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Travel and Tourism

Travel and Tourism in Madagascar

Travel alerts, currency, climate, transit, health, and safety information for visitors to Madagascar.

Practical Information

Travel alert status, currency, climate, and transit details.

Travel Alert Status
Level 2: Exercise Increased Caution
Time Difference
UTC+3 (8 hours ahead of Washington, DC, during Standard Time)
Currency
Malagasy franc (MGF)
Climate
Madagascar's geography creates many climatic subdivisions. The coastal climate is hot and tropical, with the east coast receiving the most rainfall (more than 160 inches of rain in Maroantsetra.). This is due to the effect of moisture-laden trade winds off the Indian Ocean as they encounter the steep escarpment of the Madagascar coastline. The east coast is also most affected by the cyclones which periodically hit the island, often causing extensive damage. East coast temperatures reach an average high of 85° in the summer and 72° in the winter. On the west coast, precipitation levels drop off from north to south. There are desert areas of the deep south which receive only 2 inches of rain per year. West coast temperatures are generally several degrees warmer than the east coast temperatures. The central highlands, where the capital Antananarivo is located, have a more temperate climate. There are two primary seasons; the rainy summer season, which lasts from approximately November through mid-March; and the dry season, from mid-March through October. In (southern) summer, there are periods of rain almost every day, often in the late afternoon. Cyclones, which can affect the coastal areas, do not reach the highlands, but their influence can cause extended periods of rain. The average daily high temperature in summer is in the mid 80's, with a hot mid-day sun alternating with the periods of rain. Nighttime lows average in the low 60's. The shoulder months of April, May and September, October are very pleasant, with little rain, blue skies, and daytime highs in the 70's. In the (southern) winter months of June-August, the skies are often sunny and daytime highs can reach the mid-to-high 60s. However, there are also chilly days which are overcast and windy with daytime highs in the 50's. Nighttime lows in winter can drop into the 40's in Antananarivo.
Ethnic Groups
Malayo-Indonesian (Merina and related Betsileo), Cotiers (mixed African, Malayo-Indonesian, and Arab ancestry - Betsimisaraka, Tsimihety, Antaisaka, Sakalava), French, Indian, Creole, Comoran
National Holiday
Independence Day, 26 June (1960)
Geographic Coordinates
20 00 S, 47 00 E
Location
Southern Africa, island in the Indian Ocean, east of Mozambique
Airports
116

Destinations

Regions and cities, top sights, national parks, UNESCO sites, and festivals for visitors.

Antananarivo — The City on Twelve Hills

Antananarivo — universally known as Tana among locals and travelers alike — is one of Africa's most visually dramatic capitals. The city climbs across a series of rocky highland hills rising above a broad plain in the central plateau, and its architecture cascades down hillsides in layers of colonial-era buildings, traditional Merina houses of red brick and timber, and modern concrete development. The name means "city of a thousand" in Malagasy, a reference to the thousand warriors King Andrianjaka stationed here when he established his capital in the early seventeenth century.

The defining landmark of the city, indeed of all Madagascar, is the Rova of Antananarivo, the royal palace complex that crowns the highest hill — the Hill of Analamanga — at 1,469 meters above sea level. The Rova was the seat of the Merina monarchy from the early seventeenth century until the French colonial conquest in 1896. At its center stood the Queen's Palace, known as Manjakamiadana, a majestic wooden structure sheathed in silver that represented the zenith of nineteenth-century Malagasy architecture. In 1995, a catastrophic fire of suspected arson destroyed the Manjakamiadana and severely damaged other structures within the complex. Reconstruction has been underway for decades, supported by international funding, and portions of the Rova are now accessible to visitors. Standing on the palace hill, you can survey the entire city and much of the surrounding highland plain, understanding immediately why this location was chosen as the seat of a kingdom.

The city is structured, as its Malagasy name suggests, around twelve sacred hills, each with its own historical and spiritual significance in Merina tradition. The concept of the twelve hills — the Rova de Tana, Ambohimanga, Ambohidratrimo, Ambohijoky, and others — reflects the deeply geographic and ancestral conception of royal power in Merina culture. The hills are still accorded spiritual importance, and the surviving structures on many of them remain pilgrimage sites.

