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


The IPSOS Mori survey interviewed 2,007 individuals on 28 and 29 May 2011, selected as a representative sample of the UK general population; 1,991 interviews were completed and included for further analysis. Of these, 548 had previously visited a malaria-endemic country and were analysed as a separate group. The CAA survey included 499 departing passengers to malaria-endemic countries, with some data missing on ethnicity and reason for travel.

The age, gender, socio-economic class and household income are presented in Table 1.

The study compared the CAA survey group to the UK population IPSOS-MORI group who had, in the past, visited a malaria-endemic country and found a larger proportion of the CAA group visiting West Africa (42 vs 16%). Other variables, including reason for travel and chemoprophylaxis use, were of similar proportions in the two groups. There was a larger proportion of ethnically black (39 vs 4%) travellers interviewed in the CAA survey (Table 2). In the IPSOS survey, the malaria knowledge score in those who had travelled was 63.8 (Table 2), while the scores in those who had not travelled were more than five points lower at 58.6 (95% CI for the difference is 3.9–6.5, p < 0.001).

The quality of pre-travel advice in the population who had travelled previously (IPSOS survey) and those who were about to depart (CAA survey) was similar, with over 70% having received professional advice and 18 and 24% not seeking/received pre-travel advice (Table 2). In the subgroup analysis of visitors to Ghana, Nigeria and Kenya, 22, 40 and 23% of travellers, respectively, had not sought or received advice, or used non-professional pre-travel advice for the current trip (Table 3).

Knowledge in travellers using chemoprophylaxis was very similar to those not using chemoprophylaxis in both the CAA and IPSOS surveys although the IPSOS survey group had a lower average knowledge score, with West Africans having significantly higher scores than other Africans and Asian travellers (Table 4). Comparing the knowledge scores of those who had received professional pre-travel advice with those who were self-informed or those who received no advice, the scores were almost the same. This finding was replicated in the IPSOS survey. Ethnicity provided a mixed picture, with the IPSOS survey respondents having lower knowledge levels than the CAA survey respondents and with Asians in the CAA scoring highest (81) while the mixed and other ethnic groups in the IPSOS survey scored lowest (57). Knowledge scores were not influenced by reason for travel or household income.

The use of chemoprophylaxis in passengers travelling to malaria-endemic countries in all or part of their destination was collected. Of the passengers departing to Kenya (132), Nigeria (86) and Ghana (81), (71%, 38% and 74%) respectively, reported taking an effective chemoprophylaxis for their travel (Table 3). Examining the chemoprophylaxis regimens being taken, 57% of travellers to Kenya, 37% to Ghana and 32% of travellers to Nigeria were using atovaquone and proguanil. The mean knowledge score in those using chemoprophylaxis was 69 for all three destinations. This was lower than knowledge scores in those using no chemoprophylaxis.