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Rodriguez-Valero N, Ledesma-Carbayo MJ, Martí-Soler H, Cuadrado Sanchez D, Vladimirov A, Camprubí-Ferrer D, Pinazo MJ, Losada I, Almuedo-Riera A, Romero L, Roman A, Vera I, Roldan-Torralvo M, Ferrer E, de Alba T, Jimenez A, Gómez-Valverde JJ, Muñoz J, Luengo Oroz M. A Smartphone App for Real-Time Assessment of Malaria Prophylaxis Adverse Events. Telemed J E Health 2024; 30:1436-1442. [PMID: 38215269 DOI: 10.1089/tmj.2023.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Background: Growth of international travel to malarial areas over the last decades has contributed to more travelers taking malaria prophylaxis. Travel-related symptoms may be wrongly attributed to malaria prophylaxis and hinder compliance. Here, we aimed to assess the frequency of real-time reporting of symptoms by travelers following malaria prophylaxis using a smartphone app. Method: Adult international travelers included in this single-center study (Barcelona, Spain) used the smartphone Trip Doctor® app developed by our group for real-time tracking of symptoms and adherence to prophylaxis. Results: Six hundred four (n = 604) international travelers were included in the study; 74.3% (449) used the app daily, and for one-quarter of travelers, malaria prophylaxis was prescribed. Participants from the prophylaxis group traveled more to Africa (86.7% vs. 4.3%; p < 0.01) and to high travel medical risk countries (60.8% vs. 18%; p < 0.01) and reported more immunosuppression (30.8% vs. 23.1% p < 0.01). Regarding symptoms, no significant intergroup differences were observed, and no relationship was found between the total number of malarial pills taken and reported symptoms. Conclusions: In our cohort, the number of symptoms due to malaria prophylaxis was not significantly higher than in participants for whom prophylaxis was not prescribed, and the overall proportion of symptoms is higher compared with other studies.
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Affiliation(s)
- Natalia Rodriguez-Valero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Maria Jesus Ledesma-Carbayo
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Helena Martí-Soler
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Cuadrado Sanchez
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | | | - Daniel Camprubí-Ferrer
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Maria Jesus Pinazo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Irene Losada
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Alex Almuedo-Riera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Lucia Romero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Anna Roman
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Vera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Roldan-Torralvo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Ferrer
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Teresa de Alba
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Alejandra Jimenez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Juan Jose Gómez-Valverde
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Jose Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Luengo Oroz
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
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Hossain MS, Matin MA, Ferdous NEN, Hasan A, Sazed SA, Neogi AK, Chakma S, Islam MA, Khan AA, Haque ME, Islam S, Islam MN, Khan WA, Islam MA, Haque R, Alam MS. Adherence to Anti-Malarial Treatment in Malaria Endemic Areas of Bangladesh. Pathogens 2023; 12:1392. [PMID: 38133277 PMCID: PMC10745796 DOI: 10.3390/pathogens12121392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Ensuring adherence to antimalarial treatment is crucial for achieving a radical cure and elimination of malaria, especially in hard-to-reach areas. We conducted this study to assess the current scenario of drug adherence in four endemic sub-districts of Bangladesh. Among 110 enrolled participants, 70% were mono-infected with Plasmodium falciparum and the remaining 30% with P. vivax. The overall treatment adherence frequency was 92.7% (95% CI: 83.0-96.3%). A total of eight participants were found to be nonadherent to treatment and all of them were from Bandarban. Level of nonadherence was equally observed in two age groups: 11-17 and 18+ years. However, male participants (n = 6) were found to be more nonadherent than females (n = 2). Among 7.3% with nonadherence to treatment, a single participant with P. falciparum mono-infection refused to take medication and became nonadherent. Remaining participants stated that they were feeling well and going to work, thus leaving treatment course uncompleted. Although overall compliance with malaria medication seems good, a gradual increase in noncompliance to P. vivax malaria treatment suggests that the National Malaria Elimination Program must be enhanced and monitored to fulfil the projected malaria elimination goal before 2030 from Bangladesh.
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Affiliation(s)
- Mohammad Sharif Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.S.H.); (M.A.M.); (M.A.I.); (W.A.K.); (R.H.)
| | - Mohammad Abdul Matin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.S.H.); (M.A.M.); (M.A.I.); (W.A.K.); (R.H.)
| | - Nur-E Naznin Ferdous
- Bangladesh Rural Advancement Committee (BRAC) Health Programme, BRAC, Dhaka 1212, Bangladesh (A.K.N.)
| | - Anamul Hasan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.S.H.); (M.A.M.); (M.A.I.); (W.A.K.); (R.H.)
| | - Saiful Arefeen Sazed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.S.H.); (M.A.M.); (M.A.I.); (W.A.K.); (R.H.)
| | - Amit Kumer Neogi
- Bangladesh Rural Advancement Committee (BRAC) Health Programme, BRAC, Dhaka 1212, Bangladesh (A.K.N.)
| | - Sumit Chakma
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.S.H.); (M.A.M.); (M.A.I.); (W.A.K.); (R.H.)
| | - Md. Atiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.S.H.); (M.A.M.); (M.A.I.); (W.A.K.); (R.H.)
| | - Afsana Alamgir Khan
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka 1212, Bangladesh (M.N.I.)
| | - Md. Ekramul Haque
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka 1212, Bangladesh (M.N.I.)
| | - Shayla Islam
- Bangladesh Rural Advancement Committee (BRAC) Health Programme, BRAC, Dhaka 1212, Bangladesh (A.K.N.)
| | - Md. Nazmul Islam
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka 1212, Bangladesh (M.N.I.)
| | - Wasif Ali Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.S.H.); (M.A.M.); (M.A.I.); (W.A.K.); (R.H.)
| | - Md. Akramul Islam
- Bangladesh Rural Advancement Committee (BRAC) Health Programme, BRAC, Dhaka 1212, Bangladesh (A.K.N.)
| | - Rashidul Haque
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.S.H.); (M.A.M.); (M.A.I.); (W.A.K.); (R.H.)
| | - Mohammad Shafiul Alam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (M.S.H.); (M.A.M.); (M.A.I.); (W.A.K.); (R.H.)
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Deressa A, Gamachu M, Birhanu A, Mamo Ayana G, Raru TB, Negash B, Merga BT, Regassa LD, Ababulgu FA. Malaria Risk Perception and Preventive Behaviors Among Elementary School Students, Southwest Ethiopia. Generalized Structural Equation Model. Infect Drug Resist 2023; 16:4579-4592. [PMID: 37465183 PMCID: PMC10351682 DOI: 10.2147/idr.s415376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
Background In 2020, more than three billion of the world's population were the risk of being infected with malaria and four out of five deaths were from the African population. However, information is scarce on the association between risk perceptions and malaria prevention behaviors in resource-limited countries, particularly Ethiopia. Therefore, this study aimed to assess malaria risk perceptions and preventive behaviors. Methods A cross-sectional study design was conducted among 401 elementary school students in Jimma zone, Oromia, Ethiopia, from April 2 to June 8, 2020. Data were collected through interviews using a semi-structured questionnaire. The data were entered into Epi-data 4.6 and analyzed using STATA version 14.2. The descriptive statistics were presented using frequency and percentages. A Cronbach's α coefficient of 0.7 or higher was used to assess the reliability of each domain. The Generalized Structural Equation Model (GSEM) was employed to examine the relationships and prediction of explanatory variables with risk perception and preventive behaviors of malaria. The model with a lower information criterion was taken as a better-fitting model. Finally, the statistically significant model effects were declared at a P-value of less than 0.05 at a confidence interval of 95%. Results This study showed that having knowledge about malaria had an indirect positive effect on malaria preventive behavior (β = 1.29, 95% CI 0.11 to 2.47), and had a positive total effect on the preventive behavior (β = 2.99, 95% CI 0.08 to 2.67). Besides, an increased knowledge level had a direct positive effect on malaria risk perceptions (β = 0.08, 95% CI 0.01 to 0.14), and malaria risk perception had a direct positive effect on malaria preventive behavior (β = 1.21, 95% CI 0.10 to 2.31). Conclusion and Recommendation This study demonstrated that having knowledge about malaria had a direct and indirect association with malaria preventive behavior. An increased level of knowledge had a direct positive effect on malaria risk perceptions. Moreover, malaria risk perception had a direct positive effect on malaria preventive behavior. Therefore, malaria prevention-targeted interventions, behavior change, and knowledge enhancing communication should be enhanced or scaled up to contribute to prompt treatment and progress toward the elimination of malaria.
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Affiliation(s)
| | - Mulugeta Gamachu
- School of Medicine, CHMS, Haramaya University, Harar, Ethiopia
- Departments of Public Health, Rift Valley University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, CHMS, Haramaya University, Harar, Ethiopia
| | | | | | - Belay Negash
- School of Public Health, CHMS, Haramaya University, Harar, Ethiopia
| | | | | | - Fira Abamecha Ababulgu
- Department of Health, Behavior, and Society, Faculty of Public Health Institute of Health, Jimma University, Jimma, Ethiopia
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García-Marín NM, Marrero GA, Guerra-Neira A, Rivera-Deán A. Profiles of travelers to intermediate-high health risk areas following the reopening of borders in the COVID-19 crisis: A clustering approach. Travel Med Infect Dis 2023; 54:102607. [PMID: 37353065 PMCID: PMC10284617 DOI: 10.1016/j.tmaid.2023.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND The reactivation of international travel in 2021 has created a new scenario in which the profile of the traveler to medium-high health risk areas may well have changed. However, few studies have analyzed this new profile since the reopening of borders in that year. METHODS We designed an ad hoc questionnaire that was administered face-to-face by our medical team during appointments with 330 travelers in the second half of 2021. Information was collected on the following topics: sociodemographic and socioeconomic status; type of travel and previous travel experience; health status and risk perception (of COVID-19 and tropical infectious diseases). Using all features simultaneously, an unsupervised machine learning approach (k-means) is implemented to characterize groups of travelers. Pairwise chi-squared tests were performed to identify key features that showed statistically significant differences between clusters. RESULTS The travelers were clustered into seven groups. We associated the clusters with different intensities of perceived risk of acquiring COVID-19 and tropical infectious diseases on the trip. The perceived risk of both diseases was low in the group "middle or lower middle class young inexperienced male tourist" but high in the group "middle or lower middle-class young with children inexperienced business traveler". CONCLUSIONS Broadening our knowledge of the profiles of travelers to intermediate-high health risk areas would help to tailor the health advice provided by practitioners to their characteristics and type of travel. In a changing health context, the k-means approach supposes a flexible statistical method that calculates travelers' profiles and can be easily adapted to process new information.
