Incidence of Traveler’s Diarrhea and Associated Risk Factors in Travelers from a US Travel Clinic Open Access
Slail, Zahra (Spring 2020)
Abstract
Background:
A pre-travel visit to a doctor to receive a consultation before a trip is considered the best way to avoid any travel-related illness. The most common travel related illness is diarrhea with 60% of travelers reporting diarrhea. (Fedor, Bojanowski, & Korzeniewski, 2019).
Methods:
A longitudinal study of adult travelers done between June 2018 to August 2019 at Emory Travel Well Center was conducted. An in-person pre-travel survey was administered to participants at the travel clinic to measure the patient knowledge about travel safety followed by an electronic (by email) post-travel survey sent to every patient by the end of the trip.
The pre-travel questionnaire included questions about demographics and on the destination of their trip, the length of the trip, the reason for their travel, medical history, and other details about their trip.
The post-travel-surveys questions asked about developed any travel related illness during the trip focusing mainly on diarrhea, are what preventive measure was followed, and type of food they consumed. Relative risks were calculated to correlate the occurrence of diarrhea with unsafe behaviors practice by the travelers, the effect of following preventive measure, travelers’ activities, destination and reason for travel.
Results:
A total of 422 surveys collected pre-travel and 224 surveys collected post-travel. The age means 44.99 years. We found that the most common visited region is East Africa 28.44%. And thirty-three travelers developed diarrhea (14.67%). The measures of association showed there is a positive relative risk between eating raw produce (RR1.5, 95% CI 0.74, 3.2), and drinking freshly squeezed juices (RR 1.81, 95%CI= 0.60 - 5.46). Also, washing hands or using sanitizer showed a positive relative risk as a preventive measure against diarrhea (RR 2.77, 95%CI 0.40, 19.1). Tourism found to be having a positive risk ratio in relation to traveler’s diarrhea (RR 1.188, 95%CI 0.38, 3.64).
Conclusion:
We found a lower then reported proportion of diarrhea in our study, perhaps due to the travel advice received showing that following safe practice and behaviors during the travel is highly recommended to prevent traveler’s diarrhea. The results of our analysis also supported the association of some unsafe eating and drinking behaviors with diarrhea, although not statistically significant. Larger studies with improved response rates will help to further study these associations.
Table of Contents
Chapter 1: Introduction
Introduction.……………………………..……………………………………………………………………………….………….….8
Problem Statement……………………………………………………………………………………………………………………8
Purpose Statement……………………………………………………………………………………………………….…………..9
Significance Statement…………………………………………………………………………………………………………..….9
Definitions………………………………………………………………………………………………………………………………...10
Chapter 2: Comprehensive Review of the Literature…………………………………………………………………11
Background about travelers’ diarrhea ………………………………………………………………………………………11
Literature base on causes of diarrhea ………………………………………………………………………………………12
Literature based on severity and the length of symptoms………………………………………………………..14
Literature about seeking medical advice before traveling………………………………………………………..14
Literature about risk factors…………………………………………………………………………………………………….15
Literature about travelers and produce…………………………………………………………………………………...16
Literatures about Type of diarrhea and treatment……………………………………………………………………16
Literature type of diarrhea and treatment……………………………………………………………………………….16
Chapter 3: Methods…………………………………………………………………………………………………………………17
Introduction……………………………………………………………………………………………………………………………..17
Study Design and Participants…………………………………………………………………………………………………..18
Data Collection and Variables………………………………………………………………………………………….……….19
Statistical Analysis …………………………………………………………………………………………………………….…….20
Ethics and Approval ..……………………………………………………………………………………….……………………..20
Chapter 4: Results ………………………………………………………………………………………………….……….……..21
Demographics and travel characteristics of participants………………………………………….………………21
Previous knowledge and previous travelers…………………………………………………………………………….22
Post-travel survey result…………………………………………………………………………………………………….…...22
Reported symptoms /Medical attention…………………………………………………………………………….…...23
Reported diarrhea risk factors……………………………………………………………………………………………...…23
Chapter 5: Discussion and Conclusion…………………………………………………………………………………..….26
Discussion……………………………………………………………………………………………………………………...………..26
Conclusion and recommendations…………………………………………………………..…………………….……..…29
Chapter 6: Public health implications……………………………………………………………..…………….………....29
Table………………………………………………………………………………………………………………………..……………...31
Reference………………………………………………………………………………………………..……….………………….….36
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