Slightly north of central Tana lies Ambohimanga, which translates as the "blue hill" or "beautiful hill." Designated a UNESCO World Heritage Site in 2001, Ambohimanga was the original royal capital before Andrianampoinimerina moved the seat of the kingdom to Antananarivo in the late eighteenth century. The site encompasses a walled royal city with one of the most elaborate wooden gate systems surviving from pre-colonial Madagascar. The circular diorite stone used to block the main gateway weighed several tons and required men to roll it into place each night. Within the enclosure stand several royal houses and ritual spaces preserved much as they were in the era of the Merina kingdom. Ambohimanga remains an active pilgrimage destination, and the site is considered so sacred that until relatively recently, certain ethnic groups were forbidden to visit. Today it receives both reverent Malagasy pilgrims and international tourists.

Back in central Antananarivo, the Haute-Ville (upper city) contains the most historically significant architecture. Andohalo Hill, immediately below the Rova, is the site of a large central plaza that has served as a gathering place for royal proclamations and public events for centuries. The Cathedral of Andohalo, completed in 1890 for the Merina Protestant community, commands the hillside just below the palace with striking Gothic Revival architecture.

The Basse-Ville (lower city) is the commercial heart of modern Antananarivo. The Analakely district, situated around what was historically the site of the famous Zoma Market, remains the busiest commercial neighborhood. The Zoma — the name means "Friday" in Malagasy — was historically one of the largest outdoor markets in the world, a vast weekly gathering that flooded the entire central area of the city with white market umbrellas and thousands of vendors selling everything from fresh produce and spices to household goods, textiles, and craftwork. The government moved the full Zoma off the central streets in 1997 for urban planning reasons, but smaller versions persist, and the name remains synonymous with Antananarivo's market culture. The Analakely covered market on Boulevard de l'Indépendance remains an excellent place to experience the bustle and color of Malagasy urban commerce.

Avenue de l'Indépendance, which runs from the central Analakely area toward the Soarano railway station, is Tana's most formal boulevard. Soarano station, a graceful French colonial building of yellow and red brick, was constructed in the early twentieth century as the northern terminus of the line connecting the capital to the east coast port of Toamasina. The station no longer operates regular passenger rail service but remains a landmark of the colonial urban fabric.

Lake Anosy, in the southern part of the lower city, is a tranquil man-made lake created in the nineteenth century. Its small central island is connected to the shore by a bridge and features a war memorial erected to honor Malagasy soldiers who died serving France in the First World War. The lakeside is a pleasant place for an evening stroll and is home to several restaurants and hotels.

The Musée de l'Académie Malgache, housed in a colonial building near the Tsimbazaza zoological and botanical park, holds collections documenting Malagasy natural history, ethnography, and archaeology, including fossilized remains of the giant elephant bird and the giant lemurs that went extinct after human settlement. The Tsimbazaza Zoo itself, though limited in resources by international standards, houses a range of living lemur species and provides an opportunity to see animals up close that may otherwise be difficult to observe in the wild.

The Tsarasaotra bird sanctuary, established on a small lake in the residential Ivandry district, protects populations of wetland birds including the endemic Madagascar pond heron and the fuliginous flufftail. It is a rare patch of urban nature and demonstrates the Malagasy conservation community's efforts to protect species even within city limits.

Antananarivo is the natural starting point for any Madagascar itinerary. Ivato International Airport, eleven kilometers north of the city center, receives international flights, and domestic connections to Nosy Be, Toliara, and other regional centers depart from the same facility. The city's accommodation ranges from luxury hotels to guesthouses of varying quality, and the restaurant scene has improved dramatically in recent years, with Malagasy, French, Indian, Chinese, and international options available at different price points.