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Affiliation(s)
- Nidia M García-Marín
- International Vaccination Center at Santa Cruz de Tenerife, Spanish Ministry of Health, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain
| | - Gustavo A Marrero
- University of La Laguna, Department of Economics, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain; University of La Laguna, IUDR, Spain.
| | - Ana Guerra-Neira
- International Vaccination Center at Santa Cruz de Tenerife, Spanish Ministry of Health, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain
| | - Almudena Rivera-Deán
- International Vaccination Center at Santa Cruz de Tenerife, Spanish Ministry of Health, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain
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Lin CY, Chang K, Chang CJ. Questionnaire-Based Analysis of Adverse Events and Compliance with Malaria Chemoprophylaxis in Taiwan. J Pers Med 2023; 13:jpm13020179. [PMID: 36836413 PMCID: PMC9967687 DOI: 10.3390/jpm13020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
Malaria was eradicated in Taiwan in 1952; however, imported malaria cases are reported every year. The subtropical climate in Taiwan permits mosquito propagation and possible outbreaks of mosquito-borne diseases. The aim of this study was to investigate travelers' compliance and side effects of malaria prophylaxis to prevent a malaria outbreak in Taiwan. In this prospective study, we enrolled travelers who visited our travel clinic before going to malarious areas. A total of 161 questionnaires were collected and analyzed. Associations between the occurrence of side effects and compliance with antimalarial drugs were analyzed. Adjusted odds ratios were calculated after adjusting for potential risk factors in multiple logistic regression analysis. Of the 161 enrolled travelers, 58 (36.0%) reported side effects. Insomnia, somnolence, irritability, nausea, and anorexia were associated with poor compliance. Mefloquine was not associated with more neuropsychological side effects than doxycycline. Multiple logistic regression analysis showed that chemoprophylaxis compliance was affected by a younger age, visiting friends and relatives, visiting the travel clinic more than 1 week before the trip, and preferring to use the same antimalarial regimen on the next trip. Our findings could provide information to travelers besides labeled side effects to improve compliance with malaria prophylaxis and consequently help to prevent malaria outbreaks in Taiwan.
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Affiliation(s)
- Ching-Yun Lin
- Department of Family Medicine, Kaohsiung Municipal SiaoGang Hospital, Kaohsiung 812, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Ko Chang
- Tropical Medicine Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chai-Jan Chang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Family Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence:
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Suryapranata FS, Overbosch FW, Matser A, Grobusch MP, McCall MB, van Rijckevorsel GG, Prins M, Sonder GJ. Malaria in long-term travelers: Infection risks and adherence to preventive measures – A prospective cohort study. Travel Med Infect Dis 2022; 49:102406. [DOI: 10.1016/j.tmaid.2022.102406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
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Chinese Tourists’ Health Risk Avoidance Behavior in the Context of Regular Epidemic Prevention and Control: An Empirical Analysis. SUSTAINABILITY 2022. [DOI: 10.3390/su14116750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The health risk avoidance behavior of tourists in China, a country actively combating COVID-19, is of research significance. This study proposes and tests a model based on three theories—stimulus-organism-response model, motivation-opportunity-ability model, and health belief model—to examine the impact mechanism of tourists’ health risk avoiding behavior under COVID-19′s regular epidemic prevention and control situations and the moderating effect of health risk perception. The results reveal that, from the stimulus perspective, tourists’ motivation, opportunities to travel, and the ability to travel negatively affect tourists’ health risk avoidance behavior. That is to say, the stronger the motivation of tourists to undertake tourist activities, the stronger the safeguards provided by the government, and the better that tourists are informed of the virus and more equipped with healthy habits and skills, the more likely it is that tourists will not take avoidance behavior. From the organism perspective, perceived severity and perceived susceptibility, as mediating factors, positively influence tourists’ health risk avoidance behavior. In contrast, if tourists are more likely to believe in the controllability of the health risk of the epidemic, then they are more likely to travel and less likely to show avoidance behavior. Managerial implications and theoretical contributions are also provided.
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Underestimation of travel-associated risks by adult and paediatric travellers compared to expert assessment: A cross-sectional study at a hospital-based family pre-travel clinic. Travel Med Infect Dis 2022; 47:102315. [PMID: 35331951 DOI: 10.1016/j.tmaid.2022.102315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/20/2022] [Accepted: 03/17/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Travellers' perception of their risk for acquiring travel-related conditions is an important contributor to decisions and behaviors during travel. In this study, we aimed to assess the differences between traveller-perceived and expert-assessed risk of travel-related conditions in children and adults travelling internationally and describe factors that influence travellers' perception of risk. METHODS Children and adults were recruited at the Hospital for Sick Children's Family Travel Clinic between October 2014 and July 2015. A questionnaire was administered to participants to assess their perceived risk of acquiring 32 travel-related conditions using a 7-point Likert scale. Conditions were categorized as vector-borne diseases, vaccine-preventable diseases, food and water borne diseases, sexually transmitted infections and other conditions. Two certified travel medicine experts reviewed each patient's chart and assigned a risk score based on the same 7-point Likert scale. Traveller and expert risk scores were compared using paired t-tests. RESULTS In total, 207 participants were enrolled to participate in this study, 97 children (self-reported, n = 8; parent-reported, n = 89), and 110 adults. Travel-related risk for adults and parents answering for their children were significantly underestimated when compared to expert-assessed risk for 26 of the 32 assessed conditions. The underestimated conditions were the same for both adults and parents answering for children. Travel-related risk was not over-estimated for any condition. CONCLUSIONS Adults underestimated their children's and their own risk for most travel-related conditions. Strategies to improve the accuracy of risk perception of travel-related conditions by travellers are needed to optimize healthy travel for children and their families.
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Alkadi W, Salih S, Al Darbi M. Assessment of knowledge, attitudes, and practices regarding travel health among (King Abdulaziz) international airport travelers in Jeddah, Kingdom of Saudi Arabia 2019. J Family Med Prim Care 2021; 10:3013-3020. [PMID: 34660440 PMCID: PMC8483095 DOI: 10.4103/jfmpc.jfmpc_148_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/26/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Travelers to different countries have endemic/pandemic diseases can increase the risk of exposure to various infectious agents and can facilitate their spread across borders. Objectives: To determine the levels of travel health knowledge, attitudes and practices among travelers at international airports of KSA. Methods: An observational cross-sectional study was conducted starting from 30 September, 2019 at the departure halls of King Abdulaziz International airport (KAIA). Representative sample adult travelers who were waiting to board were recruited. Results and Discussion: Good level of knowledge regarding travel health was observed among 28.2%. The majority of the participants (84.7%) got information about their destination prior to the trip. The main reported source of information was family/friends (53.8%). Negative health seeking behavior was observed among 70.8% of the participants. Purpose of the trip and duration of destination were significantly associated with health seeking behavior. Knowledge, attitude towards health information seeking behavior and practice-related to travel health among international travelers at King Abdulaziz International airport are insufficient.
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Affiliation(s)
- Wardah Alkadi
- Jazan Health Affairs,Ministry of Health, Jazan, Kingdom of Saudi Arabia
| | - Sarah Salih
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan City, Kingdom of Saudi Arabia
| | - Mohammed Al Darbi
- Family Medicine, Trainer at the Joint Program of Family Medicine, Jazan City, Kingdom of Saudi Arabia
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Hiranrusme T, Piyaphanee W, Kaewkungwal J, Silachamroon U, Leowattana W, Chatapat L, Matsee W. Risk perception of health problems among travelers visiting a travel clinic in Bangkok, Thailand. Trop Dis Travel Med Vaccines 2020; 6:7. [PMID: 32477584 PMCID: PMC7238588 DOI: 10.1186/s40794-020-00108-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Effective pre-travel consultations cannot be achieved only through individual risk assessment and advice on vaccinations and chemoprophylaxis. Travelers' perceptions of the risk of health problems represent another key factor in successful risk communication and co-operation with pre-travel advice. The objective of this study was to determine perception of travel-related health risks among Thais and westerners visiting the Thai Travel Clinic for consultation before visiting developing countries. METHODS A novel pictorial scale questionnaire-based study was conducted with both Thai and western travelers who visited the Thai Travel Clinic for pre-travel consultation. All participants were approached before and after completing the consultation, and were asked about their demographic data and perceptions of travel-related health risk. The perceptions of risk before and after consultation were compared using the McNemar test, and were also compared with the actual estimated risk. RESULTS During May to November 2019, 594 travelers (330 Thais and 264 Westerners) were enrolled and completed the pictorial scale questionnaires. Most Thai travelers visited Africa/South America (63%), and 20% had previously received counseling. Westerners were mostly backpackers (37.5%), traveling for > 30 days (71.6%), while 43.6% had previously received counseling. Overall, the westerners (n = 264) changed their risk perceptions slightly after counseling in contrast with the Thais. The change in perception of most health problems was observed statistically significant (p-value < 0.05) after receiving pre-travel consultation among both groups of travelers. Risk perception among western travelers after consultation compared with estimated actual risk showed accurate risk perception toward most of health problems especially in travelers who had previously received counseling in ones' home countries. CONCLUSIONS Risk perception of health problems plays an important role in successful risk communication and their response to pre-travel advices. Differences in risk perceptions were evident between the two groups. Therefore, this highlight the importance of obtaining pre-travel advice in one's home country before travelling. Raised awareness of the risks should be emphasized during consultations for underestimated health risks, especially for rabid animal exposure and sexually transmitted diseases.
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Affiliation(s)
- Thanyapat Hiranrusme
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Watcharapong Piyaphanee
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Jaranit Kaewkungwal
- 2Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Udomsak Silachamroon
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wattana Leowattana
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Lapakorn Chatapat
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wasin Matsee
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
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Fong EKK, Pell LG, Faress A, Nguyen JH, Ma XW, Lam RE, Louch D, Science ME, Morris SK. Adherence to recommendations at a Canadian tertiary care Family Travel Clinic - A single centre analysis. Travel Med Infect Dis 2020; 34:101579. [PMID: 32074482 DOI: 10.1016/j.tmaid.2020.101579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infectious and non-infectious risks associated with international travel can be reduced with adherence to pre-travel advice from practitioners trained in travel medicine. METHODS A prospective cohort study was conducted in a tertiary care children's hospital to assess adherence to malaria chemoprophylaxis, safe water and food consumption, mosquito bite protection, motor vehicle safety and travel vaccines using structured questionnaires. High risk groups assessed included child travelers and those visiting friends and relatives (VFRs). RESULTS In total, 290 participants (133 children and 157 adults) were enrolled and completed at least one study questionnaire. In general, with the exception of vaccines, adherence to recommendations was sub-optimal. Among children and adults, adherence to malaria prophylaxis recommendations was lower in VFRs than in non-VFRs. The proportion of children VFRs (cVFRs) and adult VFRs (aVFRs) who adhered to the following recommendations were malaria chemoprophylaxis (47%, 33%), safe water (71%, 74%) and food recommendations (18%, 6%), insect bite avoidance (21%, 12%), and motor vehicle safety (13%, 11%) respectively. Adherence to recommended vaccines uptake was greater than 90% in all groups. CONCLUSION With the exception of vaccine uptake, sub-optimal adherence levels to travel recommendations was identified in all groups, and in particular VFRs, highlighting the need for proactive discussions around barriers to adherence.
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Affiliation(s)
- Emily K K Fong
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Lisa G Pell
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Ahmed Faress
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; School of Public Health, University of Montreal, Montreal, Canada
| | - Jenny Hoang Nguyen
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Xiao Wei Ma
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Ray E Lam
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Debra Louch
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Michelle E Science
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Shaun K Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada.
