International Journal of Travel Medicine and Global Health
Volume:6 Issue: 2, spring 2018

According to the World Health Organisation ‘participation’, meaning involvement in everyday occupations, has a positive influence on health and wellbeing and lack thereof can lead to negative health consequences. Occupational therapy scholars believe this phenomenon needs exploring with attention to context. Variability is apparent in the way participation has been addressed in the context of voluntary immigration. This review aims to identify how the concept of participation and its association with the health and wellbeing of immigrants is addressed in research literature.

A literature review method was applied. The data bases searched were: PubMed, ASSIA, CINHAL, PsycINFO, AMED, CRD, EBESCO Host, Sociological Abstract, Lexis and EMBASE. Articles that fulfilled all inclusion criteria were critically appraised in order to assess their quality. Sixteen articles from major related databases were included. Qualitative analysis was used throughout.

Participation was mostly identified by measuring the number of attendances or self-report of attendance in health-related services or social occupations. Four themes were identified: outlook of participation, contributing factors to participation, approaches to studying immigrants’ participation, and outcomes of participation.

Participation lacks a common and exclusive definition that considers both objective and subjective experiences. How immigrants’ backgrounds and future perspectives affect what ‘participation’ means to them needs further exploration. The current publication has identified several contributing factors that need considering in health and social-related policies, plans and strategies. It is significant that enabling factors such as the positive attitude of immigrants, and providing support to immigrants can facilitate their participation pattern.

Insufficient attention has been paid to physical trauma as a cause of morbidity and mortality in international travellers, despite travellers themselves ranking it among their most important pre-travel health concerns. Road traffic collisions (RTCs) are the most common cause of death in younger travellers. One of the significant factors contributing to motorist accidents is tourists’ disorientation in a foreign environment. This is compounded by jet lag and travel fatigue, unfamiliarity with a hired vehicle, local road rules, weather, terrain, distracting scenery and driving on the wrong side of the road, the last factor accounting for the highest percentage of road crash-related injuries. Many of the traumatic risks of travel can be anticipated by performing a careful risk assessment. Travellers should receive targeted advice in relation to prevention of RTCs, adventure sports injuries, large mammal attacks, stampedes and breaches to their personal safety and security. This narrative review article draws attention to these risks and offers practical advice for mitigating the risk to travellers.

Preparedness for the prevention of travel-related infectious diseases among Malaysian international travelers has yet to be explored. With no such data, health programs to empower travelers on behavioral responses towards travel-related illnesses will be ineffective. The current study aimed to develop and validate a new scoring-based instrument measuring Malaysian international travelers’ preparedness in terms of their risk perception (RP), attitude, and practices (RisPAK-Q) towards travel-related infectious diseases using factor analysis. The newly developed instrument was tested among 200 Malaysian international travelers based on the systematic random sampling method. The number of domains, model-fit index, construct validity, and internal consistency for this instrument were determined using exploratory and confirmatory factor analysis (CFA). Twenty-two out of 34 questions were retained, and the following 5 domains were extracted: RP, pre-travel attitude (PTA), during-travel attitude (DTA), general traveling practice, and food practice (FP). All 22 questions had factor loadings of above 0.6. All 5 domains achieved a stable model fit index with good convergent and discriminant construct validity of above 0.5 indicated by the average variance extracted (AVE) with all of the maximum shared variance (MSV) values below their corresponding AVEs. All domains also had high internal consistency with a composite reliability (CR) of above 0.7. The RisPAK-Q containing 22 questions in 5 domains is a valid and reliable instrument for measuring the preparedness of Malaysian travelers for travel-related infectious diseases and can be used in a subsequent larger study.

Typhoidal Salmonella causes an invasive infection resulting in 200 000 deaths among 20 million patients annually. Typhoid remains a public health problem in Southeast Asia, the Indian subcontinent, Africa, and South America. Traveler’s diarrhea caused by Salmonella is common in Asia. Outbreaks of typhoidal Salmonella resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole in the 1990s pushed therapy to ciprofloxacin which was replaced by ceftriaxone due to fluoroquinolone resistance. This prospective study characterizes demographical, etiological, and resistance patterns in typhoidal Salmonella at a 1000-bed teaching hospital in New Delhi, India. Two hundred inpatients in pediatrics, obstetrics-gynecology, medicine, intensive care, and OPD in whom Salmonella bacteremia was detected were characterized by routine and automated microbiology techniques. The mean age of patients in this study was 21.4 years. Overall, 71% of patients suffered from Salmonella Typhi followed by 26% from Salmonella Paratyphi A. Four cases of Salmonella resistance to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol were encountered. A high degree of partial and complete resistance to fluoroquinolones was seen among Salmonella Typhi, Salmonella Paratyphi A, and Salmonella Paratyphi B cases. Resistance to ciprofloxacin was 48% among Salmonella Typhi and 100% among Salmonella Paratyphi A cases. Only 18% of Salmonella Typhi cases were completely resistant to quinolones, while 79% were partially resistant. A total of 92% of Salmonella Paratyphi A cases were partially resistant to quinolones. Four Salmonella cases were resistant to ceftriaxone. Salmonella Typhi remains the predominant serotype, followed by Salmonella Paratyphi A. The high prevalence of quinolone resistance in Salmonella Typhi and Salmonella Paratyphi A is a serious problem limiting empirical therapy to non-quinolone-based therapy such as ceftriaxone. Multidrug-resistant Salmonella is an emerging problem requiring active surveillance among residents and travelers presenting with tropical fever.

