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Title: The burden of imported malaria among Nigerians and Ghanaians living in London : understanding the influences of the social, cultural, environmental, economic and structural context
Author: Neave, Penny
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2013
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The majority of reports of imported malaria in Europe come from the UK, France, Germany and Italy. Most of those affected are of African origin visiting friends and relatives (VFRs). There is little understanding of the factors that enhance and constrain effective malaria prevention practices in this group. Two studies were undertaken to investigate this. An epidemiological analysis of 13813 reports made in the UK between 2001 and 2008 showed that 58% lived in London, where 83% of infections were caused by Plasmodiumfalciparum. The rate per 100000 offalciparum infections in the capital in 2008 in those categorised as of "Black African" ethnicity was 131.0 (CI: 120.0-142.1), compared to 0.3 (CI: 0.2-0.5) amongst the "White British". To investigate factors influencing the behaviours of VFRs, semi-structured interviews were undertaken with African VFRs resident in the UK visiting Nigeria and Ghana (n = 20), malaria patients (n= 6), practice nurses (n= 10), GPs (n = 10), community pharmacists (n= 7) and hospital consultants (n= 3). Factors influencing the use of mosquito avoidance methods included knowledge about the local environment, a perceived inevitability of contracting malaria, and a desire to use methods common amongst host families. Chemoprophylaxis use was influenced by perceptions of susceptibility, by previous experiences of malaria, perceptions of the seriousness of malaria, and peer pressure. Relevant structural factors included the cost of chemoprophylaxis and difficulties in accessing health advice. This research showed that in managing malaria, VFRs choose pragmatically between two parallel social and environmental contexts and the structural constraints associated with each. A novel conceptual framework shows the complex manner in which these interact, and may be appropriate in different countries and also in future research investigating other travel-related diseases in migrants. Practical recommendations for research priorities within the UK imported malaria context are made.
Supervisor: Behrens, Ron ; Jones, Caroline Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral