Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) (PDF) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

Malaria in Nigeria: prophylaxis is recommended for all travelers. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a recently approved combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.

Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.

Insect protection measures are essential.

For further information about malaria in Nigeria, including a map showing the risk of malaria in different parts of the country, go to the World Health Organization and Roll Back Malaria.

The following are the recommended vaccinations for Nigeria:

Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Yellow fever vaccine is recommended for all travelers greater than nine months of age. The vaccine is required for all travelers greater than one year of age arriving from a yellow-fever-infected country in Africa or the Americas. In Nigeria, yellow fever is reported from the states of Anambra, Bauchi, Bendel, Benue, Cross River, Imo, Kaduna, Kano, Kwara, Lagos, Niger, Ogun, Ondo, Oyo, and Plateau, but may occur elsewhere. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. The vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs (since the vaccine is produced in chick embryos). It should also not be given to those with a history of thymus disease or thymectomy. Reactions to the vaccine, which are generally mild, include headaches, muscle aches, and low-grade fevers. Serious allergic reactions, such as hives or asthma, are rare and generally occur in those with a history of egg allergy.

Polio immunization is recommended for all travelers to Nigeria. There has been a recent upsurge in polio cases, especially in the northern part of the country, due to the reluctance of local officials to allow polio immunization. Any adult who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Side-effects are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine.

Meningococcal vaccine is recommended for all travelers. Meningococcal vaccine has few side-effects. Mild redness at the injection site may occur. Young children may develop transient fever.

Measles vaccine is recommended for any traveler born after 1956 who does not have either a history of two documented measles immunizations or a blood test showing immunity. A measles outbreak was recently reported from Nigeria (see "Recent outbreaks" below). Many adults who had only one vaccination show immunity when tested and do not need the second vaccination. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.

Hepatitis B vaccine is recommended for travelers who will have intimate contact with local residents or potentially need blood transfusions or injections while abroad, especially if visiting for more than six months. It is also recommended for all health care personnel. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Rabies vaccine is recommended only for those at high risk for animal bites, such as veterinarians and animal handlers, and for long-term travelers who may have contact with animals and may not have access to medical care. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.

Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

All travelers should be up-to-date on routine immunizations, including

• Tetanus-diphtheria vaccine (recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.)
• Varicella (chickenpox) vaccine (recommended for any international traveler over one year of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immunocompromised individuals.)

Cholera vaccine is not generally recommended, despite recent outbreaks in Nigeria, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.

A cholera outbreak was reported in November 2001, chiefly affecting the states of Kano (Kano metropolis), Jigawa, Kwara (Bode Saadu), and Akwa Ibom (Opkoso health district). As of November 26, a total of 2050 cases and 80 deaths had been reported in Kano State. For details, go to World Health Organization. Previous outbreaks occurred in the states of Kano, Adamawa and Edo in 1999.

A new polio outbreak was reported from northern Nigeria in June 2008. There has been an upsurge in polio cases in Nigeria in recent years, due to the reluctance of local officials to allow polio immunization. A total of 1129 cases were recorded for the year 2006, chiefly from the northern part of the country (states of Bauchi, Jigawa, Kaduna, Kano and Katsina). The number of cases fell to 116 for all of 2007, but rose to 272 for the first half of 2008. For further information, go to the World Health Organization and MMWR. A one-time polio booster is recommended for any adult traveler who received the recommended childhood immunizations but never had polio vaccine as an adult. Children should be fully immunized against polio before traveling to Nigeria.

Cases of Lassa fever were reported from the states of Edo, Plateau, Lagos, Ogun, Nasarawa, Taraba, Borno, and Anambra between March and June, 2008. Two cases of Lassa fever, both fatal, occurred in medical doctors at the Ebonyi State University Teaching Hospital in March 2008. Cases were also reported in early 2008 in a Nigerian national, working in Nigeria, transferred to Germany for medical care, and in a Nigerian physician evacuated to South Africa for further care. Lassa fever is a life-threatening viral infection that is generally acquired by contact with the excreta of infected rodents, but may also be transmitted person-to-person. The incubation period ranges from 1-3 weeks. Initial symptoms may include fever, malaise, headache, cough, nausea, vomiting, diarrhea, and muscle aches. The presence of an extremely sore throat, with white patches on the tonsils, may help distinguish Lassa fever from other infectious diseases. In severe cases, Lassa fever may lead to dangerously low blood pressure, excessive bleeding, fluid around the lungs (pleural effusion), seizures, or inflammation of the brain (encephalopathy). The risk to most travelers is extremely low, unless they have direct contact with Lassa fever patients. Those caring for Lassa fever patients must take appropriate protective measures at all times, including strict respiratory and body fluid precautions.

