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This month we look at Malaria imported to the UK and improving advise for high risk travellers.

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This month we look at the latest report by Public Health England on Malaria imported into the United Kingdom: 2015 and the implications for travel health specialists advising travellers.

Malaria imported into the United Kingdom: 2015 - Implications for those advising travellers

 
The findings of the report show:
  • In 2015, 1,400 cases of imported malaria were reported in the UK. The majority of the cases in 2015 were caused by P. Falciparum.
  • There were six deaths from malaria reported in 2015 compared to three in 2014, all from Falciparum malaria acquired in Western Africa.
744 people had travelled abroad from the UK; of these: 80% had visited family in their country of origin (visiting friends and relatives, or VFR travellers), 14% travelled for business (including armed forces and civilian air crew and 6% travelled for a holiday.

85% of patients with malaria who had travelled abroad from the UK had not taken chemoprophylaxis.

The data implies that we are still not reaching high risk groups of travellers, those who are visiting family in their country of origin and of Black African heritage and/or born in Africa. It is likely that we are not reaching them because:
  • They are not seeking or unable to access medical advice on malaria prevention before they travel
  • They may not perceive themselves to be at risk because the destination is familiar to them
  • They are not acting on the advice given by the healthcare professional
  • They are not being given good advice, or they are not adhering to it
Outside the findings of this report, other factors commonly witnessed in a private travel clinic and likely to be a cause are:
  • The cost of antimalarials. Often families prioritise who takes chemoprophylaxis (these are often just the children)
  • Turning up to the travel clinic last minute before travel and starting chemoprophylaxis late or not at all
  • Wanting to purchase antimalarials in country as they have done in the past – unaware of the risks in doing this (counterfeit medication, risk of adverse reactions)
 

Improving Malaria advice for high risk travellers



 
So, what can we do to improve our communication and health advice on malaria in our travel clinics to these high risk group of travellers?
  • Use the ABCD of malaria prevention to ensure that you cover all 4 important aspects and education of malaria and chemoprophylaxis advice
  • Use visuals such as colour coded malaria maps, posters, malaria life cycle, short reputable YouTube videos, give scenarios of malaria cases to communicate risk
  • Ensure a good length of time for the malaria consultation so that the client has time to understand the advice being given
  • Ensure that the traveller understands the schedule for their antimalarials and why it must be completed as directed. Get them to relay the information you have given them to clarify understanding
  • If there is language difficulties, arrange for an interpreter
  • Acknowledge their perception of risk and challenge this through discussion and education that is clear and concise
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