Sub-Saharan Africa

Plasmodium falciparum dominates across most of sub-Saharan Africa — responsible for the vast majority of severe cases and deaths. Transmission is year-round in equatorial regions. All travelers to malaria-risk areas must take chemoprophylaxis and apply rigorous bite prevention. See our full Malaria Prevention guide.

Yellow fever vaccination is required for entry to many sub-Saharan countries. Many also require a valid IHR certificate if arriving from another endemic country. The vaccine must be administered at a certified Yellow Fever Vaccination Centre at least 10 days before travel. Protection is considered lifelong.

Both transmitted via contaminated food and water — extremely common risks across sub-Saharan Africa. Typhoid injectable vaccine should be given at least 2 weeks before departure. Hepatitis A vaccine should be given as early as possible — even partial protection before a trip is valuable.

Rabies is endemic throughout sub-Saharan Africa. Dog bites are the most common source of exposure. Pre-exposure prophylaxis (PrEP) is strongly recommended for rural travel, long trips, children, and anyone where access to post-exposure treatment (RIG + vaccine) may be delayed.

The African Meningitis Belt stretches across the Sahel from Senegal to Ethiopia. During the dry season (December–June), meningococcal meningitis outbreaks occur regularly. MenACWY vaccine is strongly recommended for travel to this zone, especially during the dry season.

TD rates of 20–50% affect visitors across the region. Cholera outbreaks occur in areas with poor sanitation — particularly in refugee camps and following floods. Safe food and water practices are essential. See our Food & Water Safety guide.

Ebola, Marburg, and other viral hemorrhagic fevers occur episodically in parts of Central, East, and West Africa. Monitor CDC and State Department alerts before and during travel. Avoid contact with dead animals, bushmeat, and healthcare facilities in active outbreak zones.

Schistosomiasis (bilharzia) is transmitted through freshwater contact — rivers, lakes, and streams across much of the region. Avoid swimming or wading in freshwater including Lake Victoria, Lake Malawi, and most inland waterways. Seawater and chlorinated pools are safe.

Dengue fever is increasingly common across urban and semi-urban areas of sub-Saharan Africa. Unlike malaria, the Aedes aegypti mosquito that transmits dengue bites during the day. Use DEET repellent during daylight hours as well as dusk-to-dawn for malaria prevention.

Dusk-to-Dawn Malaria Protection

Apply DEET repellent before going outdoors after sunset. Wear long sleeves and trousers from dusk. Sleep under a permethrin-treated bed net even in hotels — mosquito nets provided by lodges are not always in good repair.

Never Swim in Freshwater

Schistosomiasis risk is present in virtually all freshwater bodies including the famous lakes — Lake Victoria, Lake Malawi, Lake Tanganyika. Even brief wading or accidental splashing carries transmission risk. Stick to ocean or chlorinated pools.

Strict Food & Water Precautions

Drink bottled or purified water only — including for brushing teeth. Avoid ice, raw salads, unpeeled fruit, and street food from low-turnover stalls. Cooked food served hot is generally safe. See our complete Food & Water Safety guide.

Avoid Animal Contact

Do not handle or approach stray dogs, bats, monkeys, or any wild animals. Rabies is transmitted by any mammal bite or scratch — and post-exposure treatment with rabies immune globulin may be impossible to find in remote areas. If bitten, wash the wound immediately and seek medical care urgently.

Fever After Return = Emergency

Any fever within 3 months of return from sub-Saharan Africa must be treated as malaria until proven otherwise — even if you took prophylaxis. Go to an emergency room immediately, tell them you traveled to Africa, and request a blood smear. P. falciparum can kill within 48 hours of symptom onset.

Medical Evacuation Insurance

Emergency medical care is limited or unavailable in many parts of sub-Saharan Africa. Medical evacuation to South Africa or Europe can cost $50,000–$200,000. Never travel to this region without comprehensive medical evacuation insurance that explicitly covers your planned activities.

Sun, Heat & Altitude

Equatorial UV is intense year-round — use SPF 50+ sunscreen and protective clothing. Some destinations involve significant altitude — Kilimanjaro (5,895 m), the Ethiopian Highlands (2,000–4,000 m), Rwanda and Lesotho. See our Altitude Sickness guide if your itinerary includes high elevation.

Entry Requirements & Yellow Fever Certificate

Many sub-Saharan countries require proof of yellow fever vaccination on entry. Even countries that do not formally require it may demand the certificate if you are arriving from another endemic country. Carry your ICVP (yellow card) at all times. Check visa and health requirements 8 weeks before departure.

