Durreesamin Journal (ISSN: 2204-9827)

KNOWLEDGE OF MALARIA AMONG ALBANIAN TRAVELLERS

Adela Haxhiraj
Faculty of Public Health
University “Ismail Qemali”, Vlora, Albania
adelahaxhiraj@gmail.com

Brunilda Subashi
Faculty of Public Health
University “Ismail Qemali”, Vlora, Albania
brunasubashi@gmail.com

Marjola Haxhiraj
Regional Environmental Agency, Vlora, Albania
marjolahaxhiraj@gmail.com

Jora Koçiaj
Health Care Centre No.4,
Paediatric Health Care, Vlora, Albania
jorakociaj@gmail.com

Pellump Pipero
Faculty of Medicine
University of Medicine, Tirana, Albania
piperop@gmail.com

Saad Masood Butt

Computer Science Department
Atlantic International University, USA
saadmasoodbutt444@gmail.com

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 Durreesamin Journal (ISSN: 2204-9827)

Abstract

Background – This study aims to evaluate the level of information that Albanian travellers have on

malaria, known as one of the most impactful diseases in a worldwide scale.

Materials and Methods – For this purpose, it was conducted a cross-sectional survey with Albanian

passengers departing from Tirana International Airport from July till September 2015. The travellers were

given a questionnaire with fourteen closed questions about their information on infectious diseases and

their status of vaccination. The questionnaire included malaria related questions. It was focused mainly on

basic knowledge of malaria likewise how it was transmitted and how it could be prevented.

Results - Six hundred and five persons responded to the questionnaire. The majority of the participants in

the survey were women in the age group of 20-40 years old. 56% of the participants of the survey replied

negatively to the question if they get informed about infectious diseases and other health related topics

while preparing to travel, whether the purpose of the travel is leisure or job related. Regarding their

knowledge specifically on malaria, more than half of the participants responded that they have information

about it, mainly from the educational system. Almost 90% of the persons knew malaria as a mosquito-

borne disease but less than 28% of them took measures to prevent mosquito bites during their travel.

Conclusions - In conclusion, the survey showed that the majority of Albanian travellers have general

information about malaria and know the right ways of prevention but few use protection against

mosquitoes during their journeys.

Key words: knowledge, malaria, traveller, Albania.

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Background

Travel health is a major factor in the overall health of an individual, especially in these last decades

(Gautret et al., 2012). International travelling has increased rapidly and travellers are exposed to a whole

new variety of health risks in unfamiliar or unexplored environments (Zuckerman et al., 2015). One of the

most globally present diseases is malaria. Its health, economic and social impact is well known and still

present, despite worldwide programs to reduce it (Sachs et al., 2002). According to the World Malaria

Report 2017 from World Health Organization (WHO), only in 2016 there have been 216 million new

cases with malaria in the world. 90% of the cases were reported from the African Region and a

considerable percentage of 2% coming from Mediterranean Region (WHO, 2017). The still rising number

of malaria cases in the Mediterranean is consistent with the natural habitat of Anopheles, the type of

mosquito responsible for transmitting the disease. Albania, as part of the Mediterranean Region has a

close history with malaria. During the first half of the 19th century, malaria was a prominent disease with

over 50% of the population infected. After the World War II, the disease quickly disappeared as a result of

national strategies and prevention programs. The latest cases were reported in 1958 for Plasmodium

falciparum, in 1962 for Plasmodium Vivax and in 1967 for Plasmodium Malaria. Since the 60s the only

reported cases in Albania were those imported from abroad (Aliu, 2014). The last one was confirmed in

2016 with the case of a worker coming home from Greece, place in which he encountered the disease

(Sot, 2016).

National strategies for vector controlling are present and ongoing in Albania as part of the World Health

Organization program for increasing awareness and helping minimizing the impact this disease has. As the

number of travellers from abroad increases, the need arises to collect new information regarding this issue.

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There are many studies concerning travel health from around the world in which this study aims to be a

part of.

Materials and Methods

For this topic, it was conducted a cross-sectional study during the period of July through September 2015 in

Tirana International Airport (TIA). The study was based on a self- administered questionnaire. The

questionnaire included socio-demographic variables (age, occupation, destination of travel), questions

about infectious diseases in general and malaria in specific. The questions included information about risk

factors and prevention of this disease. The questionnaires were distributed at the departure gates of the

airport. The study involved only Albanian passengers departing from TIA during that period.

The study encountered some difficulties along the way which consisted on some conflicting or incomplete

answers by passengers and resistance of some of the travellers to the questionnaire which resulted in

incomplete forms and missing data.

In total, 605 questionnaires were completed. The number of questionnaires prepared and delivered was

determined by the data given by INSTAT (Albanian Statistic Institute) for 2015 related to the Albanian

population (INSTAT, 2015). According to these data, the population of Albania is 2,893,005. To obtain a

95% confidence level and a margin of error of 3.3%, it requires surveying a number of 600 to 800 people.

Cross tabulation (MxN) tables and, X2 test / Fisher test were used for the analysing of the data. The data

were analysed and reconstructed with Microsoft Excel 2007 and Epi Info 7. The participants were fully

informed of the purpose and use of this study.

Results

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There were 605 forms filled by Albanian passengers surveyed in Tirana International Airport during the

period of three months (from July to September 2015). The majority of the respondents were female. The

mean age of respondents was 37 years old. The data is presented in table 1 and 2. Destinations varied from

European, African, Asian and American countries. A slight majority of respondents received information

about infectious disease before or during travelling as seen in table 3. Regarding knowledge about

Malaria, almost 90% of respondents were positive in their response. Information came mostly from school

as presented in table 4 and 5. When asked about the way this disease is transmitted, more than 95% of

passengers responded correctly. The results are presented in table 6. 71.72% of travellers denied taking

precautions against mosquito biting during their journeys, whether it was for business, pleasure or any

other kind of purpose, regardless of the destination.

