Malaria in NYC Residents: Examining the determinants of chemoprophylaxis use and adherence among immigrants who travel abroad to visit friends and relatives (VFR)
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Title
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Malaria in NYC Residents: Examining the determinants of chemoprophylaxis use and adherence among immigrants who travel abroad to visit friends and relatives (VFR)
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Identifier
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d_2009_2013:949e36f0940e:11467
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identifier
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11883
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Creator
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Jones, Lucretia E.,
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Contributor
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Luisa N. Borrell | Juan Battle
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Date
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2012
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Language
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English
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Publisher
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City University of New York.
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Subject
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Public health | Epidemiology | Medicine | adherence | Africa | chemoprophylaxis | immigrants | malaria | VFR
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Abstract
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Background: Malaria is an infectious disease caused by Plasmodium parasite spread by the bite of an Anopheles mosquito in tropical areas. Though not transmitted in the United States (US), New York City (NYC) reports approximately 200 diagnoses of malaria annually predominantly in immigrants who traveled home to visit friends and relatives (VFR).1 This study aimed to examine the associations between 1) reasons of travel and taking chemoprophylaxis, and 2) type of chemoprophylaxis used and adherence; and to understand the reasons why travelers do not take malaria preventive measures.;Methods: Two quantitative methods were used for this research study: 1) secondary data analysis of NYC malaria surveillance data 2004-2010 (n=1335), and 2) an in-depth open ended interview of a sample (n=32) of newly diagnosed malaria cases diagnosed in 2011. Descriptive and chi-square statistics were calculated for selected characteristics. Logistic regression was used to estimate the strength of the association between a) reason for travel and chemoprophylaxis use and b) type of drug taken and adherence before and after controlling for age, gender, race, borough of residence, and travel region. SAS 9.2 was used for statistical analysis.;Results: No chemoprophylaxis was taken by, 84% of malaria cases and only 5% took and adhered to the complete regimen. The odds of not taking any chemoprophylaxis was 1.5 (OR: 1.48; 95% CI: 1.09-2.01) greater among VFRs than those that traveled for other reasons. However, after adjusting for age, gender, race, borough of residence, and travel region, this association was no longer significant. When compared to those who reported taking chemoprophylaxis daily, the odds of not adhering to the full regimen was 4.1 times (unadjusted ) greater for travelers who stated chemoprophylaxis use, but the name of drug was unknown. A sub-sample of 2011 malaria cases found 59.4% did not take any chemoprophylaxis and 28.1% adhered. People's knowledge, attitude, and beliefs were more important in influencing chemoprophylaxis use (25% of the sub-sample stated that they did not know about malaria or chemoprophylaxis, and 34.4% knew but still did not take chemoprophylaxis) than having health insurance (84.4% had health insurance).;Conclusion: Outreach and education are recommended to travelers, immigrant communities, and healthcare providers on malaria awareness, the importance of pre-travel medical advice for the appropriate chemoprophylaxis and the necessity of taking and adhering to the dosage. To increase chemoprophylaxis use and adherence, malaria prevention programs must focus on individuals' knowledge, attitude, and beliefs regarding malaria risk and disease severity. *Please refer to dissertation for footnotes.
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Type
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dissertation
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Source
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2009_2013.csv
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degree
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D.P.H.
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Program
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Public Health
