Investigating the Impact of Travel Medicine Advice on Risk-Taking Behaviour and Travel-Related Illness Open Access

Shittu, Rukaya Adeola (Spring 2019)

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Background: The number of annual international travelers yearly has exceeded one billion in recent years. Much of this growth has involved destinations with increased health risk; yet there are few prospective studies investigating behavioral risk factors among travelers and how much these are associated with travel-related illness.

Objectives: We sought to determine if travel-related illnesses were associated with certain behaviors while traveling and whether pre-travel counseling deters certain risk-taking behaviors.

Methods: A prospective study was carried out at Emory Travel Well Center from June to December 2018, where adult travelers to low or middle-income countries were recruited at the time of pre-travel consultation. Data on travelers’ trip details, health and behavior were collected using self-administered questionnaires before and after travel. Medical co-morbidities, vaccines administered, and prescriptions were extracted from the medical charts. Demographic and travel details were described; univariate, bivariate and multivariate analyses performed with Pearson chi-square, Fisher’s exact tests and logistic regression to identify factors associated with illness.

Results: We recruited 174 travelers with 110 travelers answering both the pre-travel and post-travel surveys. The median age was 39 years (18, 76); 61% were females. The most common region of travel was Africa (52% of travelers). Twenty-eight (26%) became sick, with diarrhea being the most common. A high proportion of travelers reported eating fresh produce (n=86, 75%), 11% drank tap water, 39% consumed ice, and 19% ate street food. In multivariate analysis, only travel to multiple regions (OR 9.36) (95% CI 1.49 – 58.50) remained statistically significantly associated with travel- related illness.

Conclusions: Travel-related illnesses, especially diarrhea and respiratory illness, were common in this study and falls in line with previously reported studies. The most significant risk factor associated with illness is traveling to multiple regions. Surprisingly, the proportion of unsafe eating and drinking behaviors was high, especially given that the cohort all received anticipatory guidance during their pre-travel consultation. A large sample size will further elucidate the impact of behaviors and travel advice on illness, leading to improved strategies to help travelers remain healthy while overseas.

Table of Contents

Chapter 1: Introduction. 1

Problem Statement 2

Purpose Statement 3

Significance Statement 3

Definition of Terms. 5

Chapter 2: Comprehensive Review of the Literature. 6

Background of Travel Medicine. 6

International Travelers and Tourism.. 7

Travel-related health risks. 9

Traveler’s diarrhea. 12

Travelers health risk profile. 13

Travelers’ Perception of Risk. 14

Travel Medicine Consultation. 16

Public Health Implications. 17

Travelers’ health prevention during travel 18

Gap in Knowledge. 18

Chapter 3: Manuscript 20

Introduction. 24

Methods. 25

Results. 30

Discussion. 34

Tables. 42

Chapter 4: Conclusions and Recommendation. 49

Reference. 51

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