Table 1. Distribution of participants by gender

Gender Frequency Percentage (%) Wilson 95% LCL Wilson 95% UCL

Female 327 53.96 49.98 57.89

Male 276 45.54 41.62 49.53

NA 3 0.50 0.17 1.45

Total 605 100 % 100 100

Table 2. Distribution of age

Observation Mean Variable Standard Minimum 25 Median 75 Maximum Mode

Age Deviation % %

605 37.01 253.31 15.92 7 25 34 48 87 27

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Table 3. Distribution of participants for the question “Do you have information on

infectious diseases while travelling”

Frequency Percentage (%) Wilson 95% Wilson 95%

LCL UCL

No 335 55.37 51.75 % 59.66 %

Yes 266 43.96 40.34 % 48.25 %

NA 4 0.66 0.17 % 1.45 %

Total 605 100 100 % 100 %

Table 4. Distribution of participants for the question “Have you ever heard of

malaria”

Frequency Percentage Wilson 95% Wilson 95%

(%) LCL UCL

No 62 10.28 8.10 12.96

Yes 541 89.76 87.04 91.90

Table 5 – Distribution of sources of information

Frequency Percentage (%)

School 399 65.95

My doctor 104 17.19

The internet 189 31.24

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Sources of information

The internet
31,24%

School
My doctor 65,95%
17,19%

Table 6. Distribution of participants for the question “Is malaria transmitted by

mosquito biting”

Frequency Percentage Wilson 95% Wilson 95%

(%) LCL UCL

No 12 2.16 1.24 3.74

Yes 543 97.84 96.26 98.76

Table 7. Distribution of participants for the question “Do you keep with you anti

mosquito protection while travelling”

Frequency Percentage Wilson 95% Wilson 95%

(%) LCL UCL

No 421 71.72 67.95 75.21

Yes 166 28.28 24.79 32.05

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Do you keep with you anti mosquito protection

while travelling

Yes
28%

No
72%

Discussion

The survey conducted in Tirana International Airport for a period of three months (from July till

September 2015) were attended by 605 people with the mean age being 37 years old and 53.96% of

participants being females (see Table 1) (see Table 2). The study was based on data obtained from

anonymous questionnaires compiled by Pëllumb Pipero, Ph.D professor at the University of Medicine in

Tirana and infectious disease specialist in University Hospital Centre “Mother Teresa”, Tirana. Only

Albanian travellers travelling abroad were chosen for this study.

Based on the answers obtained, the following conclusions were reached:

Most of the passengers (55.37 %) did not have information on infectious diseases while travelling (see

Table 3), in contrast with the results of a pilot survey conducted in nine European states airports in 2002-

2003 (Van Herck, et al., 2003), (Van Herck, et al., 2004). According to our survey, travellers, generally

knew about malaria and only approximately 10 % of them had not heard of the disease (see Table 4). Over

97% of the participants associated malaria with mosquito bite compared to a Mexican study where the

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result for the same question was only 48% (Rodriguez et al., 2003). In 2004 a Turkish study was

published which revealed that knowledge about malaria in Turkey was insufficient as more than 30 % of

the participants in this study didn’t know how malaria was transmitted (Simsek & Kurcer, 2005).

Compared to both studies, Albanian travellers were well acquainted with the disease.

In regard to acquiring information, most of the participants referred to school as their main source. A less

influential source was the media. The National Health System was impactful in organized groups of

travellers such as Islamic religious who travelled to Mecca each year for their traditional pilgrimage or job

seekers in endemic areas. In Albania, each year, there are over 400 persons who travel to malaria endemic

areas for religious tourism or work (BotaSot, 2016). Such groups are obliged to get information and to be

provided with prophylaxis for malaria or other diseases present in the areas in which they will travel. The

centre of the organization of this work is the Tropical Disease Cabinet at the University Hospital Centre

“Mother Teresa” in Tirana.

Regarding travellers travelling in small groups or without sufficient information, such as over 50% of

TIA's Albanian travellers, the commitment to protective equipment is more limited. 71.72% of the

respondents stated that they did not take with them any kind of solution against mosquitos. In a study by

Schoepke, Steffen and Gratz only 2% of Europeans travelling to East Africa, an endemic region for

malaria (Omumbo et al., 2005), took all necessary measures to be protected against mosquitoes

(Schoepke, Steffen & Gratz, 1998). A significant percentage is seen in Albanian travellers, stating that

although information about malaria is present, practical awareness is insufficient.

Conclusions

As a conclusion, according to the study, the information that Albanian travellers possess of malaria is

sufficient to prevent both transmission and propagation of the disease but there is still a lack of practical

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application of the knowledge by travellers, especially those who visit endemic areas. In Albania, a lot of

work is done in this department and a lot is yet to be done in order to keep this disease under control.

By continuously keeping the health personnel up to date with the latest reports about malaria and by

raising awareness in the population, there is the chance for the goals of WHO for this disease to be

achieved faster.

Acknowledgements

The permission of Tirana International Airport “Mother Teresa” for letting us in and giving us the

possibility of conducting the survey is gratefully acknowledged especially of the Border Unit of Health

Inspectorate Services. Only the authors are responsible for the interpretation of the data.

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