title: Malaria prevention knowledge, attitudes, and practices (KAP) among international flying pilots and flight attendants of a US commercial airline.
abstract: BACKGROUND
  In 2010, malaria caused approximately 216 million infections in people and 655,000 deaths. In the United States, imported malaria cases occur every year, primarily in returning travelers and immigrants from endemic countries. In 2010, five Plasmodium falciparum malaria cases occurred among crew members of one US commercial airline company (Airline A). This investigation aimed to assess the malaria prevention knowledge, attitudes, and practices (KAP) of Airline A crew members to provide information for potential interventions.
  
  
  METHODS
  The web link to a self-administered on-line survey was distributed by internal company communications to Airline A pilots and flight attendants (FA) eligible for international travel. The survey collected demographic information as well as occupation, work history, and malaria prevention education.
  
  
  RESULTS
  Of approximately 7,000 nonrandomly selected crew members, 220 FA and 217 pilots completed the survey (6%). Respondents correctly identified antimalarial medication (91% FA, 95% pilots) and insect repellents (96% FA, 96% pilots) as effective preventive measures. While in malaria-intense destinations, few FA and less than half of pilots always took antimalarial medication (4% FA, 40% pilots) yet many often spent greater than 30 minutes outdoors after sundown (71% FA, 66% pilots). Less than half in both groups always used insect repellents (46% FA, 47% pilots). Many respondents were unaware of how to get antimalarial medications (52% FA, 30% pilots) and were concerned about their side effects (61% FA, 31% pilots).
  
  
  CONCLUSIONS
  Overall, FA and pilots demonstrated good knowledge of malaria prevention, but many performed risky activities while practicing only some recommended malaria preventive measures. Malaria prevention education should focus on advance notification if traveling to a malaria-endemic area, how to easily obtain antimalarial medications, and the importance of practicing all recommended preventive measures.
authors: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA. monica.selent@us.af.mil
authors: Monica
authors: M
authors: Selent
authors: Valery M Beau
authors: VM
authors: de Rochars
authors: Danielle
authors: D
authors: Stanek
authors: Diana
authors: D
authors: Bensyl
authors: Barbara
authors: B
authors: Martin
authors: Nicole J
authors: NJ
authors: Cohen
authors: Phyllis
authors: P
authors: Kozarsky
authors: Carina
authors: C
authors: Blackmore
authors: Teal R
authors: TR
authors: Bell
authors: Nina
authors: N
authors: Marano
authors: Paul M
authors: PM
authors: Arguin
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D001359:Aviation / Q000706:statistics & numerical data; D018890:Chemoprevention / Q000379:methods; D003906:Developing Countries; D019353:Endemic Diseases / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control; D016273:Occupational Exposure / Q000517:prevention & control / Q000706:statistics & numerical data; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D057236:Travel Medicine / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D000078329:Workforce
chemical_list: D000962:Antimalarials