Travel health tips for Madagascar

A trip to Madagascar is, for many, a once-in-a-lifetime opportunity. However, it's important to know that Madagascar isn't without its challenges, especially when it comes to health and safety. The healthcare system, especially outside major cities, can be limited, and there are some health concerns you need to watch out for. To stay safe, it's crucial to take the right precautions before and during your trip. With the right planning, you’ll be able to enjoy Madagascar’s incredible biodiversity and culture without worrying about health concerns. Here are some of our best Madagascar travel health tips.
 

Essential vaccines for traveling to Madagascar

You technically don’t need any vaccines to enter Madagascar unless you're coming from a country where yellow fever is a risk. In that case, you’ll need to show proof of a yellow fever vaccination. But just because vaccines aren’t required doesn’t mean you should skip them—Madagascar’s Ministry of Health strongly recommends getting a few key shots, especially if you’re planning to leave the cities and explore more rural areas.

Madagascar travel health tip: Ideally, you’ll want to start thinking about vaccinations at least 6 weeks before your trip. Some need more than one dose or take a while to become fully effective, so giving yourself a couple of months’ lead time is smart.

Some vaccines for Madagascar travel  that are recommended:

• Typhoid fever vaccine: Typhoid spreads through contaminated food and water, and it’s pretty common in Madagascar—especially in places with poor sanitation. If you're planning to eat outside of hotels or restaurants catering to tourists, this one’s a good idea.
• Hepatitis A vaccine: This is a must for pretty much everyone. Hep A is also spread through food and water and is found all over the country, not just in rural areas. It’s an easy one to catch and not something you want to deal with while traveling.
• Tetanus-diphtheria-pertussis (Tdap) vaccine: If you’re doing any hiking, biking, or other outdoor activities, make sure your Tdap is up to date. Tetanus lives in soil, and even a small cut or scrape can become serious fast if you’re not protected.
• Measles-Mumps-Rubella (MMR) vaccine: There have been serious measles outbreaks in Madagascar in recent years. If you didn’t get the MMR vaccine as a kid—or aren’t sure—check with your doctor. It’s a quick and important way to protect yourself and others.

Other vaccines for Madagascar travell that might be worth it, depending on your plans:

• Yellow fever vaccine: Not required unless you’re coming from a yellow fever country, but still worth considering if you’re traveling through multiple countries in the region. It’s mosquito-borne and can be deadly, so it’s better to be safe than sorry.
• Rabies vaccine: If you’ll be spending time in rural areas, volunteering, working with animals, or just staying longer than a couple weeks, rabies protection is a good call. It’s present in both wild and domestic animals across Madagascar.
   

Pre-travel health checklist

Getting ready for Madagascar takes more than just booking flights and packing sunscreen. You’ll want to plan ahead for your health too, since access to medical supplies can be pretty limited once you’re outside the bigger cities. Here’s what you’ll want to think about before you go:

• Prescription medications: Bring more than enough of anything you take regularly, and keep them in their original containers with clear labels. It’s also smart to carry a copy of your prescriptions and a letter from your doctor explaining what each medication is for—especially in case you get asked at customs or need care on the road.
• Anti-malarial medication: If you’re heading anywhere outside the main cities—especially along the coast—you’ll need malaria protection. The risk is year-round in many places. Talk to your doctor about which antimalarial is right for you.
• Traveler’s diarrhea antibiotics: Stomach issues are common, so having a prescribed antibiotic like azithromycin or ciprofloxacin can make a big difference if things get rough. It’s not something you’ll easily find once you’re there.
• Basic first aid kit: Pack a small kit with essentials: bandages, antiseptic, tweezers, scissors, painkillers, and anything you typically use for fevers, allergies, or digestive problems. You might not be near a pharmacy when you need it.
• Insect repellent: Mosquitoes are a real issue, especially because of diseases like malaria. DEET-based repellents (30–50%) work best. You can find some in Madagascar, but the quality and price ($8–15) vary, so it’s better to bring your own.
• Sunscreen: You’ll need a high-SPF sunscreen (at least SPF 30), especially if you’re hitting the coast or going hiking. Tourist areas sell it for $12–20, but quality brands can be hard to find, so pack it if you can.
• Water purification method: Clean drinking water isn’t a given. Bring tablets, a filter, or a UV sterilizer to avoid getting sick. It’s a small thing that can make a huge difference.
  Oral rehydration salts: If you get sick, especially with diarrhea, staying hydrated is critical—especially in the heat. These packets don’t take up much space and are lifesavers when you need them.

