‘Home from home’: risk perceptions, malaria and the use of chemoprophylaxis among UK South Asians

Abstract

Objectives. Malaria is a serious disease hazard facing travellers to tropical countries. On average around 2000 cases of malaria are annually imported into the UK, with an over-representation of ethnic minority members. The current research examined adherence to chemoprophylaxis among UK South Asians travelling to malarial regions in South Asia and East Africa. Design. Four hundred South Asians were interviewed with a questionnaire investigating use of malaria prophylaxis, knowledge of malaria, risk perceptions and reasons for inadequate or zero adherence to chemoprophylaxis. Two hundred interviews were conducted in 1994, and a further 200 interviews in 2004. Participants were recruited from areas of known ethnic density in Leicester, London and Oxford. Results. In 1994, although 49% embarked on taking anti-malaria tablets, only 22% took tablets for 2 or more weeks upon return to the UK (and only 6% for the medically advisory period of 4 weeks). In 2004, 32% embarked on taking tablets but only 9% took tablets for 2 or more weeks upon returning to the UK (and only 2.5% for 4 weeks). Good adherence was associated with greater knowledge about the symptoms and transmission of malaria, and being more likely to define the trip as a ‘holiday’ rather than as a visit to ‘family and friends’. Zero adherence was associated with a failure to recognise the potential severity and critical nature of malaria. Common reasons for partial and zero adherence were the perception that the personal risk of getting malaria was low and an erroneous belief in immunity. Conclusions. The specific cognitions available to ethnic minority members travelling ‘home’ contribute to a very low use of chemoprophylaxis, thus placing them at a heightened risk of acquiring malaria. Health messages need to stress that malaria is a serious health hazard and that émigrés visiting malarial regions cannot rely on personal immunity.