title: Imported malaria among African immigrants: is there still a relationship between developed countries and their ex-colonies?
abstract: BACKGROUND
  The objective of this study was to compare cases of imported malaria originating from the Spanish ex-colony of Equatorial Guinea (EG) with those originating from the rest of Africa (RA).
  
  
  METHODS
  All the African cases detected in Barcelona between 1989 and 2007 were investigated in a retrospective analysis. Clinical-epidemiological variables such as sex, age, visiting friends and relatives (VFR), species, hospital admission and chemo-prophylaxis were compared. Data were analysed by logistic regression, calculating the Odds Ratio (OR) and 95% Confidence Intervals (95% CI).
  
  
  RESULTS
  Of the 489 African patients, 279 (57,1%) had been born in EG and 210 (42,9%) in the rest of Africa. The cumulative incidence of imported malaria among those from EG was 179.6 per thousand inhabitants, while in those from the RA it was 33.7 per thousand (p < 0.001). Compliance with chemoprophylaxis (CP) was very low, but there were no differences between the two groups. Comparing those from EG to those from RA, the former were characterized by having more patients in the visiting friends and relatives (VFR) category, and more individuals younger than 15 years or older than 37 years, and more women. They also visited a traveller's health centre more often, had fewer hospital admissions and were less likely to reside in the inner city.
  
  
  CONCLUSIONS
  Cases of imported malaria originating in Africa, are more likely to come from the Spanish ex-colony of EG, and VFR are more likely to be affected. It is recommended that developed countries promote prevention programmes, such as CP advice directed at African immigrants, and develop programmes of cooperation against malaria in their ex-colonies.
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain. jmillet@aspb.es
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Millet
authors.forename: Patricia Garcia
authors.initials: PG
authors.lastname: de Olalla
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gascón
authors.forename: Jordi Gómez I
authors.initials: JG
authors.lastname: Prat
authors.forename: Begoña
authors.initials: B
authors.lastname: Treviño
authors.forename: M Jesús
authors.initials: MJ
authors.lastname: Pinazo
authors.forename: Juan
authors.initials: J
authors.lastname: Cabezos
authors.forename: José
authors.initials: J
authors.lastname: Muñoz
authors.forename: Francesc
authors.initials: F
authors.lastname: Zarzuela
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D017677:Age Distribution; D000818:Animals; D018890:Chemoprevention; D016001:Confidence Intervals; D004641:Emigration and Immigration; D016703:Equatorial Guinea; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D014195:Travel; D055815:Young Adult