Isalo National Park and the Southwest

The landscape of Isalo National Park bears no obvious resemblance to any other part of Madagascar. Straddling the Ihorombe plateau in south-central Madagascar, Isalo presents a moonscape of eroded sandstone massif, a rugged, ancient geological formation of orange and red rock carved by millions of years of rain and wind into canyons, amphitheaters, isolated pillars, natural arches, and hidden valleys. The comparison most often made by first-time visitors is to the American Southwest, to the canyon country of Utah and Arizona, and the resemblance is more than superficial: the Isalo Sandstone is of similar age and composition to many of the American desert formations, and the colors, textures, and scale produce a genuinely comparable experience of vast, ancient, sun-baked rock wilderness.

The park covers approximately 81,540 hectares and was established in 1962. Its principal appeal for most visitors is a set of hiking routes through the canyons that include swimming in natural rock pools fed by springs, waterfalls dropping from sandstone ledges into emerald pools, and dramatic viewpoints over the eroded massif. The Piscine Naturelle (natural swimming pool) is the park's most famous feature — a series of rock pools fed by a waterfall where cold, crystalline water collects in carved stone basins shaded by palms, a paradise in the middle of the dry and dusty sandstone desert. Several similar natural pools, including the blue pool and the black pool, offer equally excellent swimming and are reached by various trail routes through the canyons.

Wildlife in Isalo includes ring-tailed lemurs, Verreaux's sifakas, and a variety of endemic birds, reptiles, and insects. The sandstone environment does not support the dense wildlife of the rainforests but has its own distinctive cast of desert-adapted and endemic species. The banded kestrel, Madagascar buzzard, and Isalo rock thrush are among the birds that have adapted to the sandstone environment. The park's flora includes the distinctive palm Pachypodium rosulatum, with its rose-pink flowers growing directly from the rock, and various succulents and dryland species that thrive in the rocky substrate.

The gateway town of Ranohira sits on the RN7 highway at the edge of the park and provides accommodation and guiding services for park visitors. A distinctive natural sandstone arch — visible from the road — is another iconic Isalo landmark. The town and the surrounding area are home to people of the Bara ethnic group, who are traditionally cattle herders and whose cultural relationship with zebu cattle defines much of their social and economic life.

The Ilakaka region, between Ranohira and Fianarantsoa, became the site of one of the world's most dramatic gemstone rushes when sapphires were discovered there in 1998. Within months, tens of thousands of prospectors arrived from across Madagascar and other countries, and the previously tiny village of Ilakaka became a boomtown of makeshift stalls, rough accommodations, gem trading, and the attendant social problems of any mining rush. The area around Ilakaka remains a major global source of sapphires and rubies, and while the wild days of the initial rush have calmed somewhat, the gem trade continues and the area remains a distinctive — if rough — stop on the RN7.

All UNESCO World Heritage Sites in Madagascar

Madagascar has several properties inscribed on the UNESCO World Heritage List, recognizing the exceptional universal value of the country's natural and cultural heritage.

Andrefana Dry Forests (formerly Tsingy de Bemaraha Strict Nature Reserve) was inscribed in 1990 as the first Madagascar site on the World Heritage List. The original inscription recognized the outstanding geological formations of the limestone tsingy and the exceptional biodiversity harbored within the reserve, including numerous endemic species of lemur, bird, reptile, and plant. At the 45th session of the World Heritage Committee in 2023, the site was significantly extended and officially renamed Andrefana Dry Forests, incorporating five additional protected areas: the Special Reserves of Ankarana and Analamerana, and the National Parks of Ankarafantsika, Mikea, and Tsimanampesotse. The iconic Tsingy de Bemaraha landscape remains the centerpiece of this expanded designation.

The Royal Hill of Ambohimanga was inscribed in 2001 as a Cultural World Heritage Site. The inscription recognized the site as an outstanding example of a sacred royal hill settlement and ancestral homeland with exceptional cultural and historical importance to the Malagasy people, and particularly to the Merina people, for whom it remains an active pilgrimage site. Ambohimanga has been maintained as a sacred space for more than five hundred years and represents a unique example of Malagasy architectural, cultural, and spiritual heritage.