A measles outbreak was reported in May 2008 from Jigawa State, which apparently spread from the neighboring country of Niger. In December 2007, a measles outbreak occurred in Zaria and environs in the north-central state of Kaduna, killing more than 200 children. In June 2007, a measles outbreak was reported from the northern state of Borno, killing 60 children (see ProMED-mail, June 20 and December 9, 2007; May 20, 2008). In February 2005, a measles outbreak was reported from 12 Local Government Areas (LGAs) of Adamawa state, resulting in over 1100 cases, including 76 deaths. Measles outbreaks were also reported from the states of Gombe, Jigawa, Kaduna, Kano, and Kebbi (see the World Health Organization). All travelers born after 1956 should make sure they have had either two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune to measles. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months who will be traveling to Nigeria should be given a single dose of measles or MMR vaccine. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.

A single human case of H5N1 avian influenza ("bird flu") was reported from Nigeria in January 2007. Other possible cases are under investigation. Since February 2006, outbreaks of avian influenza have been reported from poultry farms in almost all of the country’s 37 states and in the Federal Capital Territory. The most recent outbreak was reported in September 2007 from Nasarawa State.

Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The Centers for Disease Control and the World Health Organization do not advise against travel to countries affected by avian influenza, but recommend that travelers should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to Nigeria should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.

Cholera outbreaks occur regularly in Nigeria. The most recent were reported in March 2008 from the central Benue state; in February 2008 from northern Cross River state and from Asaba and neighboring towns in Delta State; in January 2008 from Gbajimba in Benue State, in the southern part of the country; in November 2007 from the central Nigerian state of Plateau and from the Ajakajak community in Rivers State; and in October 2007 from Makurdi, the Benue state capital, and from Bauchi. In January 2007, an outbreak was reported from Delta State, chiefly affecting Oshimili South, Oshimili North, Aniocha South, Bomadi and Burutu. In September 2006, outbreaks were reported from Sokoto state in northwestern Nigeria and from Borno state in the far northeastern part of the country. Before that, outbreaks were reported from Bayelsa state and from the southwestern states of Ogun and Lagos in January 2006, from Delta state in December 2005, and from Borno in October 2005. A major outbreak in November 2004, chiefly involving Kano and Edo States, caused a total of 1616 cases and 126 deaths (see the World Health Organization). The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. Most outbreaks are related to contaminated drinking water, typically in situations of poverty, overcrowding, and poor sanitation. Most travelers are at extremely low risk for infection. Cholera vaccine, where available, is recommended only for certain high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. All travelers should carefully observe food and water precautions, as below.

An outbreak of meningococcal disease was reported in March 2004 from Jigwa state, resulting in 327 cases and 46 deaths as of March 26. The outbreak appeared to have ended by late April. See the World Health Organization for further information. Previously, an outbreak of meningococcal meningitis occurred in 1996, causing more than 17,000 cases and 2500 deaths. Most of the cases were reported from the states of Kano, Bauchi, Kaduna, Katsina, Kebbi, Sokoto, and Jigawa. Meningococcal vaccine is recommended for all travelers.

Onchocerciasis, a parasitic infection that may result in blindness, is highly prevalent. Nigeria is thought to contain more persons infected with onchocerciasis than any other country in the world.

Schistosomiasis may be acquired by swimming, wading, rafting, or bathing in contaminated fresh water. Swimming and bathing precautions are advised (see below).

HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

Other infections include

• Dengue fever (flu-like illness sometimes complicated by hemorrhage or shock; transmitted by mosquitoes)
• African trypanosomiasis (sleeping sickness)
• Leptospirosis (chief animal hosts are cattle, rodents and pigs)
• Lymphatic filariasis
• Rift Valley fever (chiefly among persons in close contact with livestock)
• West Nile fever (transmitted by mosquitoes)
• Brucellosis (the most common animal source is infected cattle)
• Myiasis (caused by Tumbu flies, which lay their eggs on wet clothing, bedding, and outdooor furniture; larvae hatch within two days and can penetrate human skin, causing a raised area which looks like a boil; treatment is to remove the larvae with tweezers and clean the wound; to prevent myiasis, keep towels and laundry as dry as possible and avoid sitting directly on grass or bare ground)

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.

All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accomodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

Insect repellents are ineffective against tsetse flies, which transmit sleeping sickness (African trypanosomiasis). Areas infested with tsetse flies, which are usually known to local inhabitants, should be avoided. Travelers at risk should wear long sleeves and long pants of medium weight fabric in neutral colors that blend with the environment. Also, travelers should avoid riding in the back of open vehicles, since dust may attract tsetse flies, and should take care not to disturb bushes (where tsetse flies rest) during the warmer parts of the day.

Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Chlorinated swimming pools are considered safe.

