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Malaria

Malaria. By Rami Hamid. contents. General introduction Study introduction Population and methods Results tables Discussion Conclusion . study: Observational prospective cohort Target: assess malaria risk perception, knowledge and prophylaxis.

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Malaria

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  1. Malaria By RamiHamid

  2. contents • General introduction • Study introduction • Population and methods • Results tables • Discussion • Conclusion

  3. study: Observational prospective cohort • Target: assess malaria risk perception, knowledge and prophylaxis. • Population: African ethnicity living in Paris and travelling to their country of origin.

  4. Two groups A) who had visited a travel clinic (n=122) B) or a travel agency (n=69) • Study time:8-month the visit duration longer than 7 days Pre-travel & post-travel phase interviews using a standardized questionnaire with open and closed-ended questions

  5. The questionnaire ( malaria prophylaxis practice, chemoprophylaxis, and anti-vector measures) • Three social classes (low, medium, high) • Frequency of previous travel to Africa (high, intermediate, low, or never )

  6. Table 1 Characteristics of the travel clinic (TC) and travel agency (TA) pre-travel groups of travelers of African ethnicity Total (N = 191) n (%) TC group (N = 122) n (%) TA group (N = 69) n (%) P-value Mean age (years) 37.8 37.9 37.70 0.91 Male 111 (58) 72 (59) 39 (57) 0.74 African-born 180 (94) 112 (92) 68 (99) 0.11 French citizenship 51 (27) 36 (30) 15 (22) 0.34 Travel for family visit 162 (85) 104 (85) 58 (84) 0.99 Social class High 23 (12) 13 (11) 10 (14) 0.002 Medium 81 (42) 42 (34) 39 (57) Low 87 (46) 67 (55) 20 (29) Mean length of stay in France (years) 15.7 16.7 14.1 0.03 Frequency of previous travel to Africa 0.001 Once every 1—3 years 84 (44) 41 (34) 43 (62) Once every 4—7 years 33 (17) 24 (20) 9 (13) Last trip ≥8 years ago 31 (16) 25 (20) 6 (9) Never 43 (23) 32 (26) 11 (16) Median length of visit (days) 33 44 25 0.001 Location of country visited 0.04 West Africa 132 (69) 92 (75) 40 (58) Central Africa 54 (28) 28 (23) 26 (38) Indian Ocean 5 (3) 2 (2) 3 (4)

  7. Table 2 Analysis of main themes evoked in answers by travelers of African ethnicity to open-ended questions regarding health risk perceptions and knowledge of malaria transmission Analysis of main themes Pre-travel population n (%) • ‘What are your health concerns?’ (N = 191) Malaria 89 (47) Food- and water-borne diseases 49 (26) None 45 (24) AIDS 13 (7) Meningitis 10 (5) • ‘For you, why is malaria a health concern?’ (N = 89) Inevitable destiny 60 (67) Mosquito bites impossible to prevent 22 (25) • ‘For you, why is malaria not a health concern?’ (N = 102) Availability of chemoprophylaxis 45 (44) Availability of a vaccine 22 (22) Never had malaria attack 25 (25) • ‘For you, how is malaria transmitted?’ (N = 191) Mosquito bites 141 (74) Water or poor personal hygiene 12 (6) Sun exposure 7 (4)

  8. Table 3 Analysis of answers by travelers of African ethnicity to five closed-ended questions regarding general malaria knowledge (A) General malaria knowledge Yes n (%) No n (%) Do not know n (%) ‘Is it possible to get malaria in the country you are travelling to?’ 166 (87) 4 (2) 21 (11) ‘Is there a vaccine against malaria?’ 67 (35) 49 (26) 75 (39) ‘Does one have to be vaccinated against malaria before travelling?’ 119 (62) 38 (20) 34 (18) ‘Are skin repellents a good protection against malaria?’ 114 (60) 36 (19) 41 (21) ‘Is sleeping under a bed net a good protection against malaria?’ 145 (76) 25 (13) 21 (11) (A) No statistically significant differences between the travel clinic and travel agency groups.

  9. Table 4 Chemoprophylaxis practices reported by the travel clinic (TC) and travel agency (TA) post-travel groups of travelers of African ethnicity Chemoprophylaxis practices (adequate or not) Total(N=106)n(%) TC group(N=64)n(%) TA group(N=42)n(%) Chloroquine + proguanil 48 (45) 42 (66) 6 (14) • Chloroquine alone 16 (15) 3 (5) 13 (31) • Mefloquine 12 (11) 8 (13) 4 (10) • Other 4 (4) 2 (3) 2 (5) • None 26 (25) 9 (14) 17 (40) • Total 106 (100) 64 (100) 42 (100)

  10. Results (p< 0.05) • In the pre-travel population considered themselves at high risk for malaria. • Wearing long cloth at night (TC) • Taking tablets against malaria up to one month after returning to France (TC) • Planning to use chemoprophylaxis (TC) • Planning to use impregnated bed nets (TC) (Few subjects were misclassified) (44 travelers return after the survey deadline)

  11. Factors appears to hinder the use of adequate protective measures. • Lower perceived risk of malaria attack • Absence of the drug after return t France • Fatality and inadequate knowledge on transmission modes of malaria • Incorrect belief that the yellow fever vaccine also works against malaria • Drug costs & French Public Health Insurance System

  12. Conclusion • Limited knowledge on malaria and inadequate prophylaxis practices • Need of public strategies for this high risk population • Media coverage • chemoprophylaxis reimbursement

  13. Thank You

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