The Rainforests of the Atsinanana were inscribed in 2007 as a Natural World Heritage Site. The property comprises six national parks distributed along the eastern coast of Madagascar: Marojejy, Tsaratanana, Zahamena, Ranomafana, Andringitra, and Andohahela. Together these parks protect the most significant remaining blocks of Madagascar's eastern rainforest and the extraordinary biodiversity they contain, including the majority of Madagascar's lemur species and an unparalleled assemblage of endemic plants, birds, reptiles, and amphibians. In 2010, the site was placed on the List of World Heritage in Danger due to ongoing threats from illegal logging, particularly the extraction of rosewood and ebony, as well as illegal lemur hunting. Conservation work continues in partnership between the Malagasy government and international organizations.

These World Heritage designations represent international recognition of Madagascar's exceptional significance for global biodiversity and cultural heritage, and they underpin the protected status that currently shields a portion of Madagascar's remaining natural and cultural patrimony.

Outdoor Adventures and Ecotourism

Madagascar is an outdoor adventure destination of exceptional scope and variety. The combination of extraordinary wildlife, diverse landscapes, and the relative absence of mass tourism infrastructure gives Madagascar's outdoor experiences a quality of genuine wildness that more developed destinations cannot match.

Lemur trekking is the most popular wildlife activity and the one that most visitors prioritize. The experience varies significantly by destination: Andasibe-Mantadia offers the best chance of hearing and seeing indri, and guided morning walks through the forest bring visitors into the presence of family groups that are accustomed to human observers. Ranomafana combines lemur watching with the magnificent scenery of montane rainforest and the possibility of seeing rare species including the greater bamboo lemur. Ankarafantsika National Park in the northwest offers excellent viewing of Coquerel's sifaka. Berenty in the far south provides an extraordinary immersion experience with habituated ring-tailed lemurs and Verreaux's sifakas. Kirindy Forest, near Morondava, is the premier destination for nocturnal species including the giant jumping rat, the fat-tailed dwarf lemur, and the fossa.

Night walks in Madagascar's national parks and reserves reveal a completely different world from the one visible during the day. With a torch and a guide, visitors can find sleeping mouse lemurs curled in their tree hollows, nocturnal chameleons rigid on their branches with eyes closed (chameleons are visible in the dark because they lighten in color while sleeping), aye-ayes tapping for grubs, and a host of nocturnal frogs, insects, and other invertebrates that emerge after dark. Night walks are available at Andasibe, Ranomafana, Berenty, and many other parks.

Humpback whale watching in the waters around Nosy Be and the Ile Sainte Marie (Nosy Boraha) is among Madagascar's most extraordinary wildlife experiences. From June through October, the warm, shallow waters of the Mozambique Channel and the northeastern coast serve as the mating and calving grounds for populations of southern hemisphere humpback whales migrating from their Antarctic feeding grounds. The Ile Sainte Marie, a long narrow island off the northeast coast, hosts some of the highest concentrations of humpback whales in the world during July and August, when the adjacent Scaphandrier Bay becomes a stage for the elaborate aerial displays — breaching, slapping pectorals on the water, spy-hopping — that are part of humpback courtship behavior.

Hiking in Madagascar's national parks ranges from gentle walks to serious expeditions. The tsingy via ferrata in Bemaraha requires fitness and some nerve but not technical climbing skills. The Isalo canyon system offers multi-day circuits through stunning sandstone scenery. The Andringitra Massif in the southern highlands contains the country's second highest peak and is rated among the finest mountain trekking experiences in Africa, involving routes through cloud forest, rocky moorland, and spectacular granite terrain. Marojejy in the northeast requires a multi-day expedition but rewards trekkers with some of the most pristine rainforest and highest altitude scenery in Madagascar.

Diving and snorkeling in Madagascar's coastal waters offer exceptional marine wildlife. The Toliara coral reef is a vast complex of coral gardens, channels, and seagrass beds in the southwest. Nosy Be's surrounding waters include both reef diving and pelagic experiences. Masoala's coastal reefs on the northeast Peninsula are among the least disturbed in the country. The island of Ile Sainte Marie offers diving in waters protected within a national marine park.