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12
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Rodrigo C, Rajapakse S, Fernando SD. Compliance with Primary Malaria Chemoprophylaxis: Is Weekly Prophylaxis Better Than Daily Prophylaxis? Patient Prefer Adherence 2020; 14:2215-2223. [PMID: 33204072 PMCID: PMC7665499 DOI: 10.2147/ppa.s255561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chemoprophylaxis is an effective tool for individuals to minimize their risk of contracting malaria and serves an important public health role in preventing imported malaria. Yet, it is only effective if the traveller is fully compliant with the prescribed regimen. For many destinations, a choice of prophylactic agents is available, so historical compliance data can be helpful for both physicians and travellers to make an informed decision. METHODS We analyzed the historical self-reported compliance data for six chemoprophylactic agents currently recommended by CDC for primary malaria chemoprophylaxis by searching PubMed, Embase, CINAHL, Web of Science, and Scopus for observational studies reporting on travelers within the last 25 years. The quality of data was graded as "good" or "poor" using the NIH quality assessment tool for cohort and cross-sectional studies. Cumulative compliance data were compiled for all studies (gross compliance) and the subgroup of studies with "good" quality evidence (refined compliance). Subgroup analyses were performed for weekly vs daily administered regimens, between military and civilian travelers, and across each prophylactic agent. RESULTS Twenty-four eligible studies assessed compliance for mefloquine (n=20), atovaquone-proguanil (n=11), doxycycline (n=13), and chloroquine (n=3). No studies were found for primaquine or tafenoquine. Both gross and refined compliance were significantly better for weekly regimens than daily regimens (P<0.0001). Stopping chemoprophylaxis due to adverse events was significantly more for doxycycline (P<0.0001) compared to other drugs. Compliance was significantly worse in military travelers, but they were also more likely to be prescribed doxycycline. CONCLUSION Malaria chemoprophylaxis for a traveler should depend on prevailing resistance patterns at destination, current national guidelines, and patient preferences. However, when there is a choice, historical compliance data are useful to select a regimen that the traveler is more likely to comply with.
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Affiliation(s)
- Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, UNSW, Sydney, NSW, Australia
- Correspondence: Chaturaka Rodrigo Department of Pathology, School of Medical Sciences, University of New South Wales (UNSW), 207, Wallace Wurth Building, Sydney2052, NSW, AustraliaTel +61 2 9065 2186 Email
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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13
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Lau CL, Ramsey L, Mills LC, Furuya-Kanamori L, Mills DJ. Drug-free Holidays: Compliance, Tolerability, and Acceptability of a 3-Day Atovaquone/Proguanil Schedule for Pretravel Malaria Chemoprophylaxis in Australian Travelers. Clin Infect Dis 2018; 69:137-143. [DOI: 10.1093/cid/ciy854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 09/28/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Colleen L Lau
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory
- Dr Deb the Travel Doctor, Travel Medicine Alliance, Brisbane, Queensland
| | - Lani Ramsey
- Travel-Bug Vaccination Clinic, Travel Medicine Alliance, Adelaide, South Australia, Australia
| | - Laura C Mills
- Dr Deb the Travel Doctor, Travel Medicine Alliance, Brisbane, Queensland
| | - Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory
- Department of Population Medicine, College of Medicine, Qatar University, Doha
| | - Deborah J Mills
- Dr Deb the Travel Doctor, Travel Medicine Alliance, Brisbane, Queensland
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14
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Misra AK, Rai RK, Takeuchi Y. Modeling the effect of time delay in budget allocation to control an epidemic through awareness. INT J BIOMATH 2018. [DOI: 10.1142/s1793524518500274] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The emergence of any new infectious disease poses much stress on the government to control the spread of such disease. The easy, fast and less expensive way to slow down the spread of disease is to make the population be aware of its spread and possible control mechanisms. For this purpose, government allocates some funds to make public aware through mass media, print media, pamphlets, etc. Keeping this in view, in this paper, a nonlinear mathematical model is proposed and analyzed to assess the effect of time delay in providing funds by the government to warn people. It is assumed that susceptible individuals contract infection through the direct contact with infected individuals; however the rate of contracting infection is a decreasing function of funds availability. The proposed model is analyzed using stability theory of delay differential equations and numerical simulations. The model analysis shows that the increase in funds to warn people reduces the number of infected individuals but delay in providing the funds destabilizes the interior equilibrium and may cause stability switches.
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Affiliation(s)
- A. K. Misra
- Department of Mathematics, Institute of Science, Banaras Hindu University, Varanasi 221 005, India
| | - Rajanish Kumar Rai
- Department of Mathematics, Institute of Science, Banaras Hindu University, Varanasi 221 005, India
| | - Yasuhiro Takeuchi
- Department of Physics and Mathematics, College of Science and Engineering, Aoyama Gakuin University, Kanagawa 252-5258, Japan
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15
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Tickell‐Painter M, Maayan N, Saunders R, Pace C, Sinclair D. Mefloquine for preventing malaria during travel to endemic areas. Cochrane Database Syst Rev 2017; 10:CD006491. [PMID: 29083100 PMCID: PMC5686653 DOI: 10.1002/14651858.cd006491.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mefloquine is one of four antimalarial agents commonly recommended for preventing malaria in travellers to malaria-endemic areas. Despite its high efficacy, there is controversy about its psychological side effects. OBJECTIVES To summarize the efficacy and safety of mefloquine used as prophylaxis for malaria in travellers. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published on the Cochrane Library; MEDLINE; Embase (OVID); TOXLINE (https://toxnet.nlm.nih.gov/newtoxnet/toxline.htm); and LILACS. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; http://www.who.int/ictrp/en/) and ClinicalTrials.gov (https://clinicaltrials.gov/ct2/home) for trials in progress, using 'mefloquine', 'Lariam', and 'malaria' as search terms. The search date was 22 June 2017. SELECTION CRITERIA We included randomized controlled trials (for efficacy and safety) and non-randomized cohort studies (for safety). We compared prophylactic mefloquine with placebo, no treatment, or an alternative recommended antimalarial agent. Our study populations included all adults and children, including pregnant women. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility and risk of bias of trials, extracted and analysed data. We compared dichotomous outcomes using risk ratios (RR) with 95% confidence intervals (CI). Prespecified adverse outcomes are included in 'Summary of findings' tables, with the best available estimate of the absolute frequency of each outcome in short-term international travellers. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 20 RCTs (11,470 participants); 35 cohort studies (198,493 participants); and four large retrospective analyses of health records (800,652 participants). Nine RCTs explicitly excluded participants with a psychiatric history, and 25 cohort studies stated that the choice of antimalarial agent was based on medical history and personal preference. Most RCTs and cohort studies collected data on self-reported or clinician-assessed symptoms, rather than formal medical diagnoses. Mefloquine efficacyOf 12 trials comparing mefloquine and placebo, none were performed in short-term international travellers, and most populations had a degree of immunity to malaria. The percentage of people developing a malaria episode in the control arm varied from 1% to 82% (median 22%) and 0% to 13% in the mefloquine group (median 1%).In four RCTs that directly compared mefloquine, atovaquone-proguanil and doxycycline in non-immune, short-term international travellers, only one clinical case of malaria occurred (4 trials, 1822 participants). Mefloquine safety versus atovaquone-proguanil Participants receiving mefloquine were more likely to discontinue their medication due to adverse effects than atovaquone-proguanil users (RR 2.86, 95% CI 1.53 to 5.31; 3 RCTs, 1438 participants; high-certainty evidence). There were few serious adverse effects reported with mefloquine (15/2651 travellers) and none with atovaquone-proguanil (940 travellers).One RCT and six cohort studies reported on our prespecified adverse effects. In the RCT with short-term travellers, mefloquine users were more likely to report abnormal dreams (RR 2.04, 95% CI 1.37 to 3.04, moderate-certainty evidence), insomnia (RR 4.42, 95% CI 2.56 to 7.64, moderate-certainty evidence), anxiety (RR 6.12, 95% CI 1.82 to 20.66, moderate-certainty evidence), and depressed mood during travel (RR 5.78, 95% CI 1.71 to 19.61, moderate-certainty evidence). The cohort studies in longer-term travellers were consistent with this finding but most had larger effect sizes. Mefloquine users were also more likely to report nausea (high-certainty evidence) and dizziness (high-certainty evidence).Based on the available evidence, our best estimates of absolute effect sizes for mefloquine versus atovaquone-proguanil are 6% versus 2% for discontinuation of the drug, 13% versus 3% for insomnia, 14% versus 7% for abnormal dreams, 6% versus 1% for anxiety, and 6% versus 1% for depressed mood. Mefloquine safety versus doxycyclineNo difference was found in numbers of serious adverse effects with mefloquine and doxycycline (low-certainty evidence) or numbers of discontinuations due to adverse effects (RR 1.08, 95% CI 0.41 to 2.87; 4 RCTs, 763 participants; low-certainty evidence).Six cohort studies in longer-term occupational travellers reported our prespecified adverse effects; one RCT in military personnel and one cohort study in short-term travellers reported adverse events. Mefloquine users were more likely to report abnormal dreams (RR 10.49, 95% CI 3.79 to 29.10; 4 cohort studies, 2588 participants, very low-certainty evidence), insomnia (RR 4.14, 95% CI 1.19 to 14.44; 4 cohort studies, 3212 participants, very low-certainty evidence), anxiety (RR 18.04, 95% CI 9.32 to 34.93; 3 cohort studies, 2559 participants, very low-certainty evidence), and depressed mood (RR 11.43, 95% CI 5.21 to 25.07; 2 cohort studies, 2445 participants, very low-certainty evidence). The findings of the single cohort study reporting adverse events in short-term international travellers were consistent with this finding but the single RCT in military personnel did not demonstrate a difference between groups in frequencies of abnormal dreams or insomnia.Mefloquine users were less likely to report dyspepsia (RR 0.26, 95% CI 0.09 to 0.74; 5 cohort studies, 5104 participants, low certainty-evidence), photosensitivity (RR 0.08, 95% CI 0.05 to 0.11; 2 cohort studies, 1875 participants, very low-certainty evidence), vomiting (RR 0.18, 95% CI 0.12 to 0.27; 4 cohort studies, 5071 participants, very low-certainty evidence), and vaginal thrush (RR 0.10, 95% CI 0.06 to 0.16; 1 cohort study, 1761 participants, very low-certainty evidence).Based on the available evidence, our best estimates of absolute effect for mefloquine versus doxycyline were: 2% versus 2% for discontinuation, 12% versus 3% for insomnia, 31% versus 3% for abnormal dreams, 18% versus 1% for anxiety, 11% versus 1% for depressed mood, 4% versus 14% for dyspepsia, 2% versus 19% for photosensitivity, 1% versus 5% for vomiting, and 2% versus 16% for vaginal thrush.Additional analyses, including comparisons of mefloquine with chloroquine, added no new information. Subgroup analysis by study design, duration of travel, and military versus non-military participants, provided no conclusive findings. AUTHORS' CONCLUSIONS The absolute risk of malaria during short-term travel appears low with all three established antimalarial agents (mefloquine, doxycycline, and atovaquone-proguanil).The choice of antimalarial agent depends on how individual travellers assess the importance of specific adverse effects, pill burden, and cost. Some travellers will prefer mefloquine for its once-weekly regimen, but this should be balanced against the increased frequency of abnormal dreams, anxiety, insomnia, and depressed mood.
