Abstract
Following re-emergence of malaria in Evrotas, Laconia, in 2009–12, a malaria-control programme was implemented in 2011–12 targeting migrants from malaria-endemic countries, including house-to-house active case detection, health education and distribution of mosquito protection items. In June 2013, we surveyed migrants in Evrotas to assess their malaria knowledge, attitudes and practices to guide prevention activities. We selected participants using simple random sampling and interviewed them, using structured questionnaires. We defined mosquito protection practices (MPPs) as the use of full-length clothes/topical repellent, mosquito screens, fans or air-conditioning, and insecticides. We calculated prevalence ratios (PRs) using Poisson regression and we allowed for clustering of participants in a residence. Of 654 migrants, we invited 132 and 130 participated (all men; 120 (92%) from Pakistan). Of the 130, 56 (43%) identified fever as a malaria symptom; those who were aware of this had higher level of education (PR: 3.2; 95% confidence interval (CI): 1.2–9.0). A total of 111 (85%) used insecticide-treated bednets and 95 (73%) used more than two MPPs. Poor housing conditions (warehouses/shacks: PR: 0.8; 95% CI: 0.6–0.9), were associated with use of up to two MPPs. Despite extensive interventions in Evrotas, the level of malaria awareness among migrants remained suboptimal and poor housing conditions hindered effective mosquito protection. We recommend culturally adapted health education and improvement of housing conditions to minimise the risk of new cases and re-establishment of malaria in Greece.
Highlights
In 2012, the World Health Organization (WHO) estimated that malaria caused 207 million infections and 627,000 deaths globally [1]
Participants older than 34 years (PR: 1.3; 95% confidence interval (CI): 1.1–1.6), with more than seven years of education (PR: 1.4; 95% CI: 1.0–1.9) and those who would seek medical treatment for fever (> 38 °C) from active case detection (ACD) teams (PR: 1.3; 95% CI: 1.1–1.5) were more likely to know about malaria transmission (Table 4)
Participants who were more likely to use more than two mosquito protection practices (MPPs) included those who would seek fever (>38 °C) treatment from ACD teams (PR: 1.3; 95% CI: 1.0–1.6) and those worried about becoming seriously ill with malaria (PR: 1.5; 95% CI: 1.1–2.0)
Summary
In 2012, the World Health Organization (WHO) estimated that malaria caused 207 million infections and 627,000 deaths globally [1]. Environmental conditions in southern Europe favour breeding of anopheline vectors of malaria, allowing for transmission of the Plasmodium parasites [4,5]. The carriage of Plasmodium by travellers and migrants from malaria-endemic areas favours the potential for local transmission under suitable ecological conditions [6]. During the May to October transmission period [10] of 2013, Evrotas was host to a community of 554 to 859 male migrant farm workers from the Indian subcontinent, predominantly Pakistan. This population was mobile, with a high turnover of people and fluctuating numbers throughout the year [11]. Poorly constructed buildings, often located close to mosquito breeding sites [10]
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Schedule a callMore From: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin
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