Pre-travel health check

Maybe the most important Madagascar travel tip is to plan to see a travel doctor 4–8 weeks before your trip. They’ll go over your vaccinations, help you figure out a malaria plan, and talk through any health issues you already manage. This is especially important since healthcare in Madagascar really varies depending on where you are. In Antananarivo, you’ll find decent private clinics, but in rural areas, it might just be a basic health post with very limited supplies.

Your doctor can also give tips on how to adjust your meds across time zones and how to safely store any temperature-sensitive meds in the tropical heat.

Madagascar travel health tip: Keep in mind that healthcare services slow down a lot during major holidays—especially around Christmas, New Year, and Madagascar’s Independence Day (June 26). If your trip lines up with any of these, make sure you’ve got extra meds and don’t expect quick medical help, even in the cities.
 

How to avoid mosquito-borne illnesses

If you're heading to Madagascar, mosquito protection isn’t optional—it’s essential. The island’s warm, humid climate and all that standing water (in everything from rice paddies to old tires) make it a paradise for mosquitoes. And unfortunately, these aren’t just annoying insects; they can carry serious diseases. Outbreaks have become more common in recent years, so being prepared makes a big difference.

Here’s what actually helps when you’re on the ground:

• Stick to long, light-colored clothing that covers your arms and legs—especially at dawn and dusk when mosquitoes are most active.
• Use a good DEET-based repellent (30–50% concentration) and reapply every 4–6 hours. You’ll need to reapply more often if you’re sweating a lot or swimming.
• Sleep under a mosquito net treated with permethrin, even in cities. Always check for holes or gaps before using it.
• If you’ve got AC, use it. Mosquitoes don’t like cool, dry environments and are less likely to sneak into air-conditioned rooms.
• Try to stay away from places with standing water—think ponds, buckets, and rice fields—especially during the early morning and evening.
• Treat your clothes and gear with permethrin before you go. It sticks around for several washes and gives you another layer of defense.
• Put on repellent after sunscreen and give it about 15 minutes between applications to let both work properly.

Malaria

Malaria is still a big problem in Madagascar—there are hundreds of thousands of cases each year, and travelers aren’t immune. Around 2% of visitors end up needing treatment. The risk is highest along the coasts and in lower elevation areas below 1,500 meters. Highlands like Antananarivo are lower risk but not entirely off the hook.

You’re most at risk during the rainy season (November to April), and mosquitoes that carry malaria tend to bite from dusk to dawn. If you’re visiting coastal or rainforest areas, antimalarial medication is a must. Get a prescription before your trip and take it exactly as directed—it’s your best bet at staying healthy.

Symptoms can take a week or more to show up and usually start with high fever, chills, headache, and exhaustion. Malaria needs fast treatment, it’s best to come prepared.
 

Dengue fever

Dengue is becoming more common, especially in Toamasina, Mahajanga, and Antsiranana. The mosquitoes that spread dengue (Aedes) are active during the day, which makes this one tricky.

They love urban places with poor drainage and any little puddle they can find in things like flowerpots or trash.

If you catch dengue, symptoms usually show up 4–7 days later and hit hard: high fever, a nasty headache, eye pain, joint and muscle aches, and sometimes a rash. There's no vaccine or cure for travelers, so you’ll need to rest, stay hydrated, and avoid painkillers like aspirin or ibuprofen that could increase bleeding risk. If symptoms get worse—like severe pain or bleeding—see a doctor right away.

