prevention that works is the prevention you will still be doing in week three, which means picking a tablet you tolerate and building a bite-avoidance routine that takes thirty seconds a night. Perfection abandoned on day four protects nobody.

On tablets, a travel clinic will discuss the options with you — the daily and weekly regimens differ in cost, in how long you must continue after leaving, and in side effects, and the right one depends on your health, your other medication and how long you are staying. Take the first dose on schedule before arrival, take it at the same time each day, and finish the full course after you get home. Stopping early because you have landed safely is the classic mistake, and it is the reason people fall ill a fortnight after returning.

On bites, the routine is short. Use a repellent with DEET or picaridin on exposed skin from late afternoon, reapply after swimming or heavy sweating, and put it on after sunscreen rather than before. Wear long sleeves and trousers in the evening, particularly outdoors at dinner or on a hotel terrace. Sleep either in a properly air-conditioned room with the windows closed or under an intact net tucked under the mattress, and check the net for holes before you get in rather than at two in the morning.

Two small things make a disproportionate difference. Treating your clothes and your net with permethrin before you travel is cheap and lasts several washes. And plug-in insecticide vaporisers, sold in every Ghanaian supermarket and most pharmacies, work well in a closed bedroom — switch one on an hour before you go up.

If you get a fever

Treat any fever in Ghana, or within a year of leaving, as possible malaria until a blood test says otherwise — and get the test the same day rather than waiting to see how you feel tomorrow. This single rule is the difference between a treatable illness and an emergency.

Malaria does not present tidily. It often looks like flu: fever, chills, sweating, headache, aching muscles, sometimes nausea, diarrhoea or a cough. There is no symptom that distinguishes it reliably from other causes, which is exactly why you test rather than guess. Do not assume that because you have taken every tablet you cannot have it, because prophylaxis reduces risk substantially but does not eliminate it.

Testing in Ghana is fast and ordinary. Rapid diagnostic tests and blood film microscopy are available at clinics, hospitals and many pharmacies and laboratories across the country, results come back quickly, and nobody will find your request unusual. Treatment, if you test positive, is an artemisinin-based combination therapy, which is the standard first-line treatment used in Ghana and is widely stocked.

Fever in Ghana means a malaria test today, not a paracetamol and a lie-down.

Buy medication from a registered pharmacy rather than a street stall or a hawker at a lorry station. Substandard and falsified antimalarials circulate in the region, and a real pharmacy with a pharmacist behind the counter is your protection against them. If you develop a fever after you get home, tell the doctor you were in Ghana and say the word malaria out loud — a GP in Manchester or Toronto may not think of it, and the delay is what causes harm.

Water, food and the stomach week

Do not drink tap water anywhere in Ghana, including in good hotels in Accra. Drink sachet water or bottled water, both of which are sold everywhere, cost very little and are what most Ghanaians drink themselves.

Sachets — half a litre of filtered water in a sealed plastic bag, universally called pure water — are the local default. Bite a corner and drink from it. Buy them from a shop or a fridge rather than from a basin of melting ice at a junction, check the seal is intact, and put the empties in a bin rather than out of the window, which is where a good deal of Accra's drain problem comes from. Bottled water is fine too; check the cap seal is unbroken.

Ice, salad and unpeeled fruit are the usual culprits when someone gets ill, because they carry tap water into a meal that otherwise looked safe. Established restaurants and hotels in Accra, Kumasi and Cape Coast generally make ice from treated water and wash produce properly. A roadside place in a small town probably does not, and that is where you eat hot food and skip the salad.

Street food itself is not the enemy, and avoiding it would cost you the best eating in the country. The rule is heat and turnover. Waakye served from a busy stand at seven in the morning with a queue is fine. Grilled tilapia and banku cooked in front of you is fine. Kelewele coming straight out of the oil is fine. What you avoid is food that has been sitting warm since lunchtime, anything with a lot of hands between the pot and your plate, and stands where nobody is buying.

If your stomach does turn, the answer is usually oral rehydration salts, which every pharmacy in the country sells in sachets for almost nothing, plus rest and bland food. See a doctor if there is blood, a high fever, or if it goes past two or three days, because that is no longer ordinary travellers' diarrhoea.

Heat, sun and the tiredness nobody expects

Heat is the health issue that affects the most visitors and gets the least preparation, because it does not feel like a medical problem until you are already flattened by it. Ghana is hot and humid year-round in the south and hotter still in the north before the rains, and the humidity is what makes it hard — sweat does not evaporate, so your body cannot cool itself efficiently.

The symptoms creep. A headache in the late afternoon, a heavy tiredness that feels like jet lag on day five, irritability, cramp, dark urine. Most people put it down to travel and carry on, which is how mild dehydration becomes heat exhaustion by the third day of a busy itinerary.

What works is unglamorous. Drink considerably more water than you think you need and keep a bottle in the vehicle. Add electrolytes or an oral rehydration sachet on hard days, particularly after a long walk at Kakum or a climb at Shai Hills. Move your walking and your driving to the morning and keep the middle of the day slow — Ghanaians do, and the country's rhythm is built around it. Wear loose cotton and a wide hat, and use sunscreen, because you are close to the equator and a cloudy day will still burn you.