Kayaking the Canal des Pangalanes, a system of interconnected natural lakes and man-made canals running parallel to the east coast for nearly 700 kilometers, is a slow, intimate journey through coastal communities, tropical vegetation, and fishing villages. The canal was built by the French colonial administration and remains used today for small-boat transport and fishing. Kayaking sections of it allows visitors to experience the everyday life of the east coast at water level.

The RN7 road trip, described in more detail in its own section, is considered by many Madagascar travelers to be the country's premier adventure experience — a land journey that combines highland culture, rainforest wildlife, semi-arid canyon landscapes, and the shifting scenery of Madagascar's most varied terrain.

Festivals and Events

Madagascar's cultural calendar is rich with ceremonies and celebrations that reflect the diverse traditions of its many ethnic groups. Understanding the major festivals can help you plan your visit to coincide with the most vivid expressions of Malagasy cultural life.

The famadihana ceremonies of the central highlands take place primarily between July and September, the dry season when highland temperatures are cool and the timing is considered auspicious according to the vintana system. There is no fixed calendar for individual family famadihana — each family holds the ceremony according to their own schedule — but July to September is the concentrated season, and it is possible, particularly with local contacts or a knowledgeable guide, to receive an invitation to attend as a respectful observer.

The Donia Music Festival, held annually in late May or early June on Nosy Be, is the most prominent music event in Madagascar. Donia brings together Madagascar's leading musical artists for several days of concerts featuring salegy, tsapiky, hira gasy, and other Malagasy musical traditions, along with invited international artists from the wider Indian Ocean music world. The festival draws thousands of Malagasy visitors from around the country and an increasing number of international music enthusiasts.

The Festival des Baleines (Whale Festival) is held on Ile Sainte Marie in July, coinciding with the peak of the humpback whale season. The festival combines whale watching excursions, cultural events, and conservation awareness activities and has grown steadily in international profile as the whale watching destination of Ile Sainte Marie has become better known.

Madagascar's Independence Day is celebrated on June 26 with official events, parades, and public festivities in Antananarivo and regional centers. The day is an important national occasion, and Malagasy families typically gather for meals and celebrations.

Alahamady Be is the Malagasy New Year, celebrated according to the Malagasy lunar calendar in late February or March. The timing is determined by the alignment of the moon and the traditional astrologers' calendar. Celebrations include the ritual slaughter of zebu, family gatherings, the preparation of special foods, and visits to ancestral tombs.

The Santabary ceremony, which marks the first tasting of the new rice harvest, is another important agricultural and spiritual ceremony that varies in timing by region according to the local harvest calendar. The ceremony involves ritual prayers and offerings to ancestors before the community begins eating the new season's rice, and reflects the central place of rice in Malagasy spiritual as well as material life.

Local festivals, market days, and traditional sports events (including the athletic games held at highland ceremonies) occur throughout the year and represent perhaps the richest layer of Malagasy cultural life for the traveler willing to get off the main tourist circuit and seek out the rhythms of everyday Malagasy society.

The East Coast and Ile Sainte Marie

The east coast of Madagascar stretches for more than 1,600 kilometers from north to south, a ribbon of tropical coastline backed by the escarpment of the central highlands and fronted by a surf-battered shoreline that receives the full force of the Indian Ocean trade winds. The coast is accessed at several points, primarily through the port cities of Toamasina (Tamatave) in the north-center and Manakara and Farafangana in the south, and via the island of Ile Sainte Marie (Nosy Boraha) offshore.

Toamasina is Madagascar's principal port city, a hot, humid, palm-shaded town of substantial size that handles the majority of Madagascar's seaborne trade. The city has a more African feel than the highland capital, with a street life defined by the rhythms of port commerce, market trade, and the social patterns of the Betsimisaraka ethnic group who predominate on the east coast. The beaches north of Toamasina, including the Foulpointe area, are popular with Malagasy vacationers from the capital.