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Affiliation(s)
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Rachel Saunders
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - Cheryl Pace
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
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16
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Vinnemeier CD, Rothe C, Kreuels B, Addo MM, Vygen-Bonnet S, Cramer JP, Rolling T. Response to fever and utilization of standby emergency treatment (SBET) for malaria in travellers to Southeast Asia: a questionnaire-based cohort study. Malar J 2017; 16:44. [PMID: 28122576 PMCID: PMC5264331 DOI: 10.1186/s12936-017-1678-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Guidelines in several European countries recommend standby emergency treatment (SBET) for travellers to regions with low or medium malaria transmission instead of continuous chemoprophylaxis: travellers are advised to seek medical assistance within 24 h in case of fever and to self-administer SBET only if they are not able to consult a doctor within the time period specified. Data on healthcare-seeking behaviour of febrile travellers and utilization of SBET is however scarce as only two studies were performed in the mid-1990s. Since tourism is constantly increasing and malaria epidemiology has dramatically changed in the meantime more knowledge is urgently needed. Methods Some 876 travellers to destinations in South and Southeast Asia with low or medium malaria transmission were recruited in the travel clinic of the University Medical Center Hamburg-Eppendorf. Demographic and travel-related data were collected by using questionnaires. Pre-travel advice was carried out and SBET was prescribed in accordance to national guidelines. Post-travel phone interviews were performed to assess health incidents during travel and individual responses of travellers to febrile illness. Results Out of 714 patients who were monitored, 130 (18%) reported onset of fever during travel or 14 days after return. Of those travellers who reported fever, 100 (80%) carried SBET during travel. The vast majority of 79 (79%) febrile travellers who carried SBET did not seek medical assistance. Overall, 14 (14%) febrile patients who carried SBET and six (20%) patients who did not carry SBET took the correct measure (doctor visit or timely SBET administration) as a response to febrile illness, respectively. Only two travellers self-administered SBET, but both of them applied the wrong regimen. Conclusions In view of declining malaria transmission and improving medical infrastructure in most countries of Southeast Asia and obvious obstacles concerning SBET as shown in this study the current strategy should be re-evaluated. Pre-travel advice concerning malaria in SEA should focus on appropriate mosquito bite protection and clearly emphasize the need to see a doctor within 24 h after onset of fever.
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Affiliation(s)
- Christof D Vinnemeier
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Camilla Rothe
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benno Kreuels
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Vygen-Bonnet
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jakob P Cramer
- Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Thierry Rolling
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
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17
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Pacheco JM, Van Segbroeck S, Santos FC. Disease Spreading in Time-Evolving Networked Communities. TEMPORAL NETWORK EPIDEMIOLOGY 2017. [PMCID: PMC7124106 DOI: 10.1007/978-981-10-5287-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human communities are organized in complex webs of contacts that may be represented by a graph or network. In this graph, vertices identify individuals and edges establish the existence of some type of relations between them. In real communities, the possible edges may be active or not for variable periods of time. These so-called temporal networks typically result from an endogenous social dynamics, usually coupled to the process under study taking place in the community. For instance, disease spreading may be affected by local information that makes individuals aware of the health status of their social contacts, allowing them to reconsider maintaining or not their social contacts. Here we investigate the impact of such a dynamical network structure on disease dynamics, where infection occurs along the edges of the network. To this end, we define an endogenous network dynamics coupled with disease spreading. We show that the effective infectiousness of a disease taking place along the edges of this temporal network depends on the population size, the number of infected individuals in the population and the capacity of healthy individuals to sever contacts with the infected, ultimately dictated by availability of information regarding each individual’s health status. Importantly, we also show how dynamical networks strongly decrease the average time required to eradicate a disease.
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18
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Sridhar S, Régner I, Brouqui P, Gautret P. Methodologies for measuring travelers' risk perception of infectious diseases: A systematic review. Travel Med Infect Dis 2016; 14:360-72. [PMID: 27238906 PMCID: PMC7110652 DOI: 10.1016/j.tmaid.2016.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022]
Abstract
Numerous studies in the past have stressed the importance of travelers' psychology and perception in the implementation of preventive measures. The aim of this systematic review was to identify the methodologies used in studies reporting on travelers' risk perception of infectious diseases. A systematic search for relevant literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were 39 studies identified. In 35 of 39 studies, the methodology used was that of a knowledge, attitude and practice (KAP) survey based on questionnaires. One study used a combination of questionnaires and a visual psychometric measuring instrument called the 'pictorial representation of illness and self-measurement" or PRISM. One study used a self-representation model (SRM) method. Two studies measured psychosocial factors. Valuable information was obtained from KAP surveys showing an overall lack of knowledge among travelers about the most frequent travel-associated infections and associated preventive measures. This methodological approach however, is mainly descriptive, addressing knowledge, attitudes, and practices separately and lacking an examination of the interrelationships between these three components. Another limitation of the KAP method is underestimating psychosocial variables that have proved influential in health related behaviors, including perceived benefits and costs of preventive measures, perceived social pressure, perceived personal control, unrealistic optimism and risk propensity. Future risk perception studies in travel medicine should consider psychosocial variables with inferential and multivariate statistical analyses. The use of implicit measurements of attitudes could also provide new insights in the field of travelers' risk perception of travel-associated infectious diseases.
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Affiliation(s)
- Shruti Sridhar
- Aix Marseille Université, Emerging Tropical and Infectious Disease Unit (URMITE), Faculty of Medicine, 27 Bd Jean Moulin, 13005 Marseille, France
| | - Isabelle Régner
- Aix Marseille Université, CNRS, LPC UMR 7290, 13331, Marseille, France
| | - Philippe Brouqui
- Aix Marseille Université, Emerging Tropical and Infectious Disease Unit (URMITE), Faculty of Medicine, 27 Bd Jean Moulin, 13005 Marseille, France; Assistance Publique Hôpitaux de Marseille, Institut Méditerranée Infection, Infectious Diseases and Tropical Medicine Unit, North Hospital, Chemin des Bourrelys, 13915, Marseille, France
| | - Philippe Gautret
- Aix Marseille Université, Emerging Tropical and Infectious Disease Unit (URMITE), Faculty of Medicine, 27 Bd Jean Moulin, 13005 Marseille, France; Assistance Publique Hôpitaux de Marseille, Institut Méditerranée Infection, Infectious Diseases and Tropical Medicine Unit, North Hospital, Chemin des Bourrelys, 13915, Marseille, France.
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19
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Créach MA, Velut G, de Laval F, Briolant S, Aigle L, Marimoutou C, Deparis X, Meynard JB, Pradines B, Simon F, Michel R, Mayet A. Factors associated with malaria chemoprophylaxis compliance among French service members deployed in Central African Republic. Malar J 2016; 15:174. [PMID: 26987358 PMCID: PMC4797250 DOI: 10.1186/s12936-016-1219-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a public health concern in the French armed forces, with 400-800 cases reported every year and three deaths in the past 2 years. However, lack of chemoprophylaxis (CP) compliance is often reported among service members. The aim of this study was to explore factors associated with CP compliance. METHODS A retrospective study (1296 service members) was carried out among troops deployed in Central African Republic. Determinants of CP were collected by self-questionnaire. Socio-demographic variables, behavioural characteristics, belief variables, operational determinants such as troops in contact (TIC) and number of nights worked per week and peer-to-peer reinforcement were studied. Relationships between covariates and compliance were explored using logistic regressions (outcome: compliance as a dummy variable). RESULTS Chemoprophylaxis compliance was associated with other individual preventive measures against mosquito bites (bed net use, OR (odds ratio) = 1.41 (95% CI [1.08-1.84]), and insecticide on clothing, OR = 1.90 ([1.43-2.51]) and malaria-related behaviours (taking chemoprophylaxis at the same time every day, OR = 2.37 ([1.17-4.78]) and taking chemoprophylaxis with food, OR = 1.45 ([1.11-1.89])). High perceived risk of contracting malaria, OR = 1.59 ([1.02-2.50]), positive perception of CP effectiveness, OR = 1.62 ([1.09-2.40]) and the practice of peer-to-peer reinforcement, OR = 1.38 ([1.05-1.82]) were also associated with better compliance. No association was found with TIC and number of nights worked. CONCLUSIONS This study, which shows a positive relationship between peer-to-peer reinforcement and CP compliance, also suggests the existence of two main personality profiles among service members: those who seek risks and those who are health-conscious. Health education should be expanded beyond knowledge, know-how and motivational factors by using a comprehensive approach based on identification of health determinants, development of psychosocial skills and peer-to-peer reinforcement.
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Affiliation(s)
- Marie-Aude Créach
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.
| | - Guillaume Velut
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France
| | - Franck de Laval
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France
| | - Sébastien Briolant
- Inter-Army Health Service Directorate, Cayenne, French Guiana, France.,Parasitology Laboratory, Institut Pasteur of French Guiana, Cayenne, French Guiana, France.,Research Unit on Emerging Infectious and Tropical Diseases, Aix Marseille University, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - Luc Aigle
- Operation Sangaris, Bangui, Central African Republic
| | - Catherine Marimoutou
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France
| | - Xavier Deparis
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France.,Ecole du Val-de-Grâce, Paris, France
| | - Jean-Baptiste Meynard
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France.,Ecole du Val-de-Grâce, Paris, France
| | - Bruno Pradines
- Research Unit on Emerging Infectious and Tropical Diseases, Aix Marseille University, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France.,Parasitology and Entomology Unit, Department of Infectious Diseases, Armed Forces Biomedical Research Institute, Brétigny sur Orge, France.,National Reference Centre for Malaria, Marseille, France
| | - Fabrice Simon
- Parasitology and Entomology Unit, Department of Infectious Diseases, Armed Forces Biomedical Research Institute, Brétigny sur Orge, France.,Department of Infectious and Tropical Diseases, Laveran Armed Forces Teaching Hospital, Marseille, France.,Ecole du Val-de-Grâce, Paris, France
| | - Rémy Michel
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,Department of Infectious and Tropical Diseases, Laveran Armed Forces Teaching Hospital, Marseille, France
| | - Aurélie Mayet
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France
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Allen KC. Phenomenological analysis of going home in Caribbean-American international travelers. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2015; 1:12. [PMID: 28883943 PMCID: PMC5531102 DOI: 10.1186/s40794-015-0016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND In travel health risk assessments visiting friends and relatives (VFR) travel status is often used as an indicator for high-risk travel behavior. VFR travelers have been associated with increased risk of travel-associated illnesses due to poor adherence to travel guidelines and lack of pre-travel health consultations. For travelers to dengue endemic regions, guidelines include compliance with mosquito avoidance practices (MAP). The goal of this study is to understand the meaning of travel experiences to the home country for immigrant and first generation American VFR travelers in the United States (US). METHODS A phenomenology study was conducted on VFR travelers to identify social and physical environmental factors associated with travel health behaviors, and determine how 'going home' influences compliance with recommendations for dengue prevention. Purposive sampling identified participants for semi-structured interviews on travel behavior with iterative collection and analysis until data reached saturation. RESULTS Interviews revealed five themes that defined the experience of going home: connectedness; control of the experience; two different experiences at home; seeing what home has to offer; and there is no place like home. Moreover, risk perception of health and disease risks in the travel destination influenced travel behavior and compliance with guidelines. CONCLUSIONS VFR travel status does not fully capture the experience of international travel. Behavior was associated with the emergent concept of Cultural Embeddedness when traveling home and to new destinations. More research on improving terminology for travel health risk assessments is needed to improve prevention strategies in VFR travelers.
