Towards improved uptake of malaria chemoprophylaxis among West African travellers: identification of behavioural determinants

Abstract

BackgroundMalaria is a potentially lethal illness for which preventive measures are not optimally used among all travellers. Travellers visiting friends and relatives in their country of origin (VFRs) are known to use chemoprophylaxis less consistently compared to tourist travellers. In this study, factors explaining the low use of chemoprophylaxis were pursued to contribute to improving uptake of preventive measures among VFRs.MethodsFollowing in-depth interviews with Ghanaians living in Amsterdam, a questionnaire was developed to assess which behavioural determinants were related to taking preventive measures. The questionnaire was administered at gates of departing flights from Schiphol International Airport, Amsterdam (the Netherlands) to Kotoka International Airport, Accra (Ghana).ResultsIn total, 154 questionnaires were eligible for analysis. Chemoprophylaxis had been started by 83 (53.9%) and bought by 93 (60.4%) travellers. Pre-travel advice had been obtained by 104 (67.5%) travellers. Those who attended the pre-travel clinic and those who incorrectly thought they had been vaccinated against malaria were more likely to use preventive measures. Young-, business- and long-term travellers, those who had experienced malaria, and those who thought curing malaria was easier than taking preventive tablets were less likely to use preventive measures.ConclusionAlmost half of the VFRs travelling to West Africa had not started chemoprophylaxis; therefore, there is room for improvement. Risk reduction strategies could aim at improving attendance to travel clinics and focus on young-, business and long term travellers and VFRs who have experienced malaria during consultation. Risk reduction strategies should focus on improving self-efficacy and conceptions of response efficacy, including social environment to aim at creating the positive social context needed.

Response to fever and utilization of standby emergency treatment (SBET) for malaria in travellers to Southeast Asia: a questionnaire-based cohort study

“…Challenges in adherence are not limited to the concept of SBET but are also seen for continuous malaria chemoprophylaxis for travellers to high-risk countries [22–26]. Several studies prove that the majority of returning travellers with malaria did not take malaria chemoprophylaxis or applied an incorrect regimen, the majority being travellers visiting friends or relatives (VFR) abroad [22, 27–31]. …”

Imported malaria in pregnant women: A retrospective pooled analysis

“…This was confirmed in our study, as VFR travellers account for a significant fraction of our study population (48.6%). VFR travellers may mistakenly believe that previous, partial immunity protects them from the disease [31] which is true with regard to protection against severe disease [32]. The cost of the chemoprophylaxis is also believed to be a discouraging factor for some VFRs [33].…”

A systematic review of factors affecting adherence to malaria chemoprophylaxis amongst travellers from non-endemic countries

“…Eleven studies found that older participants were more likely to be adherent [12,17,18,20,21,24,30,32,[38][39][40]. Another study reported that those under 30 were less likely to be adherent than older people [22], but significance was not reported.…”

“…Wieten et al [38] Travellers to Ghana from the Netherlands 154 Questionnaire survey 53.9% (had started chemoprophylaxis) Attending pretravel clinic and receiving pre-travel advice was related to a greater likelihood of starting chemoprophylaxis (p < 0.01); if a participant incorrectly thought they had been vaccinated (p = 0.009) they were also more likely to use chemoprophylaxis Higher age (p = 0.004) and travelling for family purposes (p = 0.022) rather than business were positively associated with starting chemoprophylaxis. Having had malaria (p = 0.028) and spending more than 6 weeks in West Africa (p = 0.001) were negatively associated with starting and buying chemoprophylaxis Those who thought curing malaria was easier than taking preventative tablets (p = 0.046) were more likely to be nonadherent-it was felt that subjectively held information is more important than accurate information Previous use of chemoprophylaxis was not found to influence current preventive behaviour Medium to be non-adherent compared with white-collar workers [41].…”