Malaria is among the most significant travel-related infections encountered by travelers to endemic countries in terms of morbidity and mortality. In Qatar, imported malaria has increased over the last 5 years; 493 travel-related cases were confirmed in 2016. In the current study, the knowledge of malaria chemoprophylaxis among physicians in the State of Qatar was assessed.

This was a cross-sectional study conducted during a national travel health workshop at the Ministry of Public Health, Qatar. Physicians participating in the workshop from different national healthcare institutions providing travel medicine services were invited to voluntarily complete a self-administered, structured questionnaire.

Forty-two medical doctors participated in the study (92 response rate). Based on their specialty, almost two-thirds (64.3%) of the participants were family medicine physicians, and one-fifth (21.43%) were general practitioners. Furthermore, most of the doctors were untrained in travel medicine. The majority of participants demonstrated a good knowledge of the malaria parasite (100%), Plasmodium species (64.3%), incidence (83.3%), transmission (66.7%), and drug-resistance (95.2%) of malaria. Additionally, most physicians (>90) were knowledgeable about the major features of severe or complicated malaria as well as malaria prevention and chemoprophylaxis.

This study highlights several areas of good knowledge on travel-related malaria prophylaxis and prevention among the study participants; however, there are still a few knowledge gaps that require mitigation. Continuing training programs on malaria prevention in travelers will sustain this good level of knowledge among physicians and improve the quality of pre-travel advice provided by travel medicine practitioners in Qatar.

The number of foreign travelers arriving in India has shown an exponential increase from 1.2 million in 1981 to 8.03 million in the year 2015, with an annual growth rate of 4.5%. With the influx of internationally mobile students to developing countries such as India comes the responsibility of having to cater to the health needs of these visitors. The current study was undertaken with the objective of assessing how travel prepared the international student travelers were, what gaps existed, and how better to address this issue in the future. A cross-sectional study was conducted at a medical college in Bengaluru city of South India during the 6-month period from March to August, 2015. International students doing an elective rotation at the medical college were approached to participate in the study. Written informed consent was obtained from participants, and a 23-item, self-administered questionnaire was distributed to them. Data was entered in EpiData software v3.1 and analyzed using Statistical Package for Social Science v 21.0. The current study comprised 43 elective students. The mean age of the participants was 24 ± 2 years with age ranging from 19-29 years. Females made up the majority (79.1%). A majority of the students (69.8%) had purchased travel insurance, 62.8% had consulted a doctor prior to their travel, and 74.4% had carried a first aid kit during their travel. The current study highlights the variability in the uptake of pre-travel health consultation, vaccination, and other precautions taken by student travelers. Determining the most appropriate strategies for increasing pre-travel health preparation is the next step in advancing travel medicine research.

Intertrigo is a common disease of the skin usually caused by fungi and/or bacteria, often involving major or minor skin folds. Here, we report a case of severe, ulcerative intertrigo of all interdigital folds of both feet caused by Pseudomonas aeruginosa in a patient with type II diabetes who acquired the infection during a trip to Senegal.

Lesions involved all toe-web spaces and the back of the toes and the soles. Ulcers with a purulent-necrotic bed, with some of them covered by brownish-black eschars associated with a greenish, odiferous discharge were recorded. The patient was treated with piperacillin/tazobactam IM for 14 days, achieving complete remission of the infection. In this article, we underline the importance of an early diagnosis and appropriate treatment to achieve healing of bacterial intertrigo without complications. Topical therapy with antiseptics (potassium permanganate, gentian violet solution, hydrogen peroxide) or antibiotics (gentamicin, amikacin) is effective only in early stages of the infection. Systemic antibiotics must be considered in all extensive and severe cases. The choice of antibiotic should be based on the culture and antibiogram results. When this is not possible, wide-spectrum antibiotics that act on both gram-positive and gram-negative bacteria (such as third-generation cephalosporin or quinolone) should be prescribed.

The length of treatment should not be less than ten days. In addiction, all patients should be trained to avoid predisposing conditions and adopt preventive measures to reduce the risk of infection.