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Affiliation(s)
- Koya C Allen
- Department of Biostatistics, Environmental Health & Epidemiology, Kent State University College of Public Health, PO Box 5190, Kent, OH 44242 USA.,Present Address: Counter Bio-threats Cell, Force Health Protection, J42 Medical Readiness Division, US European Command Headquarters, US Department of Defense, Stuttgart, Germany
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21
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Stoney RJ, Chen LH, Jentes ES, Wilson ME, Han PV, Benoit CM, MacLeod WB, Hamer DH, Barnett ED. Malaria Prevention Strategies: Adherence Among Boston Area Travelers Visiting Malaria-Endemic Countries. Am J Trop Med Hyg 2015; 94:136-42. [PMID: 26483125 DOI: 10.4269/ajtmh.15-0565] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/29/2015] [Indexed: 11/07/2022] Open
Abstract
We conducted a prospective cohort study to assess adherence to malaria chemoprophylaxis, reasons for nonadherence, and use of other personal protective measures against malaria. We included adults traveling to malaria-endemic countries who were prescribed malaria chemoprophylaxis during a pre-travel consultation at three travel clinics in the Boston area and who completed three or more surveys: pre-travel, at least one weekly during travel, and post-travel (2-4 weeks after return). Of 370 participants, 335 (91%) took malaria chemoprophylaxis at least once and reported any missed doses; 265 (79%) reported completing all doses during travel. Adherence was not affected by weekly versus daily chemoprophylaxis, travel purpose, or duration of travel. Reasons for nonadherence included forgetfulness, side effects, and not seeing mosquitoes. Main reasons for declining to take prescribed chemoprophylaxis were peer advice, low perceived risk, and not seeing mosquitoes. Of 368 travelers, 79% used insect repellent, 46% used a bed net, and 61% slept in air conditioning at least once. Because travelers may be persuaded to stop taking medication by peer pressure, not seeing mosquitoes, and adverse reactions to medications, clinicians should be prepared to address these barriers and to empower travelers with strategies to manage common side effects of antimalarial medications.
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Affiliation(s)
- Rhett J Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - Lin H Chen
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - Emily S Jentes
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - Mary E Wilson
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - Pauline V Han
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - Christine M Benoit
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - William B MacLeod
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - Davidson H Hamer
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
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Sturrock HJW, Roberts KW, Wegbreit J, Ohrt C, Gosling RD. Tackling imported malaria: an elimination endgame. Am J Trop Med Hyg 2015; 93:139-144. [PMID: 26013369 PMCID: PMC4497886 DOI: 10.4269/ajtmh.14-0256] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 02/01/2015] [Indexed: 12/31/2022] Open
Abstract
As countries move toward malaria elimination, imported infections become increasingly significant as they often represent the majority of cases, can sustain transmission, cause resurgences, and lead to mortality. Here we review and critique current methods to prevent malaria importation in countries pursuing elimination and explore methods applied in other transmission settings and to other diseases that could be transferred to support malaria elimination. To improve intervention targeting we need a better understanding of the characteristics of populations importing infections and their patterns of migration, improved methods to reliably classify infections as imported or acquired locally, and ensure early and accurate diagnosis. The potential for onward transmission in the most receptive and vulnerable locations can be predicted through high-resolution risk mapping that can help malaria elimination or prevention of reintroduction programs target resources. Cross border and regional initiatives can be highly effective when based on an understanding of human and parasite movement. Ultimately, determining the optimal combinations of approaches to address malaria importation will require an evaluation of their impact, cost effectiveness, and operational feasibility.
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Affiliation(s)
- Hugh J. W. Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California
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Tudball J, Smith L, Ryan K, Williamson M, Manias E. Challenges to consumers travelling with multiple medicines. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2015. [DOI: 10.1111/jphs.12097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jacqueline Tudball
- School of Public Health & Community Medicine; Faculty of Medicine; University of New South Wales/School of Nursing and Midwifery; Faculty of Health; Deakin University; Sydney New South Wales Australia
| | - Lorraine Smith
- Faculty of Pharmacy; The University of Sydney; Sydney New South Wales Australia
| | - Kath Ryan
- School of Nursing & Midwifery; La Trobe University; Melbourne Victoria Australia
| | | | - Elizabeth Manias
- School of Nursing and Midwifery; Deakin University; Melbourne Victoria Australia
- Department of Medicine; Royal Melbourne Hospital; Melbourne Victoria Australia
- Melbourne School of Health Sciences; The University of Melbourne; Melbourne Victoria Australia
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Lestelle C, Aymeric S, Maakaroun-Vermesse Z, Pouliquen A, Bernard L, Chandenier J, Grammatico-Guillon L. Impact of advice given to travelers concerning the main infectious risks associated with traveling in the tropics. Med Mal Infect 2015; 45:222-8. [PMID: 26026227 DOI: 10.1016/j.medmal.2015.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/02/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The prevention of sanitary risks related to traveling in the tropics implies delivering a large amount of information to travelers. The objective of our study was to assess the knowledge acquired by travelers during a pre-travel consultation. METHODS A before and after study was conducted among 202 travelers having consulted at the Tours international vaccine center. We used self-administrated questionnaires (score out of 100 marks) concerning diet, hygiene, anti-vectorial prevention (AVP), and sexual-transmitted infections (STI). The scores obtained before and after consultation were compared globally and for each topic. RESULTS The travelers' global knowledge had improved after consultation (66.1 vs. 75.5%; P < 0.0001) as well as for each topic. The most important improvement concerned hygiene (+12.5%; P < 0.0001) and the lowest concerned STI (+5.8%; P < 0.0001). The multivariate analysis revealed that not having searched for information before consulting was the main factor associated with global knowledge improvement (P < 0.0001) (unplanned professional traveling compared to humanitarian mission prepared ahead of departure time). The recommendations for diet were less well acquired in travelers > 50 years of age than in those < 30 years of age (P < 0.002). CONCLUSION A specialized pre-travel consultation improves the travelers' knowledge for the main prevention measures but does not allow them to acquire all required knowledge. Taking into account the travelers' initial knowledge and their ability to learn could improve the impact of the pre-travel consultation.
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Affiliation(s)
- C Lestelle
- Unité de consultation des voyageurs, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours cedex 1, France; Université François-Rabelais, Tours, France
| | - S Aymeric
- Université François-Rabelais, Tours, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, CHRU de Tours, Tours, France; Équipe émergente 1, éducation éthique santé, université François-Rabelais, Tours, France
| | - Z Maakaroun-Vermesse
- Unité de consultation des voyageurs, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours cedex 1, France; Service de médecine interne et maladies infectieuses, CHRU de Tours, Tours, France
| | - A Pouliquen
- Unité de consultation des voyageurs, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours cedex 1, France
| | - L Bernard
- Unité de consultation des voyageurs, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours cedex 1, France; Université François-Rabelais, Tours, France; Service de médecine interne et maladies infectieuses, CHRU de Tours, Tours, France
| | - J Chandenier
- Unité de consultation des voyageurs, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours cedex 1, France; Université François-Rabelais, Tours, France; Service de parasitologie-mycologie-médecine tropicale, CHRU de Tours, Tours, France
| | - L Grammatico-Guillon
- Unité de consultation des voyageurs, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours cedex 1, France; Université François-Rabelais, Tours, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, CHRU de Tours, Tours, France; Équipe émergente 1, éducation éthique santé, université François-Rabelais, Tours, France.
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McGuinness SL, Spelman T, Johnson DF, Leder K. Immediate recall of health issues discussed during a pre-travel consultation. J Travel Med 2015; 22:145-51. [PMID: 25594824 DOI: 10.1111/jtm.12183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND An important role of pre-travel consultations is to improve travelers' understanding of travel-related diseases, but the efficacy of education provided is unknown. This study sought to assess recall and knowledge immediately following a pre-travel consultation. METHODS The study was conducted at a hospital-based pre-travel clinic in Melbourne, Australia. Travelers aged ≥16 years seen between September 2010 and March 2012 were invited to complete an anonymous self-administered questionnaire immediately following their consultation to assess knowledge of appropriate preventive measures and presumptive self-treatment strategies for common travel risks. The doctor of each participating traveler also completed a survey regarding issues discussed. RESULTS A total of 300 participants were recruited (34% male, median age 31 years). Most were traveling for vacation (77%) and reported previous travel (95%). Main travel destinations were Asia (43%), Americas (21%), and Africa (17%). Doctors' and travelers' surveys showed variable levels of concordance: 94% of patients recalled discussion of malaria, 84% rabies, and 76% dengue. For malaria, 95% remembered discussions regarding insect repellents, and 92% recalled that medical advice should be sought if fever developed. For travelers with whom rabies was discussed, 94% recalled that medical advice must be urgently sought following a bite/scratch. For travelers' diarrhea (TD), 99% knew to drink only boiled/bottled water, but 13% did not recall avoiding unpeeled fruit/vegetables as a prevention strategy. There was 20% discordance between doctors and travelers regarding antibiotics for TD self-treatment, but only 4% discordance regarding prescription of malaria prophylaxis. Factors associated with improved recall were doctor discussion, previous travel, and a university education. CONCLUSIONS Key travel health messages are well assimilated after pre-travel consultation. However, large amounts of information are discussed and immediate recollection of all information is not possible. This study reinforces the importance of providing supplementary information (eg, written and/or electronic resources) to accompany pre-travel consultations.
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Affiliation(s)
- Sarah L McGuinness
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Melbourne, Australia
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26
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Goldstein I, Grefat R, Ephros M, Rishpon S. Intent-to-adhere and adherence to malaria prevention recommendations in two travel clinics. J Travel Med 2015; 22:130-2. [PMID: 25159037 DOI: 10.1111/jtm.12156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/28/2014] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Abstract
Malaria infects 30,000 travelers annually worldwide. At greatest risk are those who travel for long duration. Prevention of malaria includes chemoprophylaxis. This prospective study on 121 travelers who visited two travel clinics shows that adherence to prophylactic treatment was low, especially in long duration trips, and that adherence rate could be predicted by the much more available intent-to-adhere rate.