The Canal des Pangalanes begins just south of Toamasina and runs parallel to the coast for nearly 700 kilometers, a partly natural, partly man-made waterway system of connected lakes, rivers, and canals that provides a sheltered inland water route navigable by small boat or pirogue. The canal was developed by the French colonial administration in the early twentieth century to avoid the treacherous surf of the open east coast, and it continues to serve local communities as a transport route and fishing ground. Traveling by boat along sections of the Pangalanes canal offers an intimate and largely un-touristy window into east coast Malagasy life — fishing communities, rice paddies, tropical vegetation, and the leisurely pace of a world that operates by water rather than by road.

Ile Sainte Marie — known in Malagasy as Nosy Boraha — is an island approximately 60 kilometers long and between 5 and 7 kilometers wide, situated about 10 kilometers off the northeast coast. It was historically an important pirate base in the late seventeenth and early eighteenth centuries — the era of Caribbean and Indian Ocean piracy — and a small cemetery on the island contains the graves of several identifiable pirates. The island's elongated shape and sheltered western lagoon, protected from the Indian Ocean swells by the island itself, create waters of exceptional calm and clarity.

Ile Sainte Marie is best known today as Madagascar's premier humpback whale watching destination. From July through September, the sheltered waters of the Baie des Baleiniers (Whalers' Bay) fill with humpback whales that have migrated from their Antarctic feeding grounds to breed and calve in warmer tropical waters. The bay gets its name from the historical practice of whaling ships anchoring here, and today the same sheltered conditions that once favored whalers now make whale watching uniquely intimate and reliable. During the peak weeks of August, boats can be surrounded by multiple whale pods simultaneously, with mothers and calves, competitive groups of males pursuing females, and the extraordinary aerial displays of breaching, tail-slapping, and spy-hopping that make humpback whales the most spectacular large marine mammals for wildlife observation.

Practical Tips for Specific Regions

Navigating Madagascar effectively requires region-specific preparation, as the country's infrastructure, climate, and travel dynamics vary considerably from one area to another.

For visitors to Antananarivo, the most important practical advice concerns safety. The capital has experienced periodic petty crime and occasional more serious incidents targeting tourists, particularly in the Basse-Ville at night. Walking alone at night in less busy areas is not recommended. Taxis are the safest form of transport after dark, and using hotel-recommended or app-based taxi services is preferred over hailing street taxis. During the day, the main tourist areas including the Haute-Ville, the Analakely market, and the Rova approaches are generally safe with normal urban precautions.

For the RN7 road trip, the key preparation involves vehicle selection, timing, and booking accommodations in advance for peak season. A 4WD vehicle is not strictly necessary for the main RN7 in dry season (it is a paved road for its full length), but is strongly recommended for any detours to national parks and for better handling of road conditions that may have deteriorated since the last maintenance cycle. Booking accommodation at Ranomafana, Ranohira (Isalo), and Fianarantsoa at least a month ahead during July and August is essential, as the best lodges fill quickly.

For Nosy Be, the key variables are timing and choosing your base. The peak whale watching season of July and August brings the largest number of visitors and the most reliable wildlife sightings but also the highest prices and greatest demand on accommodation and boat services. The shoulder seasons of June and September offer good conditions with fewer visitors. The wet season from November to April brings lower prices but also higher rainfall, reduced visibility for whale watching, and some dive site closures.

For Bemaraha and the Tsingy, road access from Morondava is only feasible in the dry season, roughly May to November. The wet season renders the laterite tracks into deep mud that is impassable for most vehicles. Even in dry season, the road requires a capable 4WD vehicle and a driver experienced on the route. Flying to Bekopaka via small charter plane from Morondava or Antananarivo is an option that bypasses the road challenge entirely, though at significantly greater cost.

For the eastern rainforests, timing is somewhat less critical than for other regions, as the forests receive rain year-round. However, the peak of the wet season (December to March) brings the heaviest rain, highest leech activity, and muddiest trails. The May to November dry season offers more comfortable trekking conditions. For indri calling at Andasibe, the early morning is essential — indri calls typically occur between 7 and 10 a.m. and are rarely heard later in the day.

For the south and spiny forest, the dry season (April to November) is most comfortable, as the heat in the south is extreme year-round but most intense and humid during the wet season (December to March). The Berenty Reserve is accessible year-round. Travel to the extreme south (Tolagnaro/Fort Dauphin area and Andohahela National Park) requires either domestic flights (available but limited) or a long overland journey that is only advisable with a well-prepared vehicle and experienced driver.

