Malaria Knowledge and Utilization of Chemoprophylaxis in the UK Population and in UK Passengers Departing to Malaria-Endemic Areas

Ron H Behrens; Neal Alexander


Malar J. 2013;12(461) 

In This Article


Malaria is an important infectious disease: the World Health Organization (WHO) estimates 219 million cases of malaria (range 154–289 million) and 660,000 deaths (range 610,000–971,000) in 2010.[1] Worldwide travel, exposing travellers from non-endemic regions to malaria-endemic countries, is an ongoing source of imported malaria. In the UK approximately 1,500 cases are imported annually of which 76% are Plasmodium falciparum malaria and the majority (64.5%) of imported cases are acquired by travellers visiting friends and relatives (VFRs), and around half (54%) is acquired during travel to either Ghana or Nigeria of whom only 7% use malaria preventative measures.[2]

Understanding why the currently very effective, available measures are not used by high-risk travellers is fundamental to reducing the burden of imported disease. The challenge of studying knowledge, attitudes and practices (KAP) of travellers is in capturing the information from an unbiased and representative population, and not relying on data from those seeking pre-travel health advice or questioning patients having developed malaria after travelling. Some studies have focussed on high-risk VFR travellers. Pistone and colleagues assessed the KAP of VFRs around malaria transmission but these were recruited in travel clinics,[3] and Leonard and Van Landingham explored practices using discussion groups of Nigerians who had previously travelled to Nigeria and were recruited from a community in Houston, USA.[4] Schilthuis[5] interviewed West African immigrants, from countries including Nigeria and Ghana, living in the Netherlands who were recruited from a community through churches and local societies. Van Genderen and colleagues explored changing KAP in departing passengers from Schiphol Airport between 2002 and 2009 to understand educational needs for Dutch travellers on malaria.[6]

This study was designed to investigate the knowledge and practices of a representative sample of the population by interviewing 2,007 of the UK population of which 1991 were completed. A similar tool was used to question passengers in departure lounges at Heathrow Airport whose destination was a malaria-endemic country. This would allow a comparison of the knowledge and practices of the two populations and understand what factors might influence knowledge, including variables such as previous travel experience and sources of pre-travel information and demographics (age, income and reason for travel). The departure lounge survey also allowed for interviewing an unbiased travelling population to malaria-risk regions from which to identify the proportion of travellers using chemoprophylaxis.