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Adebayo AM, Akinyemi OO, Cadmus EO. Knowledge of malaria prevention among pregnant women and female caregivers of under-five children in rural southwest Nigeria. PeerJ 2015; 3:e792. [PMID: 25755925 PMCID: PMC4349050 DOI: 10.7717/peerj.792] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/04/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction. The morbidity and mortality from malaria are still unacceptably high in the developing countries, especially among the vulnerable groups like pregnant women and under-five children, despite all control efforts. The knowledge about the preventive measures of malaria is an important preceding factor for the acceptance and use of malaria preventive measures like Insecticide Treated Nets (ITN) by community members. Therefore, this study assessed the knowledge of malaria prevention among caregivers of under-five children and pregnant women in a rural community in Southwest Nigeria. Methodology. This is part of a larger malaria prevention study in rural Southwest Nigeria. A descriptive cross-sectional survey was conducted among pregnant women and caregivers of under-five children in Igbo-Ora, a rural town in Southwest Nigeria using a semi-structured, interviewer-administered questionnaire. Information was obtained on knowledge of malaria prevention, and overall composite scores were computed for knowledge of malaria prevention and ITN use. Data were analyzed using SPSS version 16. Associations between variables were tested using a Chi-square with the level of statistical significance set at 5%. Results. Of the 631 respondents, 84.9% were caregivers of under-five children and 67.7% were married. Mean age was 27.7 ± 6.3 years with 53.4% aged between 20 and 29 years. Majority (91.1%) had at least primary school education and 60.2% were traders. Overall, 57.7% had poor knowledge of malaria prevention. A good proportion (83.5%) were aware of the use of ITN for malaria prevention while 30.6% had poor knowledge of its use. Respondents who were younger (<30 years), had at least primary education and earn <10,000/per month had significantly poor knowledge of ITN use in malaria prevention. Majority (60.0%) respondents had poor attitude regarding use of ITNs. Conclusion. This study showed that the knowledge of malaria prevention is still low among under-five caregivers and pregnant women in rural Southwest Nigeria despite current control measures. There is a need for concerted health education intervention to improve the knowledge of rural dwellers regarding malaria prevention, including the use of ITN. This will go a long way to improving the reported low level of ownership and utilization of ITN in the rural areas.
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Affiliation(s)
- Ayodeji M Adebayo
- Department of Preventive Medicine and Primary Care, College of Medicine, University of Ibadan , Ibadan , Nigeria
| | - Oluwaseun O Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan , Ibadan , Nigeria
| | - Eniola O Cadmus
- Department of Preventive Medicine and Primary Care, College of Medicine, University of Ibadan , Ibadan , Nigeria
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Pinsent A, Read JM, Griffin JT, Smith V, Gething PW, Ghani AC, Pasvol G, Hollingsworth TD. Risk factors for UK Plasmodium falciparum cases. Malar J 2014; 13:298. [PMID: 25091803 PMCID: PMC4132200 DOI: 10.1186/1475-2875-13-298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 07/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An increasing proportion of malaria cases diagnosed in UK residents with a history of travel to malaria endemic areas are due to Plasmodium falciparum. METHODS In order to identify travellers at most risk of acquiring malaria a proportional hazards model was used to estimate the risk of acquiring malaria stratified by purpose of travel and age whilst adjusting for entomological inoculation rate (EIR) and duration of stay in endemic countries. RESULTS Travellers visiting friends and relatives and business travellers were found to have significantly higher hazard of acquiring malaria (adjusted hazard ratio (HR) relative to that of holiday makers 7.4, 95% CI 6.4-8.5, p < 0. 0001 and HR 3.4, 95% CI 2.9-3.8, p < 0. 0001, respectively). All age-groups were at lower risk than children aged 0-15 years. CONCLUSIONS These estimates of the increased risk for business travellers and those visiting friends and relatives should be used to inform programmes to improve awareness of the risks of malaria when travelling.
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Balaban V, Warnock E, Ramana Dhara V, Jean-Louis LA, Sotir MJ, Kozarsky P. Health risks, travel preparation, and illness among public health professionals during international travel. Travel Med Infect Dis 2014; 12:349-54. [DOI: 10.1016/j.tmaid.2014.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/13/2014] [Accepted: 01/15/2014] [Indexed: 11/25/2022]
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Summary of recommendations for the prevention of malaria by the Committee to Advise on Tropical Medicine and Travel (CATMAT). ACTA ACUST UNITED AC 2014; 40:118-132. [PMID: 29769893 DOI: 10.14745/ccdr.v40i07a01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background On behalf of the Public Health Agency of Canada, the Committee to Advise on Tropical Medicine and Travel (CATMAT) developed the Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers for Canadian health care providers who are preparing patients for travel to malaria-endemic areas and treating travellers who have returned ill. Objective To provide guidelines on risk assessment and prevention of malaria. Methods CATMAT reviewed all major sources of information on malaria prevention, as well as recent research and national and international epidemiological data, to tailor guidelines to the Canadian context. The evidence-based medicine recommendations were developed with associated rating scales for the strength and quality of the evidence. Recommendations Used together and correctly, personal protective measures (PPM) and chemoprophylaxis very effectively protect against malaria infection. PPM include protecting accommodation areas from mosquitoes, wearing appropriate clothing, using bed nets pre-treated with insecticide and applying topical insect repellant (containing 20%-30% DEET or 20% icaridin) to exposed skin. Selecting the most appropriate chemoprophylaxis involves assessment of the traveller's itinerary to establish his/her malaria risk profile as well as potential drug resistance issues. Antimalarials available on prescription in Canada include chloroquine (or hydroxychloroquine), atovaquone-proguanil, doxycycline, mefloquine and primaquine.
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Angelin M, Evengård B, Palmgren H. Travel health advice: Benefits, compliance, and outcome. ACTA ACUST UNITED AC 2014; 46:447-53. [DOI: 10.3109/00365548.2014.896030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lau C, Weinstein P, Slaney D. The Importance of Surveillance for Informing Pretravel Medical Advice: Imported Malaria in New Zealand 1997–2009. Vector Borne Zoonotic Dis 2014; 14:134-40. [DOI: 10.1089/vbz.2012.1261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Colleen Lau
- WHO Collaborating Centre for Children's Health and the Environment, Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
- Travel Medicine Alliance Clinics, Perth and Brisbane, Australia
| | - Philip Weinstein
- Barbara Hardy Institute, University of South Australia, Adelaide, South Australia, Australia
| | - David Slaney
- Barbara Hardy Institute, University of South Australia, Adelaide, South Australia, Australia
- Institute of Environmental Science and Research Ltd, Porirua, New Zealand
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Küpper T, Rieke B, Neppach K, Morrison A, Martin J. Health hazards and medical treatment of volunteers aged 18-30 years working in international social projects of non-governmental organizations (NGO). Travel Med Infect Dis 2013; 12:385-95. [PMID: 24332435 DOI: 10.1016/j.tmaid.2013.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 09/27/2013] [Accepted: 11/12/2013] [Indexed: 11/27/2022]
Abstract
The specific health risk profile and diversity of treatments sought by young volunteers participating in international social projects should differ from those of their older colleagues. In the absence of any data to identify whether this was correct, a retrospective analysis was performed using a standardized questionnaire. Questions included what diseases occurred, and details of the frequency and types of treatment sought during their stay - (e.g. self-treatment, medical/dental intervention, or local healer). The 153 participants were aged 18-30 years and worked in a non-governmental organization for >6 months. The participants were: 53% female, mean age 20 years, and mean duration of stay was 11.2 months. Their NGO placement abroad was in Latin America 65.4%, 14.4% in Africa, and 9.8% in Asia. 83% of the young volunteers had received some advice regarding travel medicine before their departure. However, they suffered from more injuries compared to private travellers, and febrile infections were more common when compared to older studies. 21.2% suffered from dental problems and 50% of them sought medical treatment. This study highlights a previously unreported higher risk profile of specific health problems occurring in young NGO volunteers, including some potentially life-threatening diagnoses that differed from their older colleagues and normal travellers. It is recommended that young volunteers should receive age specific, comprehensive pre-departure training in health and safety, first aid, and management of common health problems. A medical check-up upon returning home should be mandatory. The provision of a basic first aid kit to each volunteer before departure is also recommended.
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Affiliation(s)
- T Küpper
- Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany; Medical Commission of the Union Internationale des Associations d'Alpinisme (UIAA MedCom), Germany.
| | - B Rieke
- Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany; Travel Medicine and Yellow Fever Vaccination Centre, Düsseldorf, Germany
| | - K Neppach
- Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany
| | - A Morrison
- Medical Commission of the Union Internationale des Associations d'Alpinisme (UIAA MedCom), Germany
| | - J Martin
- Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany
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Zimmermann R, Hattendorf J, Blum J, Nüesch R, Hatz C. Risk perception of travelers to tropical and subtropical countries visiting a swiss travel health center. J Travel Med 2013; 20:3-10. [PMID: 23279224 DOI: 10.1111/j.1708-8305.2012.00671.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 07/15/2012] [Accepted: 07/16/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study assessed the risk perception ratings of travelers pre- and post-travel and in comparison to the ratings by travel health experts. While most surveys on travel health knowledge, attitudes, and practices focus on malaria and vaccine-preventable diseases, noninfectious travel risks were included in this study. METHODS Pre- and post-travel perception of nine travel-associated health risks was recorded among 314 travelers to tropical and subtropical destinations. All travelers sought pre-travel health advice at the Travel Clinic of the Swiss Tropical and Public Health Institute in 2008 and 2009. In addition, 18 Swiss travel health experts provided an assessment of the respective risks. A validated visual psychometric measuring instrument was used [pictorial representation of illness and self measure (PRISM)]. RESULTS Travelers and experts rated most risks similarly, except for accidents and sexually transmitted infections (STIs) which experts rated higher. Compared to other risks, accidents ranked highly in both groups and were the only risk perceived higher after travel. Pre- and post-travel perceptions of all other risks were similar with a tendency to be lower after travel. Travelers perceived mosquitoes to be the highest risk before travel and accidents after travel. CONCLUSION Travelers' risk perception appears to be accurate for most risks stated in this study. However, travel health professionals should be aware that some perception patterns among travelers regarding travel-related health risks may be different from professional risk assessment. Important but insufficiently perceived health risks, such as sexual behavior/STIs and accidents, should be considered to be part of any pre-travel health advice package.
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Affiliation(s)
- Rosalie Zimmermann
- Departments of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland.
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Toovey S, Jamieson A. Rolling back malaria: how well is Europe doing? Travel Med Infect Dis 2012; 1:167-75. [PMID: 17291910 DOI: 10.1016/j.tmaid.2003.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2003] [Revised: 09/17/2003] [Accepted: 09/18/2003] [Indexed: 11/26/2022]
Abstract
Background. The Roll Back Malaria (RBM) initiative has committed itself to halving the worlds's malaria burden by 2010, having adopted five operationally focused 'critical concepts' to guide this task. The focus of RBM's efforts is in the developing world where external support is often required. Malaria was only recently eradicated from Europe, and the continent remains under continual threat of reintroduction. The extent of this threat is examined, and the European response benchmarked against RBM's critical concepts. Methods. The following sources were searched for references using the phrase "imported malaria": RBM, WHO, European Union including Eurosurveillance, and MedLine websites. Links to related articles were followed. Citations were independently assessed by the authors for relevance and inclusion. Results. Only in application of the critical concept "disease surveillance" does the European response seem adequate. Conclusions. Europe should be making greater efforts and considering additional strategies to combat imported malaria.