West Africa

🇧🇯 Benin

High malaria transmission year-round. Yellow fever vaccine required. Northern border touches the Meningitis Belt — MenACWY recommended.

West Africa

🇧🇫 Burkina Faso

Very high malaria risk. Meningitis Belt country — MenACWY strongly recommended. Security concerns in northern and eastern regions — check State Department advisories.

West Africa

🇨🇻 Cape Verde

Island nation with lower health risks than mainland Africa. Malaria risk limited to Santiago and Boa Vista islands. Dengue outbreaks reported. Popular tourist destination with reasonable healthcare infrastructure.

West Africa

🇬🇲 Gambia

High malaria risk year-round. Yellow fever certificate required. Popular beach destination for European travelers — US visitors should ensure full pre-travel vaccination including hepatitis A and typhoid.

West Africa

🇬🇭 Ghana

High malaria risk. Yellow fever certificate required. Popular destination for African American heritage travelers. Relatively stable politically. Good healthcare in Accra but limited in rural areas.

West Africa

🇬🇳 Guinea

High malaria and yellow fever risk. Guinea was the epicentre of the 2014–2016 Ebola epidemic. Monitor CDC health notices before travel. Healthcare infrastructure is very limited.

West Africa

🇬🇼 Guinea-Bissau

Very high malaria burden. Yellow fever required. One of the world's poorest countries — healthcare is extremely limited. Cholera outbreaks occur. Not a common tourist destination.

West Africa

🇨🇮 Ivory Coast (Côte d'Ivoire)

High malaria risk throughout. Yellow fever required. Abidjan is a major commercial hub — relatively good healthcare in the capital but very limited in rural areas.

West Africa

🇱🇷 Liberia

Very high malaria. Yellow fever required. Lassa fever endemic in rural areas. Limited healthcare infrastructure. Ebola outbreaks have occurred — monitor CDC advisories before travel.

West Africa

🇲🇱 Mali

Meningitis Belt country. High malaria. Security situation is severe in northern and central regions — US State Department Level 4 (Do Not Travel) for many areas. Verify current advisories before any planning.

West Africa

🇲🇷 Mauritania

Predominantly desert. Malaria risk in southern regions near the Senegal River. Meningitis Belt country. Yellow fever vaccination recommended although not all ports of entry require certificate.

West Africa

🇳🇪 Niger

Core Meningitis Belt country. High malaria in south. Cholera outbreaks occur. Security situation is deteriorating — check US State Department advisories carefully before travel.

West Africa

🇳🇬 Nigeria

Africa's most populous country. High malaria across all regions. Yellow fever required. Lassa fever endemic in rural areas. Monkeypox risk. Polio booster recommended. Good private healthcare in Lagos and Abuja.

West Africa

🇸🇳 Senegal

One of West Africa's most stable and tourist-friendly countries. High malaria risk in south and east. Dakar has good medical facilities. Popular gateway to West Africa — complete all vaccinations before arrival.

West Africa

🇸🇱 Sierra Leone

Very high malaria. Yellow fever required. Lassa fever endemic. Ebola outbreaks have occurred. Healthcare infrastructure is severely limited. Typhoid and cholera outbreaks occur regularly.

West Africa

🇹🇬 Togo

High malaria risk. Yellow fever required. Northern Togo is within the Meningitis Belt. Cholera outbreaks occur in coastal areas. Limited healthcare outside Lomé.

Central Africa

🇦🇴 Angola

High malaria across all regions. Yellow fever required. Cholera outbreaks occur in urban areas. Healthcare infrastructure recovering after decades of conflict — carry comprehensive medical kit.

Central Africa

🇨🇲 Cameroon

Africa in miniature — diverse ecosystems from rainforest to savannah. High malaria risk across all regions. Yellow fever required. Polio booster recommended. Onchocerciasis (river blindness) in some areas.

Central Africa

🇨🇫 Central African Republic

Extremely high health risk. Ongoing armed conflict severely limits medical access. Yellow fever required. Ebola and Marburg risk. US State Dept Level 4 — Do Not Travel for much of the country. Medical evacuation insurance essential.

Central Africa

🇹🇩 Chad

Meningitis Belt country. High malaria in south. Yellow fever required. Cholera and meningitis outbreaks occur. Very limited healthcare. Security concerns in eastern and northern regions.

Central Africa

🇨🇩 DR Congo (DRC)

World's highest malaria burden per capita. Ebola is endemic — multiple ongoing outbreaks in eastern DRC. Yellow fever required. Mpox (Monkeypox). Healthcare virtually absent outside Kinshasa. Medical evacuation insurance essential.

Central Africa

🇬🇶 Equatorial Guinea

High malaria risk in rainforest environment. Yellow fever required. Oil-rich nation but healthcare outside Malabo is very limited. Marburg virus has been detected in the country.

Central Africa

🇬🇦 Gabon

High malaria in equatorial rainforest. Yellow fever required. Gabon is a biodiversity hotspot — popular for gorilla and wildlife tourism. Ebola outbreaks have occurred historically in forest areas.

Central Africa

🇨🇬 Republic of Congo (Congo-Brazzaville)

High malaria. Yellow fever required. Ebola and Marburg have occurred in forest regions historically. Polio vaccination recommended. Healthcare is limited outside Brazzaville.

Central Africa

🇸🇹 São Tomé & Príncipe

Island nation with high malaria. Yellow fever vaccination recommended (required if arriving from endemic country). One of Africa's smallest nations — limited healthcare but improving. Beautiful ecotourism destination.

East Africa

🇧🇮 Burundi

High malaria. Yellow fever required. Schistosomiasis risk in Lake Tanganyika. Cholera outbreaks occur. Healthcare is extremely limited. Political instability — check State Dept advisories.

East Africa

🇰🇲 Comoros

Island nation with significant malaria burden. Dengue also present. Yellow fever vaccination recommended if arriving from endemic country. Very limited healthcare — medical evacuation to Madagascar or mainland Africa required for serious illness.

East Africa

🇩🇯 Djibouti

Malaria risk present but not uniformly high. Dengue and chikungunya reported. Extreme heat (regularly 45°C+ in summer). US military base presence means relatively good healthcare is accessible in the capital.

East Africa

🇪🇷 Eritrea

Malaria risk in lowland and coastal areas. Yellow fever recommended if arriving from endemic country. Heavily restricted access for tourists. Very limited healthcare. Check State Dept advisories before any travel planning.

East Africa

🇪🇹 Ethiopia

Malaria in lowland areas below 2,000 m — Addis Ababa at 2,355 m is generally low risk. Yellow fever recommended. Altitude medicine relevant for the Ethiopian Highlands. Rabies prevalent. Good healthcare in Addis Ababa.

East Africa

🇰🇪 Kenya

East Africa's most popular safari destination. Malaria risk varies — high in coastal areas and Rift Valley, lower in Nairobi and highlands above 2,500 m. Yellow fever required. Nairobi has excellent private hospitals. Altitude relevant for Mt Kenya trekkers.

East Africa

🇲🇬 Madagascar

High malaria in coastal lowlands. Plague (bubonic and pneumonic) is endemic — cases reported annually. Yellow fever required if arriving from endemic country. Unique biodiversity destination — full medical kit essential. Limited healthcare outside Antananarivo.

East Africa

🇲🇼 Malawi

High malaria across all regions. Famous for Lake Malawi — but schistosomiasis risk means no freshwater swimming. Yellow fever recommended if arriving from endemic country. Popular volunteer destination — healthcare very limited outside Lilongwe and Blantyre.

East Africa

🇲🇺 Mauritius

One of Africa's most developed tourism destinations. Malaria-free. Dengue outbreaks have occurred. Excellent private healthcare and medical facilities. No yellow fever risk — relaxed health entry requirements.

East Africa

🇲🇿 Mozambique

Very high malaria risk nationwide. Schistosomiasis in freshwater bodies. Cholera outbreaks occur. Security concerns in Cabo Delgado province. Popular beach destination despite high health risks — full preparation essential.

East Africa

🇷🇼 Rwanda

Malaria risk lower at altitude (Kigali 1,567 m) but present. Yellow fever required. Famous for mountain gorilla trekking in Volcanoes NP. Altitude above 3,000 m in Virungas. One of Africa's safest and best-organised destinations. Good private healthcare in Kigali.

East Africa

🇸🇨 Seychelles

Malaria-free island paradise. Dengue and chikungunya outbreaks reported. Good private healthcare on Mahé. No yellow fever requirement for most travelers. One of Africa's lowest overall health risk destinations for US tourists.

East Africa

🇸🇴 Somalia

US State Department Level 4 — Do Not Travel. Ongoing armed conflict, terrorism, and piracy. Very high malaria and cholera risk. No functioning healthcare infrastructure. Travel here is strongly discouraged for US citizens.