Chikungunya

Like dengue, chikungunya is spread by Aedes mosquitoes that bite during the day and breed in clean, still water near where people live.

If you get it, you’ll probably feel it fast: high fever and intense joint pain (we’re talking can’t-get-out-of-bed level). Other symptoms include muscle aches, headache, nausea, and a rash. It’s not usually life-threatening, but the joint pain can drag on for months.

There’s no specific treatment for chikungunya either—just rest, fluids, and something like paracetamol (not aspirin or ibuprofen). The best defense is still prevention: stay covered, use repellent, and be extra careful during the rainy season when mosquitoes are everywhere.
 

Staying healthy in Madagascar

There are a few Madagascar travel health tips to keep in mind when you are starting to draft up your itinerary.

Dealing with tropical climate

Madagascar’s climate changes a lot depending on where you are. Along the coast, it’s hot and humid most of the year. If you’re coming from a cooler place, give yourself a few days to adjust. Plan outdoor activities for the morning, avoid the midday sun (11am–3pm), and ease into things instead of jumping straight into strenuous hikes.

The sun here is no joke. You’ll burn fast—especially at higher altitudes or on the coast—so bring a good sunscreen. Even when it’s overcast, UV levels are high enough to give you a sunburn in under half an hour.

Madagascar travel health tip: You’ll also need to drink way more water than you’re used to. Most people need at least 3–4 liters a day when sightseeing, and even more (up to 5–6 liters) if you’re hiking or sweating a lot.

Food and water safety

Even in the cities, the tap water isn’t safe to drink. Stick to bottled water (make sure the seal’s intact) or use purification tablets as backup. Most hotels and restaurants offer bottled water without issue (though it does depend on where you stay in Madagascar).

In rural areas, it’s a different story. Pretty much all water sources need to be treated—wells, rivers, rain tanks, all of it. If you’ve got access to a stove, boil your water for at least a minute (or three if you’re at altitude). Otherwise, pack a reliable filter or water-purifying tablets and use them consistently.

Food-wise, hot and freshly cooked meals are your safest bet. If you’re tempted by street food—and honestly, some of it is great—go for busy stalls where you can see the food being made. Avoid anything that’s been sitting out. As for fruits and veggies, stick to the ones you can peel yourself, or wash them with treated water.

Staying safe while hiking

Madagascar is one of the most incredible hiking destinations out there—rainforests, canyons, high-altitude peaks—it’s all here. But trails can be rough, remote, and poorly marked, so hiking without a local guide really isn’t a good idea. In fact, in most national parks, guides are required. They’re worth every penny for their local knowledge and experience.

Each region has its own challenges. Ranomafana is lush and slippery. Isalo gets scorching hot. And Andringitra (home to Peak Boby) throws in altitude and unpredictable weather. If you’re visiting during the rainy season (November to April), be ready for muddy trails, fast-flowing rivers, and possible landslides.

Weather changes fast in the mountains—fog can roll in quickly, and thunderstorms are common in the afternoon. Don’t expect reliable cell signal either. Let your hotel or guesthouse know where you're headed, and consider bringing a basic emergency beacon or satellite messenger if you're doing anything remote.

Safety during lemur watching

Watching lemurs in the wild is one of Madagascar’s highlights, but don’t let their cuteness fool you—these are wild animals, and things can go wrong if you get too close or behave unpredictably.

Places like Andasibe-Mantadia, Berenty, and Kirindy are great for sightings, but they’re still wild environments, with bugs, thorns, and uneven terrain.

For Madagascar wildlife in general, there are clear rules in the parks: stay at least 5–10 meters away from lemurs, don’t feed them, and skip the flash photography. Guides are mandatory and they know how to keep both you and the animals safe. Listen to them, especially around lemur groups. Keep your voice down, stay on the paths, and avoid sudden movements.
 