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Affiliation(s)
- Stephen Toovey
- American Society of Travel Medicine Certified in Clinical Tropical Medicine and Travelers' Health, SAA-Netcare Travel Clinics, P.O. Box 786692, Sandton 2146, South Africa
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Heywood AE, Watkins RE, Iamsirithaworn S, Nilvarangkul K, MacIntyre CR. A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports. BMC Public Health 2012; 12:321. [PMID: 22550996 PMCID: PMC3441818 DOI: 10.1186/1471-2458-12-321] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 05/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-travel health assessments aim to promote risk reduction through preventive measures and safe behavior, including ensuring travelers are up-to-date with their immunizations. However, studies assessing pre-travel health-seeking practices from a variety of medical and non-medical sources and vaccine uptake prior to travel to both developing and developed countries within the Asia-Pacific region are scarce. METHODS Cross-sectional surveys were conducted between July and December 2007 to assess pre-travel health seeking practices, including advice from health professionals, health information from other sources and vaccine uptake, in a sample of travelers departing Sydney and Bangkok airports. A two-stage cluster sampling technique was used to ensure representativeness of travelers and travel destinations. Pre-travel health seeking practices were assessed using a self-administered questionnaire distributed at the check-in queues of departing flights. Logistic regression models were used to identify significant factors associated with seeking pre-travel health advice from a health professional, reported separately for Australian residents, residents of other Western countries and residents of countries in Asia. RESULTS A total of 843 surveys were included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, pre-travel health information from any source was sought by 415 (49%) respondents with 298 (35%) seeking pre-travel advice from a health professional, the majority through general practice. Receipt of a pre-travel vaccine was reported by 100 (12%) respondents. Significant factors associated with seeking pre-travel health advice from a health professional differed by region of residence. Asian travelers were less likely to report seeking pre-travel health advice and uptake of pre-travel vaccines than Australian or other Western travelers. Migrant Australians were less likely to report seeking pre-travel health advice than Australian-born travelers. CONCLUSIONS This study highlights differences in health-seeking practices including the uptake of pre-travel health advice by region of residence and country of birth. There is a public health need to identify strategies targeting these travel groups. This includes the promotion of affordable and accessible travel clinics in low resource countries as traveler numbers increase and travel health promotion targeting migrant groups in high resource countries. General practitioners should play a central role. Determining the most appropriate strategies for increasing pre-travel health preparation, particularly for vaccine preventable diseases in travelers is the next stage in advancing travel medicine research.
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia.
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Heywood AE, Zhang M, MacIntyre CR, Seale H. Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia. BMC Infect Dis 2012; 12:43. [PMID: 22339735 PMCID: PMC3305552 DOI: 10.1186/1471-2334-12-43] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 02/17/2012] [Indexed: 11/24/2022] Open
Abstract
Background Forward planning and preventative measures before travelling can significantly reduce the risk of many vaccine preventable travel-related infectious diseases. Higher education students may be at an increased risk of importing infectious disease as many undertake multiple visits to regions with higher infectious disease endemicity. Little is known about the health behaviours of domestic or international university students, particularly students from low resource countries who travel to high-resource countries for education. This study aimed to assess travel-associated health risks and preventative behaviours in a sample of both domestic and international university students in Australia. Methods In 2010, a 28 item self-administered online survey was distributed to students enrolled at the University of New South Wales, Sydney, Australia. Multiple methods of distributing links to the online survey were utilised. The survey examined the international travel history, travel intentions, infection control behaviours and self-reported vaccination history. Results A total of 1663 respondents completed the online survey, 22.1% were international students and 83.9% were enrolled at an undergraduate level. Half had travelled internationally in the previous 12 months, with 69% of those travelling only once during that time with no difference in travel from Australia between domestic and international students (p = 0.8). Uptake of pre-travel health advice was low overall with 68% of respondents reporting they had not sought any advice from a health professional prior to their last international trip. Domestic students were more likely to report uptake of a range of preventative travel health measures compared to international students, including diarrhoeal medication, insect repellent, food avoidance and condoms (P < 0.0001). Overall, students reported low risk perception of travel threats and a low corresponding concern for these threats. Conclusions Our study highlights the need to educate students about the risk associated with travel and improve preventative health-seeking and uptake of precautionary health measures in this highly mobile young adult population. Although immunisation is not an entry requirement to study at Universities in Australia, large tertiary institutions provide an opportunity to engage with young adults on the importance of travel health and provision of vaccines required for travel, including missed childhood vaccines.
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
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Pereira EA, Ishikawa EAY, Fontes CJF. Adherence to Plasmodium vivax malaria treatment in the Brazilian Amazon Region. Malar J 2011; 10:355. [PMID: 22165853 PMCID: PMC3271049 DOI: 10.1186/1475-2875-10-355] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 12/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients' adherence to malaria treatment is an important factor in determining the therapeutic response to anti-malarial drugs. It contributes to the patient's complete recovery and prevents the emergence of parasite resistance to anti-malarial drugs. In Brazil, the low compliance with malaria treatment probably explains the large number of Plasmodium vivax malaria relapses observed in the past years. The goal of this study was to estimate the proportion of patients adhering to the P. vivax malaria treatment with chloroquine + primaquine in the dosages recommended by the Brazilian Ministry of Health. METHODS Patients who were being treated for P. vivax malaria with chloroquine plus primaquine were eligible for the study. On the seventh day of taking primaquine, they were visited at their home and were interviewed. The patients were classified as probably adherent, if they reported having taken all the medication as prescribed, in the correct period of time and dosage, and had no medication tablets remaining; probably non-adherent, if they reported not having taken the medication, in the correct period of time and dosage, and did not show any remaining tablets; and certainly non-adherent, if they showed any remaining medication tablets. RESULTS 242 of the 280 patients reported having correctly followed the prescribed instructions and represented a treatment adherence frequency (CI95%) of 86.4% (81.7%-90.1%). Of the 38 patients who did not follow the recommendations, 27 (9.6%) were still taking the medication on the day of the interview and, therefore, still had primaquine tablets left in the blister pack. These patients were then classified as certainly non-adherent to treatment. Although 11 patients did not show any tablets left, they reported incorrect use of the prescribed therapy regimen and were considered as probably non-adherent to treatment. CONCLUSIONS Compliance with the P. vivax malaria treatment is a characteristic of 242/280 patients in the surveyed region. However, the group of non-adherent patients can have an impact on the magnitude of transmission and relapses of P. vivax infections currently observed in the studied area. Simple practices can be introduced in the healthcare services in order to improve compliance with the treatment prescribed.
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Affiliation(s)
- Elza A Pereira
- Secretaria de Estado de Saúde Publica do Pará, Departamento de Controle de Endemias, Belem, (PA), Brazil.
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Travel clinic communication and non-adherence to malaria chemoprophylaxis. Travel Med Infect Dis 2011; 9:278-83. [DOI: 10.1016/j.tmaid.2011.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 09/14/2011] [Accepted: 09/19/2011] [Indexed: 11/17/2022]
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Sagui E, Resseguier N, Machault V, Ollivier L, Orlandi-Pradines E, Texier G, Pages F, Michel R, Pradines B, Briolant S, Buguet A, Tourette-Turgis C, Rogier C. Determinants of compliance with anti-vectorial protective measures among non-immune travellers during missions to tropical Africa. Malar J 2011; 10:232. [PMID: 21831319 PMCID: PMC3176253 DOI: 10.1186/1475-2875-10-232] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effectiveness of anti-vectorial malaria protective measures in travellers and expatriates is hampered by incorrect compliance. The objective of the present study was to identify the determinants of compliance with anti-vectorial protective measures (AVPMs) in this population that is particularly at risk because of their lack of immunity. METHODS Compliance with wearing long clothing, sleeping under insecticide-impregnated bed nets (IIBNs) and using insect repellent was estimated and analysed by questionnaires administered to 2,205 French military travellers from 20 groups before and after short-term missions (approximately four months) in six tropical African countries (Senegal, Ivory Coast, Chad, Central African Republic, Gabon and Djibouti). For each AVPM, the association of "correct compliance" with individual and collective variables was investigated using random-effect mixed logistic regression models to take into account the clustered design of the study. RESULTS The correct compliance rates were 48.6%, 50.6% and 18.5% for wearing long clothing, sleeping under bed nets and using repellents, respectively. Depending on the AVPM, correct compliance was significantly associated with the following factors: country, older than 24 years of age, management responsibilities, the perception of a personal malaria risk greater than that of other travellers, the occurrence of life events, early bedtime (i.e., before midnight), the type of stay (field operation compared to training), the absence of medical history of malaria, the absence of previous travel in malaria-endemic areas and the absence of tobacco consumption.There was no competition between compliance with the different AVPMs or between compliance with any AVPM and malaria chemoprophylaxis. CONCLUSION Interventions aimed at improving compliance with AVPMs should target young people without management responsibilities who are scheduled for non-operational activities in countries with high risk of clinical malaria. Weak associations between compliance and history of clinical malaria or variables that pertain to threat perception suggest that cognition-based interventions referencing a "bad experience" with clinical malaria could have only a slight impact on the improvement of compliance. Further studies should focus on the cognitive and behavioural predictors of compliance with AVPMs.
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Affiliation(s)
- Emmanuel Sagui
- Field Infectiology Department, Institute for Biomedical Research of the French Armed Forces (IRBA) & URMITE UMR6236, Allée du Médecin Colonel Jamot, Parc du Pharo, BP60109, 13262 Marseille Cedex 07, France
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Goesch JN, Simons de Fanti A, Béchet S, Consigny PH. Comparison of knowledge on travel related health risks and their prevention among humanitarian aid workers and other travellers consulting at the Institut Pasteur travel clinic in Paris, France. Travel Med Infect Dis 2010; 8:364-72. [DOI: 10.1016/j.tmaid.2010.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 09/19/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
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Adaptive contact networks change effective disease infectiousness and dynamics. PLoS Comput Biol 2010; 6. [PMID: 20808884 PMCID: PMC2924249 DOI: 10.1371/journal.pcbi.1000895] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 07/19/2010] [Indexed: 11/19/2022] Open
Abstract
Human societies are organized in complex webs that are constantly reshaped by a social dynamic which is influenced by the information individuals have about others. Similarly, epidemic spreading may be affected by local information that makes individuals aware of the health status of their social contacts, allowing them to avoid contact with those infected and to remain in touch with the healthy. Here we study disease dynamics in finite populations in which infection occurs along the links of a dynamical contact network whose reshaping may be biased based on each individual's health status. We adopt some of the most widely used epidemiological models, investigating the impact of the reshaping of the contact network on the disease dynamics. We derive analytical results in the limit where network reshaping occurs much faster than disease spreading and demonstrate numerically that this limit extends to a much wider range of time scales than one might anticipate. Specifically, we show that from a population-level description, disease propagation in a quickly adapting network can be formulated equivalently as disease spreading on a well-mixed population but with a rescaled infectiousness. We find that for all models studied here--SI, SIS and SIR--the effective infectiousness of a disease depends on the population size, the number of infected in the population, and the capacity of healthy individuals to sever contacts with the infected. Importantly, we indicate how the use of available information hinders disease progression, either by reducing the average time required to eradicate a disease (in case recovery is possible), or by increasing the average time needed for a disease to spread to the entire population (in case recovery or immunity is impossible).
