Knowledge, Attitudes and Practices of Chemoprophylaxis and other Personal Protection Measures against Malaria among Travelers to Malaria Endemic African Countries, Muscat, Oman.
Importation of malaria into countries from which it has been eliminated (or where it is very rare) is a relatively new public health problem due to the tremendous increase of human mobility and particularly to air travel. In Oman, after the launch of the National malaria Eradication Program (NMEP) in 1990, the number of cases dropped from 19274 cases in 1991 to 901 cases in 1999 and the majority of the cases were internationally imported (38.8% in 1994 to 96% in 1999). Because the majority of these cases are imported from Africa, the ministry of Health (MOH), in January 1995, started the chemoprophylaxis program for the travelers to malaria endemic African countries. Screening of passengers coming from Africa by air was also started at the airport. Surveillance data, after the start of this program showed a discrepancy between the number of Omani travelers coming for chemoprophylaxis and those who are screened at the airport. This study was conducted among the Omani and non-Omani resident travelers to malaria endemic African countries to assess their knowledge about malaria, determine their attitudes and practices towards chemoprohylaxis and other personal protection measures and to determine the reasons for not using chemoprophylaxis for those who don't use.
Methodology
To achieve the objectives of this study, a cross-sectional study was designed and conducted at the Seeb International Airport among the passengers arriving from African countries. In order to achieve the sample size (175) the flights (weekly 5 flights) to be attended each week were selected randomly and all the Omanis and the non-Omani residents in these flights were interviewed at the airport. Data was collected using a pre-tested and self-administered questionnaire, translated to Arabic. Data analysis was done using means and standard deviations (SD) and the strength of associations between selected variables was measured using Odd's Ratios (OR) and the statistical significance of the associations was calculated using 95% confidence intervals (CI).
Results
A total of 185 travelers enrolled in this study. The majority (51.5%) of the travelers were Omanis. One hundred and twelve (56%) of the travelers aged <40 years and the remaining 88 (44%) were ≥40 years old. The majority (60.5%) of the travelers were males and 56.8% were of educational level above secondary, 43.2% were of secondary and below. The reason for traveling declared by almost all of the travelers (89.2%) was to visit relatives and friends, and only 20 (10.9%) traveled for business. The majority (63.8%) traveled to Africa for the first time or once a year. One hundred and fourteen (61.6%) stayed in Africa for more than four weeks (long-stay). One hundred and eighteen (63.8%) of the travelers scored high in the knowledge scores and 67 (36.2°/a) scored low. Seventy four (40%) of the travelers believed that using chemoprophylaxis in addition to personal protection measures provide protection against mosquito bites and malaria, while only 2 (1.1%) believed that none of them provide such protection. In all their visits to Africa, 74.5% of the travelers used chemoprophylaxis during their stay there, but among these only 32.4% used them regularly, while in this visit 43.2% used chemoprophylaxis and only 29.7% used them regularly. Because use of malaria chemoprophylaxis is not required when traveling to an endemic area as does a vaccine certificate for vaccine prevented diseases, 23.8% of the travelers did not use them and 20% did not use them because they thought that they were not effective. Use of chemoprophylaxis was significantly associated with reason for traveling (OR=3.55, CI 1.18-11.1), believed that it provides protection from malaria (OR=24.3, CI 3.32-502.75), and pre travel advice (OR=20.8, CI 7.23-64.46).
Conclusion
The overall knowledge of Omani travelers to malaria endemic African countries about malaria was found to be good. However, prevention practices against malaria were not. Travelers who visit relatives and friends are the major risk group for not using chemoprophylaxis. The main reasons which led the travelers not to use chemoprophylaxis were that it is not required for traveling, not effective, didn't know where to get it from and difficulty in taking regularly.