East Africa

🇸🇸 South Sudan

Very high malaria risk. Yellow fever required. Cholera and meningitis outbreaks. Ongoing conflict and humanitarian crisis — State Dept Level 4 Do Not Travel. Healthcare is virtually non-existent outside Juba.

East Africa

🇹🇿 Tanzania

Home to Serengeti, Zanzibar, and Kilimanjaro (5,895 m). High malaria risk at lower altitudes. Yellow fever required. Altitude medicine essential for Kilimanjaro climbers. Schistosomiasis in Lake Victoria and other freshwater bodies. Good private hospitals in Dar es Salaam and Arusha.

East Africa

🇺🇬 Uganda

High malaria. Yellow fever required. Ebola outbreaks have occurred — monitor CDC alerts. Famous for gorilla trekking in Bwindi. Schistosomiasis in Lake Victoria. Mpox risk. Good private healthcare in Kampala.

Southern Africa

🇧🇼 Botswana

Malaria risk in northern areas (Chobe, Okavango Delta). Southern areas and Gaborone are generally malaria-free. One of Africa's wealthiest and most stable nations. Good private healthcare in Gaborone. Popular upscale safari destination.

Southern Africa

🇸🇿 Eswatini (Swaziland)

Malaria risk in lowveld areas. World's highest HIV prevalence rate — standard precautions essential. Yellow fever recommended if arriving from endemic country. Generally accessible healthcare for a southern African nation.

Southern Africa

🇱🇸 Lesotho

Entirely malaria-free — entire country sits above 1,400 m. Altitude medicine relevant for highland travel above 3,000 m. High HIV prevalence. Typhoid and food safety precautions still relevant. Stunning mountain kingdom destination.

Southern Africa

🇲🇼 Malawi

See full listing under East Africa above.

Southern Africa

🇳🇦 Namibia

Malaria risk in northern Namibia (Caprivi Strip, Kunene). Southern areas and Windhoek are malaria-free. Yellow fever recommended if arriving from endemic country. Good private healthcare in Windhoek. Popular Namib Desert and wildlife destination.

Southern Africa

🇿🇦 South Africa

Africa's most developed country with world-class private hospitals in Johannesburg, Cape Town, and Durban. Malaria risk only in Kruger/Limpopo area and KwaZulu-Natal coast. Most major cities and Cape region are malaria-free. Cape Town is one of Africa's lowest-risk cities for US travelers.

Southern Africa

🇿🇲 Zambia

High malaria risk nationwide. Yellow fever required. Home to Victoria Falls — a popular destination shared with Zimbabwe. Schistosomiasis in the Zambezi. Limited healthcare outside Lusaka. Full medical kit essential.

Southern Africa

🇿🇼 Zimbabwe

Malaria risk in Zambezi Valley and lower altitude areas. Cholera outbreaks occur. Typhoid risk is significant. Shared access to Victoria Falls with Zambia. Healthcare infrastructure has deteriorated significantly — carry comprehensive kit. Yellow fever recommended.

East Africa

🇿🇦 Sudan (South of Sahara)

Ongoing civil war — US State Dept Level 4 Do Not Travel. Very high malaria. Meningitis Belt. Yellow fever required. Cholera outbreaks. No functioning healthcare in most areas. Travel is extremely dangerous.

West Africa

🇲🇦 Morocco (Saharan regions)

Predominantly a North African destination but included in African 54. Malaria rare — limited risk in some southern areas near Sahara. Good healthcare in major cities. Hepatitis A and typhoid vaccines recommended. Popular and accessible destination for US travelers.

North Africa

🇩🇿 Algeria

Largely malaria-free. Typhoid and hepatitis A precautions recommended. Good healthcare in Algiers. Sahara tourism in southern Algeria requires standard precautions. Check State Dept advisories for border regions.

North Africa

🇱🇾 Libya

US State Department Level 4 — Do Not Travel due to ongoing conflict. Largely malaria-free but healthcare severely impacted by civil war. Standard food and water precautions apply. Travel not recommended for US citizens.

North Africa

🇹🇳 Tunisia

Largely malaria-free. Hepatitis A and typhoid recommended. Popular Mediterranean and Sahara destination. Good healthcare in Tunis. One of Africa's more accessible destinations for US travelers with a lower overall health risk profile.

North Africa

🇪🇬 Egypt

Largely malaria-free. Typhoid and hepatitis A recommended. Popular Nile cruise and ancient history destination. Good private healthcare in Cairo. Food and water precautions essential especially during Nile cruises.