Malaria risk perceptions and barriers for effective prophylaxis among sub-Saharan African 'visiting friends and relatives' travellers in Hamburg, Germany.

Background: The African visiting friends and relatives (VFR) community in the Global North is at high risk of contracting preventable travel-associated infections including malaria when travelling to sub-Saharan Africa. This study aimed to assess barriers to effective prevention and to develop tailored travel counselling.

Methods: A questionnaire-based survey was conducted from January to August 2023 at the Hamburg Airport among adult sub-Saharan African VFR travellers returning from malaria-endemic destinations in Africa to assess malaria risk perceptions, attitudes towards prophylaxis and counselling and their experiences with travel medicine and malaria prophylaxis.

Results: A total of 389 participants completed the survey. Of these, 67 % (n = 261) demonstrated adequate knowledge of malaria transmission. Fifty-one percent (n = 198) perceived minimal risk of contracting malaria in the malaria-endemic country leading to lower uptake of prophylaxis. Ten percent (n = 37) mistakenly believed they were vaccinated against malaria. Approximately half of the respondents did not seek medical travel advice prior to departure or take antimalarial prophylaxis due to perceived minimal risk of disease. Of those who took antimalarial drugs, 77 % (n = 149) completed the full course. On return, 5 % (n = 20) of the respondents had malaria-like symptoms and of these, 55 % (n = 11) either self-medicated or did not seek medical treatment.

Conclusions: VFR travellers mistakenly perceive a low risk of malaria, resulting in low uptake of travel medical advice and chemoprophylaxis. Mistrust of advice from healthcare providers was found. Insights from this survey are valuable for practitioners and travel medicine clinics to provide more tailored and culturally sensitive travel advice to VFR travellers.