The poor use of chemoprophylaxis is not restricted to African VFRs, and can occur irrespective of ethnicity. Fifty-six patients with falciparum malaria who visited the Gambia (a popular tourist destination for indigenous British holidaymakers) had not used chemoprophylaxis.19 The results from this review demonstrate that research among VFRs to date has

focused on individual risk factors for malaria and on recent travel or planned journeys. Furthermore, the data available provide only a superficial understanding of some of the factors that may be influencing behaviors that result in the high incidence of imported malaria seen in the African Diaspora. However, in such research, it is important to recognize that VFRs are far from a homogenous group and additional research into the nature and extent of variation in knowledge, attitudes, selleck chemicals llc and behaviors relating to malaria among the various groups that make up the African Diaspora Ceritinib across Europe is required. While there are some race-based biological factors (sickle-cell trait and G6PD deficiency) that contribute to perceptions of risk, in terms of ethnicity it is unlikely if there are discernible patterns of behavior that

can be applied to the whole ethnic populations, let alone across populations from different backgrounds. This applies particularly to issues such as the taste of antimalarial tablets and fear of side effects which are not influenced by ethnicity, and care must be taken to not overly attribute failure to access malaria protection to cultural reasons alone. Although most impact on reducing the incidence of imported malaria can be made by focusing on interventions in the African community, understanding why other travelers put themselves

at risk will also be important. The results from the review also suggest that there is a need for primary research using qualitative methodology to investigate the context within which personal decisions are made about malaria prevention. For example, Endonuclease the cumulative effect of disease-free successive journeys may affect perceptions and reduce perceived risk of disease. Although there are differences in the etiology of disease, future themes could be drawn from research in other diseases that disproportionately affect the African Diaspora, such as HIV and TB. Studies into the former, in particular, have recognized the importance of the socioeconomic and structural contexts within which decisions are made about health.20,21 Finally, research undertaken so far has focused on chemoprophylaxis. Mosquito bite prevention measures are also important with respect to malaria prevention, and there is a need to understand factors that restrict or influence VFRs from using these. The few researchers who have investigated knowledge, attitudes, and practices about malaria in the African Diaspora in Europe have made some valuable initial findings and have highlighted the need for agreement on definitions.