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.

Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.

For an excellent introduction to medical care in Nigeria, including an online list of physicians, hospitals, and emergency services, go to the U.S. Embassy website.

For a medical emergency in Nigeria, call Critical Rescue International at 0802 888 (website http://www.crinigeria.com/) or International SOS in Port Harcourt at 234 84 611 436 /437/623. The CRI ambulances carry Advanced Life Support equipment and are staffed by trained paramedics.

Some of the private and non-profit medical facilities offer acceptable medical care for routine problems, but the quality of the government facilities falls far below Western standards. The training of most physicians is not comparable to that in Western countries. Equipment is poorly maintained. Essential medications and supplies are often unavailable. Most pharmaceuticals and medical supplies are imported, chiefly from Europe.

For medical emergencies, many expatriates go to Saint Nicholas Hospital (57 Campbell Street, Lagos Island, Lagos; ph. 635576, 631739; website http://www.saintnicholashospital.com/). The facility is "rudimentary", according to the U.S. Embassy, but is recommended by Embassy personnel. Services include a 24-hour emergency room, general medicine, general surgery, orthopedics, obstetrics, gynecology, a dialysis unit, and a laboratory. For cardiac problems, the Cardiac Centre (12A, Idowu Martins Street, Victoria Island, Lagos; ph. 234 1 262 1234, 261 0445/7) offers non-invasive cardiac testing, two ICU ward beds, and an emergency room.

Many expatriates also go to International SOS, which operates clinics in Lagos, Port Harcourt, Warri, and Onne:

• Lagos: IMC (International Medical Clinic) Lagos; No 10, Plot 296 Ozumba Mbadiwe Avenue; (next to Tribes, nr. the Goethe Institute), Victoria Island; ph. 234 146 17711/3608, emergency: +234 177 56080
• Onne: IEC (Industrial Emergency Clinic) Onne; Prodeco Onne Camp, Onne Road; ph. 234 820 705, emergencies: 803 408 5715
• Port Harcourt: SMI (Service Medical International) Port Harcourt Ltd, Intels Camp, Km 12 Aba/ PHC Expressway; ph. 234 84 611 436/437, emergencies: 803 407 0005
• Warri: IMC (International Medical Clinic) Warri Ltd, House 13a, #2 Chief Edewor Estate, Effurun; ph. 234 53 254 956, emergency: 234 802 290 6364

Travel medical services such as immunizations are provided by Dr. Funmi Alakija (Q-Life Family Clinic, 867A, Bishop Aboyade Cole Street, Lagos 101241; ph. 234-1-8042000, 234-1-4448071/2). In Nnewi, Anambra State, medical services for travelers are provided by Dr. Amobi Ilika, Medical Consultant, Community Medicine Department, Christian Hospital Umuezeani Ozubulu Anambra State (ph. 234 8034 743 775; e-mail: linusilika@yahoo.com; by appointment or walk-in; payment in cash only).

For a guide to other facilities in Nigeria, go to the U.S. Embassy website at http://usembassy.state.gov/nigeria/wwwhcomd.html. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed (see the U.S. Embassy website).

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).

Because yellow fever vaccine is not approved for use in children less than nine months of age, children in this age group should not in general be brought to Nigeria.

Because of a recent measles outbreak, consider giving an initial dose of measles vaccine to children between the ages of 6 and 11 months who will be traveling to Nigeria, even though measles immunization is usually not begun until age 12 months.

The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; (2) Malarone is not recommended for children weighing less than 25 pounds; and (3) doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.

When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

Because of the risk of malaria and yellow fever, pregnant women should not in general travel to Nigeria. Yellow fever vaccine is not approved for use during pregnancy, because it contains live virus. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to areas with malaria and yellow fever is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.

Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.

U.S. citizens are strongly encouraged to register at the U.S. Embassy in Abuja or the U.S. Consulate General in Lagos, and to obtain updated information on travel and security in Nigeria. The U.S. Embassy in Abuja now provides full non-emergency and emergency consular services. Non-emergency, as well as emergency, consular services are also available at the U.S. Consulate General in Lagos.

The U.S. Embassy is located at 9 Mambilla, Maitama District, Abuja. The telephone number is [234](9) 523-0916. The Internet address for the US Embassy in Nigeria is http://usembassy.state.gov/nigeria. The U.S. Consulate General is located at 2 Walter Carrington Crescent, Victoria Island, Lagos. American citizens can call 011 [234](1) 261-1215 during office hours (7:30 a.m. to 4p.m.). For after-hours emergencies, call 011 [234] (1) 261-1414, 261-0195, 261-0078, 261-0139, or 261-6477. The e-mail address for the Consular Section in Lagos is: Lagoscons2@state.gov.

For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.