Malaria risk perceptions and barriers for effective prophylaxis among sub-Saharan African `visiting friends and relatives´ travellers in Hamburg, Germany

Abstract

Background: The African visiting-friends-and-relatives (VFR) community in the global north is at high risk of contracting preventable travel-associated infections when travelling to sub-Saharan Africa.This study aimed to assess VFR travellers’ knowledge, risk perceptions, travel medicine advice counselling and use of chemoprophylaxis for malaria to improve our understanding of barriers for effective prevention and to develop tailored travel counselling.

Methods: A questionnaire-based survey was conducted between January and July 2023 at the Hamburg Airport among adult sub-Saharan African VFR travellers returning from malaria endemic destinations in Africa to assess malaria risk perception, attitudes towards prophylactic measures and travel medicine advice, and as well as pre- and post-travel experiences with travel medicine and malaria prophylaxis.

Results: A total of 389 participants completed the survey. Among these, 67% (n=261) had adequate knowledge of malaria transmission. Fifty-one percent (n=198) stated they had little or no risk of contracting malaria in the malaria-endemic country they visited, and 10% (n=37) mistakenly believed they had been vaccinated against malaria. Approximately half of the respondents did not seek medical travel advice prior to departure and did not take antimalarial prophylaxis due to a perceived minimal risk of disease. Of those who took antimalarial drugs, 77% (n=149) completed the full course. On return, 5% (n=20) had symptoms consistent with malaria and subsequently 55% (n=11) either self-medicated or did not seek medical treatment.

Conclusion: VFR travellers mistakenly perceive a low risk of malaria, resulting in low uptake of travel medical advice and chemoprophylaxis. Distrust of advice from healthcare providers was identified. Insights from this survey are valuable for practitioners and travel medicine clinics to provide more tailored and culturally sensitive travel advice to VFR travellers.