title: Survey of visitors to a National Park in the savannah region of northeast Brazil: practices, incidents and hazardous situations.
abstract: BACKGROUND
  Wilderness travellers to remote National Parks of Brazil may be particularly at risk of tropical diseases and injury. The aim of this study was to describe injury and illness, potentially hazardous situations, accidents and other incidents experienced by travellers to a remote National Park in Brazil.
  
  
  METHODS
  The study was done in the National Park, "Serra da Capivara", in Piauí State northeast Brazil. Key informants were interviewed using semi-structured interviews, and a self-administered questionnaire was used for visitors. Questions included information on health problems and risk behaviour in the park, as well as pre-travel health advice.
  
  
  RESULTS
  In total, 14 tour guides, 7 hotel managers and 17 health professionals were interviewed, as key informants. Eighty visitors returned the completed questionnaires (60 Brazilian, 20 foreigners). The key informants reported different risk behaviour of groups and individuals travellers, and incidents most commonly mentioned were minor injuries, insect bites/bee stings and allergic reactions. Seventy percent of the Brazilian and 55% of the foreign visitors had obtained pre-travel health advice, but only 5% of Brazilians and 15% of foreign visitors has obtained this advice from a physician. The most common source of information was other people who already had visited the park and travel books. Of the Brazilians, 13.3% reported some health incident during their stay, most commonly bee bites and headache. Two foreign travellers reported three incidents (insect bites/bee stings, diarrhoea and sunburn). Most commonly reported hazardous situations perceived by the tourists were possible accidents caused by falling from a stairway or falling stones, poisonous animals and insect bites/bee stings.
  
  
  CONCLUSIONS
  Surveys conducted at remote tourist destinations are a feasible approach to report vulnerable situations, practices and incidents of visitors to a National Park. We have shown that most travellers are not adequately prepared and many experienced vulnerable situations during their visit to the National Park. It is important that visitors to National Parks in Brazil are encouraged to obtain travel health advice. The most common and potentially serious incident (bee stings) is rarely addressed in pre-travel health advice. Travel health advisers should ensure that they have access to locally relevant information for travellers, so that appropriate preventive measures can be instituted.
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, Brazil.
authors.forename: Liana
authors.initials: L
authors.lastname: Ariza
authors.forename: Marcia
authors.initials: M
authors.lastname: Gomide
authors.forename: Alberto Novaes
authors.initials: AN
authors.lastname: Ramos
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leggat
authors.forename: Jörg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D000059:Accidents; D000328:Adult; D000818:Animals; D001522:Behavior, Animal; D001938:Brazil; D003967:Diarrhea / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007299:Insect Bites and Stings; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013471:Sunburn / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014195:Travel; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control