Dr Jane Wilson-Howarth offers her expert opinion on the likely risks for tourists

Pack your coffin?

To make repatriation of the body cheaper and easier, Victorian missionaries setting sail for Africa were advised to pack their belongings into a coffin. In the 1890s they were at great risk of dying; 60 per cent succumbed to malaria alone. These days, few of us would choose to face such odds but can we be fully aware of the risks we take when heading overseas?

Risk was discussed at the 11th Conference of the International Society of Travel Medicine in Budapest last month but the 1,800 assembled experts concluded that reliable statistics were not available for travellers.

There is some good data on the numbers of people who fall ill or are injured or die abroad, but we don't know the number of people who weren't harmed. This makes risk calculation challenging.

Good news on Malaria

Children, especially those under three, are more likely to become seriously ill if they contract malaria or dysentery. For many years malaria has been responsible for about 10 per cent of deaths in African children, however efforts to combat malaria are finally making an impact. Cheap interventions including the use of insecticide-treated bednets and the prompt treatment of fever have contributed to a significant fall in the numbers of malaria cases and deaths throughout Africa.

Although it is not yet time for travellers to abandon taking malaria pills, the risk must also be less.

Collated reports of children who have brought malaria back to Europe highlight Tanzania as the destination where most travelling children contract malaria (six out of 100,000 child travellers), followed by Kenya (3.8), Namibia (0.4) and South Africa (0.2). Usually those who suffer from malaria have gone against medical advice and decided against malaria prophylaxis.

The biggest risk

Although clinicians spend a lot of time encouraging people to become fully immunised, it is not infections that take most lives or harm most travellers. Many deaths abroad are due to natural causes – events such as heart attacks which were waiting to happen wherever.

The issue for most travellers is the often avoidable risk of accidents. Studies of how people meet their deaths abroad consistently points to road accidents as the biggest preventable hazard; for example 58 per cent of Australian accidental deaths overseas are attributed to vehicles, while drowning is second (22 per cent). Alcohol and other intoxicants are often a factor in accidents.

Mind the jab?

It is easy to forget the seriousness of vaccine-preventable disease. Now though, since some people have advocated against immunisation, British adults and children are suffering, attacked by diseases I've encountered only among unvaccinated populations in rural Asia only. Seeing children die from post-measles pneumonia and diarrhoea on the Indonesian island of Lombok has made me a keen advocate of immunisation. There has been a quiet revolution in immunology over the last few decades; more vaccines are available than ever before with improved safety.

Number crunching

Travel health isn't all doom – although it can seem as if the focus is on death statistics. Yet not many of us fret too much about the risks we take when driving, even if the lifetime risk of dying on the road is about 1 per cent in the United States. This translates as about one death in 6,000 a year, similar to the risk of dying while trekking in the Himalayas. (Reassuringly, driving in the UK is three times as safe as in the US.) Those pining for real adventure may be interested to know that attempting a Himalayan peak comes with a 1 in 40 chance of not coming home alive.

But wherever you venture, it is always possible to reduce risk. Adventurous travellers should have appropriate skills, and for everyone being physically fit and properly insured for all you intend to do will go a long way to ensuring a safe return home, without any need for a coffin.

Dr Jane Wilson-Howarth's 'Essential Guide to Travel Health' is published this month by Cadogan, London; £8.99; details of her other books are at www.wilson-howarth.com