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What is bilharzia? Is it safe to swim in Lake Malawi - 2000

Question: I am planning a trip to East Africa in a few months. I've heard that there is a problem with something called bilharzia in Lake Malawi, where I was planning on staying a while. What is it? And is it safe to swim there or not?

Answer: What you have heard, sadly is correct. Lake Malawi used to be one of the only lakes in Africa where you could swim in the knowledge that there were no problems with bilharzia, however now there are reports of cases of this problem being contracted out there.

Bilharzia, or schistosomiasis as it is known medically, is an illness caused by a nasty little worm. Like a lot of parasites it needs a host to lay their eggs in, which unfortunately is us, and then another intermediary vector for the young worms to grow in before completing the cycle and reinfecting humans again. In the case of the bilharzia worm the other vector is a freshwater snail that lives in the reeds and grasses beside African lakes. It is in these areas that we can get infected, when walking barefoot through, or swimming close to the lakeside.

The worm can penetrate our skin and then goes to lay its eggs in the liver, bladder or blood supply to both. Symptoms can range from feeling mildly unwell, through to passing of blood on urination or even liver failure in the later stages. But before you worry too much, it is very easy to diagnose and easy to treat too.

It is possible to pick up the infection before the eggs have been laid by a simple blood test, and the treatment is a day's worth of tablets called praziquantel. You can try to prevent the worm from coming into contact with you by either swimming farther out in the lake, from a boat for example, and also by wearing protective shoes if you are wading through the reeds.

There are some parts of the Lake that seem to be more affected than others, and the worst appears to be in the South at Cape Maclear. Sadly, for me, this is the most beautiful part but I know there are boats there to take you out farther from the shore to go snorkelling or diving, just keep your boots on when disembarking.

So, if you do go swimming and feel unwell up to a couple of weeks after, then go to a doctor who will be able to test your blood and effect a cure if it comes back positive.

Enjoy your trip, and remember the advice is the same for the other Central African lakes too.


Dr Jules Eden

Dr Jules Eden
MBBs BSc MRCGP




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Information published on this website is not a substitute for professional medical care or advice but should be used only as an aid in understanding current medical knowledge. A Doctor should always be consulted for any health problem or medical condition.

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