Why travel insurance is a must

Healthcare in Madagascar can be hit-or-miss, and that’s putting it gently. Public hospitals—even in the capital, Antananarivo—struggle with the basics. You might find shortages of medicine, outdated equipment, and not enough trained doctors. Ambulances do exist, but they’re few and far between, often not well equipped, and might take hours to arrive—even in the city.

Private healthcare is a step up, but it’s mostly limited to Antananarivo and a few other big cities like Toamasina and Mahajanga. These clinics are cleaner, usually better stocked, and sometimes have specialists available—though it’s still not quite what you’d get in Europe or North America. Some doctors have trained abroad, and a few speak English, but French is the main language. If something serious happens, most people are evacuated to Reunion Island or South Africa.

Outside the capital, options drop off fast. Fianarantsoa and Mahajanga have a handful of decent private clinics for common issues, but once you’re in rural areas—especially near national parks or beaches—you’re probably looking at a long journey just to reach a basic government clinic. These rural centers often have very limited equipment and are usually staffed by nurses rather than doctors. Staying healthy in Madagascar means doing your research before you go.

Hospital costs in Madagascar

Medical care isn’t free, and costs can add up fast—especially if you need serious treatment or an emergency evacuation. Here’s a rough idea of what you could be looking at:

• General doctor visit: $30–60 at a private clinic in a big city. Expect to pay more if it’s after-hours or you want an English-speaking doctor.
• Specialist visit: $60–150 depending on what kind of specialist you need. Cardiologists and surgeons cost the most in top-tier clinics in the capital.
• Emergency room visit: $75–200 for an exam and basic treatment. That doesn’t include medications, lab work, or scans.
• Hospital stay: $150–300 per night in a private room with basic care in a good hospital in Antananarivo.
• Lab tests: $30–150 for standard bloodwork. More advanced tests might need to be sent to Reunion Island and can take a few days.
• Traveler treatments: $100–300 for IV fluids if you’re badly dehydrated. Malaria treatment costs around $200–500, including meds and monitoring.
• Surgery (e.g., appendectomy): $1,500–3,000 at a private hospital in the capital. That’s just the surgery—it doesn’t cover tests or recovery.
• Medical evacuation: $15,000–50,000 if you need an air ambulance to Reunion Island or South Africa. The price depends on how serious the situation is.
   

What to look for in a travel insurance

In a place where quality medical care is limited and emergencies can get expensive fast, insurance isn’t optional. The right policy can save you from a huge financial burden and make sure you actually get the help you need.

• Medical coverage: Go for a policy that covers at least $100,000 in medical costs and pays providers directly. You don’t want to be stuck paying out of pocket and chasing reimbursement later.
• Evacuation coverage: Make sure this goes up to at least $500,000 and doesn’t exclude remote areas or activities you’re planning (like hiking or diving).
• Pre-existing conditions: If you’ve got ongoing health issues, choose a plan that clearly covers them. Read the fine print on stabilization periods and paperwork.
• Adventure coverage: Many standard plans don’t include activities like scuba diving or trekking, so check this if you’re planning to get out and explore.
• 24/7 help line: Look for an insurer that offers round-the-clock assistance and can speak French—helpful when navigating Madagascar’s mostly French-speaking healthcare system.

Trusted travel insurance providers

Here are a few places to start your search for insurance:

• World Nomads: This is a go-to for anyone planning a trip with a lot of activity— hiking, diving, or off-the-grid adventures. World Nomads is known for covering riskier stuff that other insurers might exclude, and their emergency evacuation benefits are solid. 
• Allianz Global Assistance: Allianz is a reliable option if you want to tailor your coverage based on how much you're spending or what you’re planning to do. Their tiered plans give you flexibility, and the medical coverage is excellent. 
• IMG Global: Best for longer or multi-country trips. If Madagascar is just one stop on a bigger Africa trip—or if you’re staying for more than a few weeks—IMG is worth a look. They specialize in extended international coverage and have comprehensive medical benefits built for long-haul travel.
• Blue Cross Blue Shield Global: If you already have health insurance through your employer, BCBS Global might be the most seamless option. They partner with a lot of employer-provided plans and can offer direct billing at some of the better private clinics in Antananarivo, which can save you a lot of hassle if something goes wrong.
   

