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Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices

BACKGROUND: Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and rel...

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Autores principales: Volkman, Hannah R., Walz, Emily J., Wanduragala, Danushka, Schiffman, Elizabeth, Frosch, Anne, Alpern, Jonathan D., Walker, Patricia F., Angelo, Kristina M., Coyle, Christina, Mohamud, Mimi A., Mwangi, Esther, Haizel-Cobbina, Joseline, Nchanji, Comfort, Johnson, Rebecca S., Ladze, Baninla, Dunlop, Stephen J., Stauffer, William M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067457/
https://www.ncbi.nlm.nih.gov/pubmed/32163426
http://dx.doi.org/10.1371/journal.pone.0229565
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author Volkman, Hannah R.
Walz, Emily J.
Wanduragala, Danushka
Schiffman, Elizabeth
Frosch, Anne
Alpern, Jonathan D.
Walker, Patricia F.
Angelo, Kristina M.
Coyle, Christina
Mohamud, Mimi A.
Mwangi, Esther
Haizel-Cobbina, Joseline
Nchanji, Comfort
Johnson, Rebecca S.
Ladze, Baninla
Dunlop, Stephen J.
Stauffer, William M.
author_facet Volkman, Hannah R.
Walz, Emily J.
Wanduragala, Danushka
Schiffman, Elizabeth
Frosch, Anne
Alpern, Jonathan D.
Walker, Patricia F.
Angelo, Kristina M.
Coyle, Christina
Mohamud, Mimi A.
Mwangi, Esther
Haizel-Cobbina, Joseline
Nchanji, Comfort
Johnson, Rebecca S.
Ladze, Baninla
Dunlop, Stephen J.
Stauffer, William M.
author_sort Volkman, Hannah R.
collection PubMed
description BACKGROUND: Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRs–travelers to the same destinations with other purpose for travel–but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. METHODS AND FINDINGS: Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health department; members of the general VFR population (community); and VFR and non-VFR travelers presenting to a travel health clinic, both before their pretravel consultation and again, after return from travel. A Community Advisory Board of African immigrants and prior qualitative research informed survey development and dissemination. Across the three groups, 489 travelers completed surveys: 351 VFRs and 138 non-VFRs. VFRs who reported taking antimalarials on their last trip rated their concern about malaria higher than those who did not. Having taken five or more trips to SSA was reported more commonly among VFRs diagnosed with malaria than community VFRs (44.0% versus 20.4%; p = 0.008). Among travel health clinic patients surveyed before and after travel, VFR travelers were less successful than non-VFRs in adhering to their planned use of antimalarials (82.2% versus 98.7%; p = 0.001) and employing mosquito bite avoidance techniques (e.g., using bed nets: 56.8% versus 81.8%; p = 0.009). VFRs who visited the travel health clinic were more likely than VFR respondents from the community to report taking an antimalarial (83.0% versus 61.9%; p = 0.009), or to report bite avoidance behaviors (e.g., staying indoors when mosquitoes were out: 80.9% versus 59.5%; p = 0.009). CONCLUSIONS: We observed heterogeneity in malaria prevention behaviors among VFRs and between VFR and non-VFR traveler populations. Although VFRs attending the travel health clinic appear to demonstrate better adherence to malaria prevention measures than VFR counterparts surveyed in the community, specialized pretravel care is not sufficient to ensure chemoprophylaxis use and bite avoidance behaviors among VFRs. Even when seeking specialized pretravel care, VFRs experience greater barriers to the use of malaria prevention than non-VFRs. Addressing access to health care and upstream barrier reduction strategies that make intended prevention more achievable, affordable, easier, and resonant among VFRs may improve malaria prevention intervention effectiveness.
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spelling pubmed-70674572020-03-23 Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices Volkman, Hannah R. Walz, Emily J. Wanduragala, Danushka Schiffman, Elizabeth Frosch, Anne Alpern, Jonathan D. Walker, Patricia F. Angelo, Kristina M. Coyle, Christina Mohamud, Mimi A. Mwangi, Esther Haizel-Cobbina, Joseline Nchanji, Comfort Johnson, Rebecca S. Ladze, Baninla Dunlop, Stephen J. Stauffer, William M. PLoS One Research Article BACKGROUND: Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRs–travelers to the same destinations with other purpose for travel–but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. METHODS AND FINDINGS: Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health department; members of the general VFR population (community); and VFR and non-VFR travelers presenting to a travel health clinic, both before their pretravel consultation and again, after return from travel. A Community Advisory Board of African immigrants and prior qualitative research informed survey development and dissemination. Across the three groups, 489 travelers completed surveys: 351 VFRs and 138 non-VFRs. VFRs who reported taking antimalarials on their last trip rated their concern about malaria higher than those who did not. Having taken five or more trips to SSA was reported more commonly among VFRs diagnosed with malaria than community VFRs (44.0% versus 20.4%; p = 0.008). Among travel health clinic patients surveyed before and after travel, VFR travelers were less successful than non-VFRs in adhering to their planned use of antimalarials (82.2% versus 98.7%; p = 0.001) and employing mosquito bite avoidance techniques (e.g., using bed nets: 56.8% versus 81.8%; p = 0.009). VFRs who visited the travel health clinic were more likely than VFR respondents from the community to report taking an antimalarial (83.0% versus 61.9%; p = 0.009), or to report bite avoidance behaviors (e.g., staying indoors when mosquitoes were out: 80.9% versus 59.5%; p = 0.009). CONCLUSIONS: We observed heterogeneity in malaria prevention behaviors among VFRs and between VFR and non-VFR traveler populations. Although VFRs attending the travel health clinic appear to demonstrate better adherence to malaria prevention measures than VFR counterparts surveyed in the community, specialized pretravel care is not sufficient to ensure chemoprophylaxis use and bite avoidance behaviors among VFRs. Even when seeking specialized pretravel care, VFRs experience greater barriers to the use of malaria prevention than non-VFRs. Addressing access to health care and upstream barrier reduction strategies that make intended prevention more achievable, affordable, easier, and resonant among VFRs may improve malaria prevention intervention effectiveness. Public Library of Science 2020-03-12 /pmc/articles/PMC7067457/ /pubmed/32163426 http://dx.doi.org/10.1371/journal.pone.0229565 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Volkman, Hannah R.
Walz, Emily J.
Wanduragala, Danushka
Schiffman, Elizabeth
Frosch, Anne
Alpern, Jonathan D.
Walker, Patricia F.
Angelo, Kristina M.
Coyle, Christina
Mohamud, Mimi A.
Mwangi, Esther
Haizel-Cobbina, Joseline
Nchanji, Comfort
Johnson, Rebecca S.
Ladze, Baninla
Dunlop, Stephen J.
Stauffer, William M.
Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices
title Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices
title_full Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices
title_fullStr Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices
title_full_unstemmed Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices
title_short Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices
title_sort barriers to malaria prevention among immigrant travelers in the united states who visit friends and relatives in sub-saharan africa: a cross-sectional, multi-setting survey of knowledge, attitudes, and practices
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067457/
https://www.ncbi.nlm.nih.gov/pubmed/32163426
http://dx.doi.org/10.1371/journal.pone.0229565
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