A huge rise in the numbers of UK residents travelling to malaria endemic areas, combined with a failure to use prevention measures, has significantly increased cases of imported falciparum malaria in the UK over the past 20 years, according to a study published on the British Medical Journal website.
Between 1987-91 there were 5120 reported cases of the potentially fatal faliciparum malaria, increasing to 6753 in 2002-6. These findings highlight the urgent need for health messages and services targeted at travellers from migrant groups visiting friends and family abroad, say the authors.
Malaria acquired in one of the 150 countries where it is endemic and then imported into non-endemic countries accounts for a significant proportion of largely preventable disease and death in Europe every year.
Dr Adrian Smith and colleagues from the Health Protection Agency's Malaria Reference Laboratory, present the latest trends in malaria in the UK between 1987 and 2006, using data from the Malaria Reference Laboratory, involving 39 300 confirmed cases of malaria.
64.5% of 20 488 malaria cases amongst UK travellers had visited friends and relatives in malaria endemic countries. This is reflected by the huge increase in the number of UK residents travelling to malaria endemic areas--from 593 000 visits in 1987 to 2.6 million visits in 2004.
Imported malaria cases were heavily concentrated in communities with frequent travel to see friends and relatives in West Africa.
The researchers also note a worrying trend in cases of the potentially fatal falciparum malaria which have increased steady over the past 20 years in the UK. Of all malaria imported to the UK, 96% of falciparum malaria occurred after travel to Africa. Travellers to Nigeria and Ghana, neither common tourist destinations, account for half of all imported falciparum cases.
Importantly, say the authors, only 42% of UK travellers reported taking any form of malaria prophylaxis during their travels. In particular, people visiting friends and relatives in their country of origin were less likely to report using prevention measures than other travellers. For example, amongst malaria cases in travellers to sub-Saharan Africa between1999?, only 7% of people with malaria visiting friends and relatives reported using recommended drugs, compared to 24% of other travellers with malaria.
These findings highlight that health messages are not getting through to ethnic minority groups, particularly those visiting West Africa, warn the authors. "Targeting messages tailored to these groups is essential in primary care and public health...and this would have a substantial impact on UK malaria", they add.
Increasing the use of effective antimalarial prophylactic drugs by travellers visiting sub-Saharan Africa should be a priority, they conclude.
Research into cultural beliefs, knowledge, and attitude towards malaria prevention in people visiting friends and relatives in malaria endemic countries, would help identify how best to target health education campaigns and innovative techniques, says Jane Zuckerman, Director of WHO collaborating centre for reference, research, and training in travel medicine, in an accompanying editorial.
- Smith et al. Imported malaria and high risk groups: observational study using UK surveillance data 1987-2006. BMJ, 2008; 337 (jul03 2): a120 DOI: 10.1136/bmj.a120
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