Malaria Incidence and Prevention among European and North American Travellers to Kenya

By Lobel, H. O.; Phillips-Howard, P. A. et al. | Bulletin of the World Health Organization, March-April 1990 | Go to article overview

Malaria Incidence and Prevention among European and North American Travellers to Kenya


Lobel, H. O., Phillips-Howard, P. A., Brandling-Bennett, A. D., Steffen, R., Campbell, C. C., Huong, A. Y., Were, J. B. O., Moser, R., Bulletin of the World Health Organization


Introduction

The incidence of malaria among European and North American travellers returning from Africa has increased markedly during the past decade (1, 2). (a) Especially significant is the rise of malaria incidence among travellers to Kenya, which receives more than 400 000 travellers from Europe and North America each year. (b) The number of Plasmodium falciparum infections acquired in Kenya and imported into the United Kingdom and the USA tripled between 1977 and 1986 (1). (a) The increased number of travellers to Kenya, and the lack of effective and safe chemoprophylactic regimens, contributed to the increased number of cases. The lack of optimal chemoprophylaxis has led to an increased risk for acquiring malaria during travel (3).

The lack of highly safe and effective drugs to prevent infection with chloroquine-resistant P. falciparum has created a dilemma for travellers and for those who develop recommendations for malaria prevention. In North America and Europe, at least sixteen different drug regimens are recommended by various authorities for travellers to East Africa (4-6). Because many chemoprophylactic regimens do not eliminate the risk for infection, many experts recommend that travellers carry a curative dose of a drug. This dose is to be used to treat a febrile illness, when medical care is not available, in an effort to prevent death from P. falciparum infection. In addition to chemoprophylaxis, antimosquito measures, such as repellents and mosquito nets, are frequently recommended because they are considered safe and effective ways of reducing mosquito contact (7).

To formulate malaria prevention recommendations for travellers and to evaluate the use and efficacy of these measures, it is necessary to determine which measures are used and to assess the risk for malaria among travellers (8). The lack of consistent recommendations is understandable because such information is not available to travellers from most countries. A cohort of travellers departing from Kenya was therefore surveyed, in order to determine the use of and compliance with measures to prevent malaria, to assess the frequency of self-treatment for episodes of presumed malaria during travel, and to determine the occurrence of adverse reactions to antimalrial drugs as well as of episodes of malaria during and after travel in Kenya.

Materials and methods

A questionnaire, available in four languages (English, French, German, and Italian), was administered to travellers departing from Nairobi airport for Europe on all scheduled flights between 1 and 21 September 1987. The questionnaire was distributed and collected before boarding. Data collected concerned the duration and purpose of travel, countries and areas visited within Kenya, preventive anti-malarial measures used, adverse drug reactions experienced, and episodes of suspected or confirmed malaria. Eight to ten weeks later a follow-up questionnaire was mailed to these travellers. The follow-up questionnaire asked about compliance with prophylaxis and about malaria episodes after leaving Kenya. To determine the non-response bias, a random sample of travellers from North America and the United Kingdom who did not return the second questionnaire were contacted and interviewed by telephone. All cases of malaria diagnosed by a physician and all cases of persons hospitalized because of adverse reactions to malaria drugs were investigated by contacting the physician who had treated the patient. The diagnosis of malaria was considered verified if a record was available of a blood-smear examination that indicated the presence of Plasmodium parasites.

Compliance with chemoprophylaxis was defined as the regular, uninterrupted use of prophylactic drugs during travel in Africa and for four or more weeks after leaving. Use of adequate antimosquito measures was defined as the use of two or more such measures (bed nets, insect repellents, protective clothing at night, insecticides, staying indoors at night). …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Malaria Incidence and Prevention among European and North American Travellers to Kenya
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.