Emergency help: what to do if you get sick

It’s a good idea to have these emergency contacts saved in a few places—on your phone, written down in your wallet, and shared with your travel buddies. Speed matters in emergencies, and knowing who to call makes a difference.

• Police or ambulance (national emergency number): 117 — response time and quality can vary a lot by region
• Fire service/paramedics: 118 — mainly available in Antananarivo and a few larger towns
• SOS Médecins: +261 20 22 625 66 — private ambulance and home visit service (Antananarivo only)
• Polyclinique Ilafy emergency line: +261 32 07 801 01 — one of the top private hospitals in the capital
• U.S. Embassy: +261 20 23 480 00 — available 24/7 for U.S. citizens
• Your insurance provider’s emergency number — keep this saved and easily accessible

Going to the hospital

Staying healthy in Madagascar means knowing what to do in the event of an emergency. Hospital care in Madagascar isn’t like what you’re used to in Europe or the U.S. Even at the best private clinics, standards are lower. That said, private hospitals in Antananarivo are your safest bet—cleaner, faster, and more likely to have staff who speak at least some English. Public hospitals tend to be crowded, under-resourced, and not the most hygienic.

Be prepared to do more hands-on care yourself (or with a travel companion)—like helping with meals, hygiene, or even monitoring meds. That’s just how it works there.

Language can be a major barrier. Most medical staff speak French, and many don’t speak English. If you don’t speak French, it’s worth downloading a medical translation app or traveling with someone who does. Some clinics in Antananarivo might be able to get a translator if you ask in advance, but don’t count on this outside the capital.

Steps to follow when seeking medical care:

• Call your insurance’s emergency line first (unless it’s life-threatening). They can help direct you to clinics with good reputations—and may have deals in place for direct billing.
• Bring your passport, insurance documents, and cash. Even if you have insurance, you’ll probably have to pay upfront. Euros are usually preferred, but U.S. dollars are widely accepted. Some private clinics may take credit cards.
• Avoid public transport when you’re sick. Ask your hotel to arrange a taxi or private driver.
• Always ask for itemized receipts in French or English. These should list treatment codes and costs—you’ll need them to get reimbursed.
• Even in emergencies, you’re often expected to pay before you’re treated. That’s normal here. And unless your insurer has already worked out a deal with the clinic, don’t expect them to pay directly. Keep everything documented and get receipts translated if you can—it’ll make the reimbursement process much easier once you’re back home.
   

Hospitals in Madagascar by city

Here are some local hospitals to look into if you are seeking medical care:

• Polyclinique Ilafy (Antananarivo): This is one of the top private hospitals in Madagascar, offering 24/7 emergency services, surgical facilities, and intensive care units. It is known for its high-quality medical care and has a reputation for excellence in cardiology. Some of the staff are English-speaking.
• SALFA Hospital (Antsirabe): Operated by the Malagasy Lutheran Church, SALFA hospitals are mission-run facilities that maintain higher standards than many government hospitals. They offer basic emergency services, general surgery capabilities, and reliable laboratory services. 
• Clinique St. Luc (Toamasina): If you’re on the east coast, this is your best bet for medical treatment. They’ve got general doctors and a few specialists on hand, plus an emergency room that can handle serious situations until you can be transferred elsewhere if needed.  Their laboratory services are reliable for testing common tropical diseases, including malaria and dengue fever.
• Clinique Lambahoany (Fianarantsoa): This private clinic serves the highland region in the south-central part of the country. It’s relatively basic—general practitioners, emergency care, and limited equipment—but they can handle standard illnesses and stabilize patients if you need to be transferred somewhere more advanced.