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Travellers' Diarrhoea
  Travel Advice     Food & Drink Safety      
Don't let 'Banjul Belly', otherwise known as travellers' diarrhea (TD), ruin your holiday in The Gambia. Mild, moderate or severe diarrhoea affects about 40% of European travellers who spend a fortnight or more in The Gambia, but by adopting a number of food and water precautions you can minimise the chances of being one of them.

To avoid travellers' diarrhoea in Gambia do not eat food that is either not piping hot or below 5C in the case of chilled foods. Cooked meals that have been kept at room temperature are particularly prone to high bacteria levels. Don't eat vegetables or fruits unless they have been cooked properly, peeled or shelled as in the case of groundnuts. Don't eat fruits that have damaged skin as they could contain toxins or bacteria that can lead to food poisoning. Mouldy fruits could contain Botrytis, and should also be rejected.

Eating from mobile street vendors is risky as they often do not keep their raw meats and fish refrigerated or on ice, and are prone to being landed on by flies. Furthermore they maybe tempted to carry over their meat from yesterday. Undamaged fruits and nuts that can be peeled or shelled are a safer option to buy from street vendors.

When eating in a restaurant avoid raw or undercooked fish or meat. Certainly do not order rare steak. Certain kinds of fish may contain bio-toxins even after cooking. Avoid eating certain reef and predator species such barracuda, grouper, seabass, red snapper, jack,  as it could lead to ciguatera fish poisoning (CFP). Ciguatoxin is very heat-resistant, so ciguatoxin-tainted fish can't be detoxified by conventional cooking.

So the simple rule is this: boil it, cook it, peel it, or forget it!

Tap water, unpasteurised milk, dairy products such as locally made ice cream and ice cubes are linked with increased risk of getting TD in Gambia. If you want to have ice cubes you have to be sure that it is made from purified water otherwise it's just like drinking the tap water. As for ice-cream you need to make sure it has been imported and made from pasteurised milk.  Only drink purified or mineral bottled water or water that has been boiled, micro-filtered or purified with tablets such as iodine. Bottled and packaged soft drinks, hot tea or coffee, beer, and wine, are usually safe to drink.

Travellers often ask "Is it safe to brush my teeth with tap water" in their hotel. The fact is that tap water in the resorts and residential areas along the coast is chlorinated and shouldn't really cause any problems, but if you are really concerned you might want to use a mouthwash afterwards. If you really aren't confident about the water then use bottled water which is readily available in most small stores and supermarkets.

 Pharmaceutical Remedies
There are a number of over-the-counter antidiarrhoeal medicines available to treat the unpleasant intestinal disorder such as bismuth subsalicylate and loperamide.

Bismuth subsalicylate is quite effective for temporary cases of diarrhoea, if you have a chronic attack, then you'll likely need something more powerful. The remedy works by balancing the way liquid moves through your intestines. It also lessens inflammation and inhibits the growth of certain viruses and bacteria that cause diarrhoea from growing in the intestines and stomach.

Loperamide works by decreasing the speed with which food moves through your bowels. This gives your intestines more time to absorb fluid so that you have more solid stools and fewer bowel movements a day. It is normally taken after a diarrhoeal episode.

In addition to the above antidiarrhoeal drugs travellers to The Gambia should consider packing antibiotics which have been demonstrated to be effective. Among these are azithromycin, levofloxacin and rifaximin and if available prulifloxacin. These antibiotics might be taken as a prophylaxis in situations where a traveller has a history of digestive disorders, such as irritable bowel syndrome, or whose immune system is weakened.

 Prevent Dehydration
A bout of diarrhoea usually lasts only a few days and is often mild to moderate. The problem usually goes away on its own, without using any remedies. If you get a prolonged bout of diarrhoea or vomiting it can cause your body to excrete more fluid than is taken in. This leads to dehydration which can be particularly dangerous in the aged and children. It is important to increase your fluid intake when you get an attack.

Adults can increase their intake of water by taking in little regular sips throughout the day. The other method to combat diarrhoea in adults is to consume select sports drinks. Their salt and sugar contents taken together allows water to be absorbed by the body. Avoid drinks that can exacerbate the symptoms such as alcoholic, sugary or caffeinated drinks. For some individuals dairy products such as milk can worsen the symptoms.

The best way to combat dehydration, particularly for children, is Oral Rehydration Therapy. This is a type of fluid replacement which is drunk as a treatment for dehydration. It replaces the lost fluids and essential salts thus preventing or treating dehydration and lowering the danger. It is basically salt and sugar dissolved in water in precise proportions, though there are commercially available rehydration salts which contain glucose and other ingredients. The solution is also drunk throughout the day in little sips and is available in most of Gambia's Greater Banjul area pharmacies.

 Plain & Simple Diet Treatment
One way to reduce the severity and length of a diarrhoeal episode is by going on a bland diet, particularly in the first 24 hours of an attack, as certain foods can worsen symptoms. Among a few recommended foods are plain rice, porridge, bananas, toast, mashed or boiled potatoes, plain crackers, probiotic yogurt, white bread, plain pasta, canned fruit, applesauce, squash, carrots, low fat smooth peanut butter, skinless baked chicken, Tapioca pudding, boiled eggs.

Avoid eating fatty foods, dairy products such as milk and ice cream, alcohol, sorbitol, and tainted foods.

Note carefully: Disclaimer
Always seek the advice of your medical doctor before deciding to take or not to take any medications or health precautions. The above information does not and is not intended to replace or substitute the advice and / or recommendation from your doctor or other authorised medical practitioner.
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