title: Correlation between adherence to precautions issued by the WHO and diarrhea among long-term travelers to India.
abstract: BACKGROUND
  Travelers' diarrhea is the most common infectious disease afflicting travelers to developing countries. Most studies investigating the benefits of recommendations regarding the consumption of food and water have focused on short-term travelers. We investigated the benefits of adherence to the precautions from the World Health Organization (WHO) among long-term travelers.
  
  
  METHODS
  We asked 140 incidental travelers in India traveling for at least 2 months to complete a questionnaire about their adherence to the WHO precautions and the occurrence of diarrhea. Adherence was graded on a scale of 1 to 6 (least to most).
  
  
  RESULTS
  The mean age of the 114 travelers whose questionnaires were eligible was 26.6 +/- 5.7 years, and the median duration of their trip was 5 months. None of them adhered strictly to the entire set of rules. The mean individual adherence was 3.4 (range 1.2-5.8). The vast majority of the travelers (83%) suffered from diarrhea. Most travelers (60%) had diarrhea for up to 3% of their journey time. Diarrhea was accompanied by fever among 18% and necessitated hospitalization in 3%. Forty-five percent indicated that they had lost traveling days due to diarrhea, for an average of 0.7% of the traveling time. We found no correlation between the percentage of traveling time with diarrhea and the following variables: adherence to the WHO recommendations, receipt of advice regarding prevention, duration of the trip, age, sex, and nationality of the travelers.
  
  
  CONCLUSIONS
  Dietary self-restraint of travelers as proposed by the WHO is both difficult to comply with and lacks a proven value for the long-term traveler to a developing country.
authors.affiliation: Infectious Diseases and Travel Clinic, Bnai-Zion Medical Centre, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Hillel
authors.forename: Israel
authors.initials: I
authors.lastname: Potasman
mesh_terms: D000328:Adult; D003967:Diarrhea / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011322:Primary Prevention / Q000379:methods; D012307:Risk Factors; D014195:Travel; D014944:World Health Organization