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Title: Compliance of Austrian tourists with prophylactic measures.
Author: Kollaritsch H, Wiedermann G.
Journal: Eur J Epidemiol; 1992 Mar; 8(2):243-51. PubMed ID: 1644143.
Abstract:
Physicians dealing with prophylactic measures for tourists going to developing countries will often not be able to foresee the outcome of their recommendations. Therefore an open study with 2,627 Austrian tourists on their flight home from a tropical destination was carried out to evaluate the behaviour of typical short-term travellers with respect to different kinds of precautionary measures. 94.1% of all tourists informed themselves before travelling abroad, but a high proportion of travellers tends to contact only their travel agency or their personal friends, this leading to inadequate information. Regarding the individual performance of precautionary measures the results indicate a few principal conclusions: Among the recommended inoculations the vaccinations against typhoid fever, poliomyelitis and tetanus are widely underestimated, the latter two in particular for adults, while compliance with the passive immunization against Hepatitis A is generally good (more than 80% of all travellers receive Hepatitis A immunoglobulins prophylactically). The most crucial point seems to be the chemoprophylaxis against malaria in as much as a) there seems to be a considerable lack of information about malaria endemic areas among physicians, b) tourists tend to use the most simple applicable drug unaware of epidemiological considerations and c) the regular intake of chemoprophylaxis declines significantly with the complexity of the intake procedure. In addition, tourists are in general well informed about nutritional risks, but only half of them will receive adequate information on the risk of sexually transmitted diseases and a basic medical travel kit. Researchers analyzed data on 2627 Australian tourists returning from Kenya, Sri Lanka, Thailand, and the Maldives (November 1988-March 1989 and October 1989-January 1990) to examine tourist behavior regarding prophylaxis measures. 94.1% sought health information. 1st time tourists were more likely to get this information than those who had already made at least 1 visit (98.1% vs. 92%; p.05). Many tourists relied on travel agencies (37.5%) and friends (20.2%) for this information. Experienced tourists were not as likely to depend on travel agencies and friends as were 1st time tourists (p.05), however. 92% of those who sought information took at least 1 precautionary measure. 96.3% of tourists to Kenya carried out a prophylactic measure compared with 79.6% of those to the Maldives (p.05). Tourists tended to obtain immunoglobulin prophylaxis against hepatitis A (75.1-84.8%), yet not obtain vaccinations for typhoid fever (55.7-68.1%), tetanus (43.3-56.7%), and polio (25.9-38.7%). They appeared to be aware of dietary risks (86.1%), but not about sexually transmitted disease risk such as AIDS (41.7%) or taking a medical travel kit (50.5%). After a mass media campaign, these figures increased to 93.1% (not significant), 64.7% (p.01), and 68.2% (p.05). The Maldives was free of malaria, but 31.9% still took malaria prophylaxis. Most travelers to Thailand (88.35) also took malaria prophylaxis, yet 81.8% of them went to malaria-free areas. Tourists to Kenya had better compliance than those to Sri Lanka (94.2% vs. 82.7%, p.05). Moreover only 74.7% of travelers to Kenya took mefloquine, the recommended choice for short-term travelers. Compliance was greater among those who took mefloquine than it was for those taking chloroquine (74.1% vs. 90.3%, p .01). The most important finding was the considerable misinformation about and noncompliance with malaria prophylaxis. For example, the more complex the intake instructions the more likely noncompliance occurs.

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