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Atkinson JAM, Fitzgerald L, Toaliu H, Taleo G, Tynan A, Whittaker M, Riley I, Vallely A. Community participation for malaria elimination in Tafea Province, Vanuatu: Part I. Maintaining motivation for prevention practices in the context of disappearing disease. Malar J 2010; 9:93. [PMID: 20380748 PMCID: PMC2873527 DOI: 10.1186/1475-2875-9-93] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 04/12/2010] [Indexed: 12/02/2022] Open
Abstract
Background In the 1990s, the experience of eliminating malaria from Aneityum Island, Vanuatu is often given as evidence for the potential to eliminate malaria in the south-west Pacific. This experience, however, cannot provide a blueprint for larger islands that represent more complex social and environmental contexts. Community support was a key contributor to success in Aneityum. In the context of disappearing disease, obtaining and maintaining community participation in strategies to eliminate malaria in the rest of Tafea Province, Vanuatu will be significantly more challenging. Method Nine focus group discussions (FGDs), 12 key informant interviews (KIIs), three transect walks and seven participatory workshops were carried out in three villages across Tanna Island to investigate community perceptions and practices relating to malaria prevention (particularly relating to bed nets); influences on these practices including how malaria is contextualized within community health and disease priorities; and effective avenues for channelling health information. Results The primary protection method identified by participants was the use of bed nets, however, the frequency and motivation for their use differed between study villages on the basis of the perceived presence of malaria. Village, household and personal cleanliness were identified by participants as important for protection against malaria. Barriers and influences on bed net use included cultural beliefs and practices, travel, gender roles, seasonality of mosquito nuisance and risk perception. Health care workers and church leaders were reported to have greatest influence on malaria prevention practices. Participants preferred receiving health information through visiting community health promotion teams, health workers, church leaders and village chiefs. Conclusion In low malaria transmission settings, a package for augmenting social capital and sustaining community participation for elimination will be essential and includes: 'sentinel sites' for qualitative monitoring of evolving local socio-cultural, behavioural and practical issues that impact malaria prevention and treatment; mobilizing social networks; intersectoral collaboration; integration of malaria interventions with activities addressing other community health and disease priorities; and targeted implementation of locally appropriate, multi-level, media campaigns that sustain motivation for community participation in malaria elimination.
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Affiliation(s)
- Jo-An M Atkinson
- Pacific Malaria Initiative Support Centre, Australian Centre for International and Tropical Health, School of Population Health, University of Queensland, Brisbane, Australia.
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Funk S, Gilad E, Jansen VAA. Endemic disease, awareness, and local behavioural response. J Theor Biol 2010; 264:501-9. [PMID: 20184901 DOI: 10.1016/j.jtbi.2010.02.032] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 01/27/2010] [Accepted: 02/19/2010] [Indexed: 10/19/2022]
Abstract
The spread of a contagious disease is often accompanied by a rise in awareness of those in the social vicinity of infected individuals, and a subsequent change in behaviour. Such reactions can manifest themselves in lower susceptibility as people try to prevent themselves from catching the disease, but also in lower infectivity because of self-imposed quarantine or better hygiene, shorter durations of infectiousness or longer immunity. We here focus on the scenario of an endemic disease of which members of the population can be either aware or unaware, and consider a broad set of possible reactions. We quantify the impact on the endemicity of a disease in a well-mixed population under the variation of different disease parameters as a consequence of growing awareness in the population. Applying a pair-closure scheme allows us to analyse the effect of local correlations if aware individuals tend to occur near infected cases, and to link this to the amount of overlap between the networks underlying the spread of awareness and disease, respectively. Lastly, we study the consequences on the dynamics when the pathogen and awareness spread at different velocities.
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Affiliation(s)
- S Funk
- School of Biological Sciences, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK.
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Resseguier N, Machault V, Ollivier L, Orlandi-Pradines E, Texier G, Pradines B, Gaudart J, Buguet A, Tourette-Turgis C, Rogier C. Determinants of compliance with malaria chemoprophylaxis among French soldiers during missions in inter-tropical Africa. Malar J 2010; 9:41. [PMID: 20128921 PMCID: PMC2829034 DOI: 10.1186/1475-2875-9-41] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 02/03/2010] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of malaria chemoprophylaxis is limited by the lack of compliance whose determinants are not well known. Methods The compliance with malaria chemoprophylaxis has been estimated and analysed by validated questionnaires administered before and after the short-term missions (about four months) in five tropical African countries of 2,093 French soldiers from 19 military companies involved in a prospective cohort study. "Correct compliance" was defined as "no missed doses" of daily drug intake during the entire mission and was analysed using multiple mixed-effect logistic regression model. Results The averaged prevalence rate of correct compliance was 46.2%, ranging from 9.6%to 76.6% according to the companies. Incorrect compliance was significantly associated with eveningness (p = 0.028), a medical history of clinical malaria (p < 0.001) and a perceived mosquito attractiveness inferior or superior to the others (p < 0.007). Correct compliance was significantly associated with the systematic use of protective measures against mosquito bites (p < 0.001), the type of military operations (combat vs. training activities, p < 0.001) and other individual factors (p < 0.05). Conclusions The identification of circumstances and profiles of persons at higher risk of lack of compliance would pave the way to specifically targeted strategies aimed to improve compliance with malaria chemoprophylaxis and, therefore, its effectiveness.
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Affiliation(s)
- Noémie Resseguier
- Institute for Biomedical Research of the French Army & URMITE UMR6236, Allée du Médecin Colonel Jamot, Parc du Pharo, Marseille cedex 07, France
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Malaria prevention behaviour and risk awareness in French adult travellers. Travel Med Infect Dis 2010; 8:13-21. [DOI: 10.1016/j.tmaid.2009.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 10/22/2009] [Accepted: 10/27/2009] [Indexed: 11/23/2022]
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Ollivier L, Romand O, Marimoutou C, Michel R, Pognant C, Todesco A, Migliani R, Baudon D, Boutin JP. Use of short message service (SMS) to improve malaria chemoprophylaxis compliance after returning from a malaria endemic area. Malar J 2009; 8:236. [PMID: 19852811 PMCID: PMC2771031 DOI: 10.1186/1475-2875-8-236] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 10/23/2009] [Indexed: 11/30/2022] Open
Abstract
Background Malaria chemoprophylaxis compliance is suboptimal among French soldiers despite the availability of free malaria chemoprophylaxis and repeated health education before, during and after deployment to malaria endemic areas. Methods In 2007, a randomized controlled study was performed among a cohort of French soldiers returning from Côte d'Ivoire to assess the feasibility and acceptability of sending a daily short message service (SMS) reminder message via mobile device to remind soldiers to take their malaria chemoprophylaxis, and to assess the impact of the daily reminder SMS on chemoprophylaxis compliance. Malaria chemoprophylaxis consisted of a daily dose of 100 mg doxycycline monohydrate, which began upon arrival in Côte d'Ivoire and was to be continued for 28 days following return to France. Feasibility and acceptability were assessed by questionnaire. Cohort members were followed for a 28 day period, with compliance assessed by use of an electronic medication monitoring device, from which several indicators were developed: daily proportion of compliant individuals, average number of pills taken, and early discontinuation. Results Among 424 volunteers randomized to the study, 47.6% were assigned to the SMS group and 52.3% to the control group. Approximately 90% of subjects assigned to the SMS group received a daily SMS at midday during the study. Persons of the SMS group agreed more frequently that SMS reminders were very useful and that the device was not annoying. Compliance did not vary significantly between groups across the compliance indicators. Conclusion SMS did not increase malaria chemoprophylaxis compliance above baseline, likely because the persons did not benefit from holidays after the return and stayed together. So the reminder by SMS was noted by all subjects of the study. Another study should be done to confirm these results on soldiers going on holidays from employment after return or with individual travellers.
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Affiliation(s)
- Lénaïck Ollivier
- Institut de médecine tropicale du Service de santé des armées, Département d'épidémiologie et de santé publique Sud, Marseille, France.
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Hartjes LB, Baumann LC, Henriques JB. Travel health risk perceptions and prevention behaviors of US study abroad students. J Travel Med 2009; 16:338-43. [PMID: 19796105 DOI: 10.1111/j.1708-8305.2009.00322.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The number of American study abroad students increased more than 150% in the past decade, along with growth in destinations with increased health risks. This study investigated travel health risk perceptions and prevention behaviors to guide interventions that address the emerging health needs of US study abroad students. METHOD A cross-sectional design was used to collect data from 318 American study abroad students using a Web-based survey. RESULTS The primary source of travel health information was youth-oriented travel guidebooks (85%). The grand mean risk perception score for 18 travel health threats was 1.7 on a 1 to 4 scale, with top-rated threats being contaminated food/water, psychological distress, personal assault, and excessive sun exposure. Predeparture advice was received from primary care providers (52%) and travel health specialists (18%). Additional prevention measures were vaccines (42%) and medication (24%). Of 114 students listing their travel vaccinations, 11% described receiving a malaria vaccine and 4% a hepatitis C vaccine, although no such vaccines exist. Most respondents were confident/very confident in their ability to engage in prevention behaviors (94%). Health problems were primarily infectious disease (70%), psychological distress (10%), and injuries (8%). When asked if prior travel destinations involved areas where malaria transmission occurs, 20% responded, "Don't know." CONCLUSIONS Identified gaps in travel health knowledge and prevention behaviors may produce hazardous consequences when combined with low-perceived risk, reliance on travel guidebooks for health information, and high ratings for prevention self-efficacy. Future research is needed to test the effectiveness of educational interventions designed for student travelers who would benefit from guided practice with destination-specific risk appraisal and prevention planning. Web-based educational resources are a good fit for this population because they are easily updated, available in all phases of travel, and can accommodate interactive multimedia designs that actively engage and motivate students to adopt prevention behaviors.
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Affiliation(s)
- Laurie B Hartjes
- University of Wisconsin-Madison School of Nursing, Madison, WI 53792, USA.
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Askling HH, Ekdahl K, Janzon R, Henric Braconier J, Bronner U, Hellgren U, Rombo L, Tegnell A. Travellers returning to Sweden with falciparum malaria: Pre-travel advice, behaviour, chemoprophylaxis and diagnostic delay. ACTA ACUST UNITED AC 2009; 37:760-5. [PMID: 16191897 DOI: 10.1080/00365540510044120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We have investigated pre-travel advice, behaviour, chemoprophylaxis and diagnostic delay in travellers returning to Sweden with falciparum malaria. Questionnaires were distributed to patients having been notified with falciparum malaria from 1994 to 2001. Of 408 notified patients, 237 (58%) returned the questionnaires; 62% were males and 43% above the age of 45 y. Africa was the travel destination in 90% of the cases, and 27% had travelled to Kenya. 69% had spent more than 1 night in the countryside, and 6% had stayed in modern urban areas only. 40% took an adequate dose of chemoprophylaxis, although this proportion decreased from 55% to 12% during the study period. Nine per cent used both bed nets and mosquito repellents regularly. The median time from onset of symptoms to contact with health care professionals was 2 d, and from that contact to start of malaria treatment the median time was less than 24 h.
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Affiliation(s)
- Helena Hervius Askling
- From the Department of Epidemiology, Swedish Institute for Infectious Disease Control (SMI), Stockholm, Sweden
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