TRAVELERS DIARRHEA AND THE EFFECT OF PRE-TRAVEL HEALTH ADVICE IN GENERAL-PRACTICE

Background. Rates of travel-related diarrhoea vary from 8% to 50% depe nding on the country visited. Travellers' diarrhoea has social, health and economic costs. The impact of these may be reduced by relevant pr e-travel advice. Little is known of the effect of pre-travel advice on the incidence of diarrhoea among travellers abroad. Aim. To determine the 'true' attack rate of travellers' diar rhoea and to assess the ef fectiveness of pre-travel health advice in reducing the incidence of d iarrhoea and the need for subsequent GP consultation. Method. A retros pective study was carried out in a general practice in Stirling, Scotl and, using a standardized, structured questionnaire to obtain demograp hic details and patients' home and foreign health experience in the pr evious 12 months. The questionnaire was administered to a 20% sample ( n = 1771) of practice patients aged 16 years or over, stratified by ag e and sex. Main outcome measures were reported diarrhoeal illness whil e abroad, its management and outcome, and a record of diarrhoea in the two weeks prior to responding to the questionnaire. Results. The resp onse rate was 97% (n = 1649). Of those responding, 44% had travelled a broad in the past 12 months; 39% of travellers reported having diarrho ea while abroad, while 6% of the same group reported diarrhoea in the two weeks prior to being questioned; 9.7% of non-travellers reported d iarrhoea in the two weeks prior to being questioned. Travellers were 6 .5 times more likely to experience diarrhoea while abroad than when sp ending a comparable 2-week period at home. Travellers who had sought p re-travel advice were more likely to be travelling to a highrisk desti nation (P<0.0001) and were more likely to suffer diarrhoea while abroa d (P<0.05); however, they were less likely to need medical help while abroad or on their return (P<0.0001). The results indicate a markedly higher attack rate of diarrhoea in patients travelling abroad than wou ld be expected if they stayed at home. Conclusion. Pre-travel advice d oes reduce the need for medical assistance while abroad; it also reduc es GP workload in terms of post-travel health consultations with retur ning travellers.