Health and Safety

Medical facilities, vaccinations, disease risk, and sanitation conditions.

Medical Facilities and Care

Medical Facilities and Health Information
Standards of healthcare throughout Madagascar are well below U.S. standards. There are small hospitals and clinics in Antananarivo that provide basic but acceptable care for emergencies. Outside of Antananarivo, the quality of care is very questionable and should only be used when other options are not available. Caution and good judgment should be exercised when seeking hospital and medical services. The U.S. Embassy maintains a list of hospitals and specialists, which can be provided on demand. Most medications, generally of French or South African origin, are available in Antananarivo. If you need to refill a prescription from outside of Madagascar, it is important to carry a prescription from your health care provider listing the medicine's generic name, but it is best not to rely on re-filling medications in Madagascar as the availability varies. Travelers are advised to carry a supply of anti-malarial medication if traveling outside Antananarivo. U.S. citizens who will be carrying medications with them to Madagascar may wish to contact the Malagasy Embassy in Washington, D.C., regarding any restrictions on imports. Ambulance services are available in Antananarivo with Assistance Plus at 032 07 801 10 or 22 487 47; Polyclinique d’Ilafy at 22 425 73 or 033 11 458 48; Espace Medical at 22 625 66 or 22 481 73 or 034 05 625 66; and CDU (Centre de Diagnostic Medical d’Urgences) at 22 329 56. However, due to traffic jams, response times are often dangerously slow. Assistance Plus has air ambulance capacity for remote and less accessible regions of the country. Malaria is prevalent, particularly in the coastal regions. Using preventive measures and malaria prophylaxis is strongly recommended. Rabies is endemic, and there are many street dogs. It is recommended that travelers have the pre-exposure vaccination series prior to arrival in Madagascar. If bitten by an animal, wash the affected area immediately with soap and running water for ten minutes. Seek medical care immediately at the Institute Pasteur in Antananarivo. Plague is also endemic to Madagascar, but casual tourists are unlikely to be infected. While the reported HIV prevalence rate is low, particularly by African standards, Madagascar suffers from a very high reported incidence of sexually transmitted infections and tuberculosis. The East African Indian Ocean islands have seen a rise in cases of chikungunya, a viral dengue-like ailment, and dengue itself. As with malaria, chikungunya and dengue are transmitted by mosquitoes. Every effort should be made to use bed nets, repellants, proper clothing, and barriers that discourage/prevent mosquito bites. The CDC has further information on chikungunya and dengue on their website. Travelers should drink bottled water or carbonated beverages. Local water is not potable. Water purification tablets may be used as necessary. Bottled water is readily available.
Accessibility
While in Madagascar, individuals with disabilities may find accessibility and accommodation very different from what you find in the United States. While the constitution and law prohibit all forms of discrimination, including on the basis of race, gender, disability, language, and social status, there are no specific government institutions designated to enforce these provisions. There is ample public transportation, but entering and existing vehicles is precarious, and they are not equipped to accommodate passengers with disabilities. Vehicles are often still in motion as passengers enter and exit. There are no sidewalks in the vast majority of the country, and the roads are hazardous for foot travel with swerving vehicles and uneven surfaces. There are no pedestrian crossing signs or designated pathways, and crossing any street involves an element of risk. Pedestrian injuries are common. Public spaces are not wheelchair accessible. Domestic and international air services operate regularly but are subject to delays and occasional breakdowns. Air Madagascar often changes in-country flight schedules based on demand; flights that are not full may be cancelled with little or no prior warning to passengers. Overbooking is also common. Reconfirmation of tickets prior to flight day is recommended, especially when flying from provincial airports.

Disease Risk

Degree of Risk
very high
Animal-Contact Diseases
rabies
Food and Waterborne Diseases
bacterial diarrhea, hepatitis A, and typhoid fever
Vectorborne Diseases
malaria and dengue fever
Water-Contact Diseases
schistosomiasis