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 BMJ.com.
Between 1987–91 there were 5,120 reported cases of the potentially fatal faliciparum malaria, increasing to 6,753 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 endemic countries and then imported into nonendemic countries accounts for a significant proportion of largely preventable disease and death in Europe every year.
Almost 65% of 20 488 malaria cases among 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.
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.
Why do you think travellers are ignorant of the risks of malaria? Are you up-to-date with the latest antimalarial advice? Your comments: (Terms and conditions apply)
"The cost of malaria prophylaxis is far too expensive and in my opinion should be available on the NHS as the cost of treatment on return far outweighs the price of the medication. However, if you have taken Malarone and such like, you will understand why travellers often start the course and do not finish it. Weird and wonderful dreams are not pleasant along with the stomach cramps and the nausea etc etc. People are not ignorant of malaria at all, they know it exists, but like all of us think it will never happen to me. As a white woman I lived and worked in Ghana for 10 years and stopped taking medication after six months. Malaria did not hit me. I was the lucky one. I saw a good friend of mine almost die through this. So I woulod urge everyone to take something to protect you." - Georgina Hawkridge, South West
"Despite giving out information regarding suitable medication, the cost of private script is £10 in the surgery, so patients often choose cheaper the option doxycycline, resulting in abdominal problems, etc, so they do not complete the suggested course. Despite spending thousands on their holiday, for many the cost of Malarone is an issue - many will not pay the price of Malarone no matter how much information they are given." - Mary Swinney, Hebburn, Tyne & Wear
"I find that most patients that are going home to visit relatives in a malarious area think that they are immune, and trying to convince them otherwise is really difficult. Howerer at our surgery we are luckly that our PCT backs us to put antimalarials on FP10, which has seen a significant increase of patients actually taking the medications now, and a fall in the number of cases of malarial in our patients. We do still have the odd few patients that think it will never happen to them and are
totally resiliant to any advice offered." - Janet Norris, Lamberth
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