Northern Ghana deserves a separate line. Around Tamale, Mole and Bolgatanga, the dry-season heat in the weeks before the rains is a different order of thing, and the Harmattan months bring dust that irritates eyes, throats and asthma. Anyone with a respiratory condition should carry their inhaler and expect to need it. Our Ghana packing list covers the practical kit for both extremes.

The other risks worth knowing about

Three more things are worth your attention: freshwater contact, animals, and the road — and the road is by a wide margin the most dangerous of them.

Schistosomiasis, also called bilharzia, is present in Lake Volta and in other slow-moving fresh water in Ghana. The parasite enters through intact skin, so wading counts, not only swimming. Do not swim at Akosombo, Ada's river side or in rural streams, however inviting the water looks and however many local children are in it. Swimming pools with treated water and the sea are fine. If you have had freshwater exposure and feel unwell weeks later, tell a doctor exactly where and when.

Animal bites need immediate attention. Wash any dog, cat or monkey bite or scratch with soap and running water for a good fifteen minutes, then get to a clinic the same day for assessment — rabies is invariably fatal once symptoms begin and entirely preventable before that. The monkeys at sanctuaries such as Boabeng-Fiema and Tafi Atome are wild animals accustomed to being fed, and they do bite.

Then there is the road. Road traffic injury is the most realistic serious risk a visitor to Ghana faces, far ahead of any infection. Night driving on unlit intercity roads with unmarked vehicles and livestock is genuinely dangerous; overloaded trotros and speeding long-distance buses are a real hazard. Use seatbelts front and back, avoid motorbike taxis, refuse to travel with a driver who is clearly exhausted, and do not schedule long drives to finish after dark.

Two smaller notes. Dengue is mosquito-borne but transmitted by day-biting mosquitoes, so daytime repellent has a purpose too. And meningococcal disease is a consideration in the far north during the Harmattan, which a travel clinic will raise with you if your route goes that way.

Pharmacies: the first stop for most problems

For most minor illness in Ghana the pharmacy is the right first stop, and pharmacists here are accessible, experienced and used to advising walk-in patients directly. You do not need an appointment and you will not wait long.

There is a distinction worth knowing. A registered pharmacy has a qualified pharmacist and stocks the full range, including prescription medicines. A licensed chemical seller is a smaller shop permitted to sell a limited list of over-the-counter medicines, and these are far more common in small towns and villages. Both are legitimate; for anything beyond painkillers and rehydration salts, find the pharmacy.

Stock is generally good in Accra, Kumasi, Takoradi and Tamale, and thinner as you go rural. Bring your own supply of any prescription medication you depend on, in its original labelled packaging, with a copy of the prescription — brand names differ between countries and a pharmacist in Kasoa cannot dispense against a foreign brand name they do not recognise. Carry the generic name written down.

Two cautions. Buy only from a shop with a proper counter, and never from hawkers selling tablets at lorry stations or in traffic, because that is where falsified medicine circulates. And ask the price before the pharmacist starts packing; it is a normal question and nobody will be offended.

Where to go if you need a doctor or a hospital

For anything beyond a pharmacy, Accra has both good private facilities and major public hospitals, and as a visitor you will generally be directed to the private ones for speed. Nyaho Medical Centre and The Bank Hospital are among the private facilities used by expatriates and insurers in Accra; the public teaching hospitals are Korle Bu, along with 37 Military Hospital and the Greater Accra Regional Hospital at Ridge.

Outside Accra, Komfo Anokye Teaching Hospital in Kumasi, Cape Coast Teaching Hospital and Tamale Teaching Hospital are the main referral centres for their regions, and there are district hospitals and private clinics in every sizeable town. If you are somewhere remote and something serious happens, the realistic plan is stabilisation locally and transfer to Accra or Kumasi, which is exactly what medical evacuation cover is for.

Payment is the part that surprises people. Ghana's National Health Insurance Scheme is for residents; as a visitor you are a private patient, and private hospitals normally expect payment or a confirmed guarantee from your insurer before treatment rather than after. Some deal directly with international insurers and some do not. Carry a means of paying and your policy details, keep every receipt and every discharge summary, and call your insurer's emergency line early rather than after you have been admitted.

For emergencies, 112 reaches the National Ambulance Service and emergency services. Response times vary with location and traffic, and within a city a taxi or hotel vehicle often gets there faster. Ask your hotel or your driver which facility they use; local knowledge about which hospital is functioning well this month is more reliable than any list.

What we do about this for our travellers

Ghana Travel & Tour builds the practical side of this into the trips we arrange: drivers who do not do long night drives, vehicles with working seatbelts and air conditioning, accommodation with nets or reliable air conditioning, and a note of the nearest functioning hospital and pharmacy for each stop on your route. If you fall ill mid-trip, your trip manager will get you to a clinic and rearrange what needs rearranging.

We are not medical advisers and we will always send you to a travel clinic for vaccines and prophylaxis. What we can do is on our travel services page, and every quote is itemised and comes from a named trip manager you can reach directly.

Questions people ask