- The study evaluated knowledge of malaria among 605 Albanian travelers departing from Tirana International Airport between July and September 2015. - While most travelers knew malaria is transmitted by mosquitoes, over 55% did not seek information on infectious diseases while traveling. - The majority of travelers had heard of malaria before, mainly from school, but under 30% reported taking anti-mosquito precautions during travel. - In conclusion, Albanian travelers had sufficient knowledge to prevent malaria transmission but lacked practical application of prevention measures.

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KNOWLEDGE OF MALARIA AMONG ALBANIAN TRAVELLERS
Adela Haxhiraj
Faculty of Public Health
University “Ismail Qemali”, Vlora, Albania
adelahaxhiraj@gmail.com
Brunilda Subashi
Faculty of Public Health
University “Ismail Qemali”, Vlora, Albania
brunasubashi@gmail.com
Marjola Haxhiraj
Regional Environmental Agency, Vlora, Albania
marjolahaxhiraj@gmail.com
Jora Koçiaj
Health Care Centre No.4,
Paediatric Health Care, Vlora, Albania
jorakociaj@gmail.com
Pellump Pipero
Faculty of Medicine
University of Medicine, Tirana, Albania
piperop@gmail.com
Saad Masood Butt
Computer Science Department
Atlantic International University, USA
saadmasoodbutt444@gmail.com

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Abstract
Background – This study aims to evaluate the level of information that Albanian travellers have on
malaria, known as one of the most impactful diseases in a worldwide scale.
Materials and Methods – For this purpose, it was conducted a cross-sectional survey with Albanian
passengers departing from Tirana International Airport from July till September 2015. The travellers were
given a questionnaire with fourteen closed questions about their information on infectious diseases and
their status of vaccination. The questionnaire included malaria related questions. It was focused mainly on
basic knowledge of malaria likewise how it was transmitted and how it could be prevented.
Results - Six hundred and five persons responded to the questionnaire. The majority of the participants in
the survey were women in the age group of 20-40 years old. 56% of the participants of the survey replied
negatively to the question if they get informed about infectious diseases and other health related topics
while preparing to travel, whether the purpose of the travel is leisure or job related. Regarding their
knowledge specifically on malaria, more than half of the participants responded that they have information
about it, mainly from the educational system. Almost 90% of the persons knew malaria as a mosquito-
borne disease but less than 28% of them took measures to prevent mosquito bites during their travel.
Conclusions - In conclusion, the survey showed that the majority of Albanian travellers have general
information about malaria and know the right ways of prevention but few use protection against
mosquitoes during their journeys.
Key words: knowledge, malaria, traveller, Albania.

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Background
Travel health is a major factor in the overall health of an individual, especially in these last decades
(Gautret et al., 2012). International travelling has increased rapidly and travellers are exposed to a whole
new variety of health risks in unfamiliar or unexplored environments (Zuckerman et al., 2015). One of the
most globally present diseases is malaria. Its health, economic and social impact is well known and still
present, despite worldwide programs to reduce it (Sachs et al., 2002). According to the World Malaria
Report 2017 from World Health Organization (WHO), only in 2016 there have been 216 million new
cases with malaria in the world. 90% of the cases were reported from the African Region and a
considerable percentage of 2% coming from Mediterranean Region (WHO, 2017). The still rising number
of malaria cases in the Mediterranean is consistent with the natural habitat of Anopheles, the type of
mosquito responsible for transmitting the disease. Albania, as part of the Mediterranean Region has a
close history with malaria. During the first half of the 19th
century, malaria was a prominent disease with
over 50% of the population infected. After the World War II, the disease quickly disappeared as a result of
national strategies and prevention programs. The latest cases were reported in 1958 for Plasmodium
falciparum, in 1962 for Plasmodium Vivax and in 1967 for Plasmodium Malaria. Since the 60s the only
reported cases in Albania were those imported from abroad (Aliu, 2014). The last one was confirmed in
2016 with the case of a worker coming home from Greece, place in which he encountered the disease
(Sot, 2016).
National strategies for vector controlling are present and ongoing in Albania as part of the World Health
Organization program for increasing awareness and helping minimizing the impact this disease has. As the
number of travellers from abroad increases, the need arises to collect new information regarding this issue.

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There are many studies concerning travel health from around the world in which this study aims to be a
part of.
Materials and Methods
For this topic, it was conducted a cross-sectional study during the period of July through September 2015 in
Tirana International Airport (TIA). The study was based on a self- administered questionnaire. The
questionnaire included socio-demographic variables (age, occupation, destination of travel), questions
about infectious diseases in general and malaria in specific. The questions included information about risk
factors and prevention of this disease. The questionnaires were distributed at the departure gates of the
airport. The study involved only Albanian passengers departing from TIA during that period.
The study encountered some difficulties along the way which consisted on some conflicting or incomplete
answers by passengers and resistance of some of the travellers to the questionnaire which resulted in
incomplete forms and missing data.
In total, 605 questionnaires were completed. The number of questionnaires prepared and delivered was
determined by the data given by INSTAT (Albanian Statistic Institute) for 2015 related to the Albanian
population (INSTAT, 2015). According to these data, the population of Albania is 2,893,005. To obtain a
95% confidence level and a margin of error of 3.3%, it requires surveying a number of 600 to 800 people.
Cross tabulation (MxN) tables and, X2 test / Fisher test were used for the analysing of the data. The data
were analysed and reconstructed with Microsoft Excel 2007 and Epi Info 7. The participants were fully
informed of the purpose and use of this study.
Results

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There were 605 forms filled by Albanian passengers surveyed in Tirana International Airport during the
period of three months (from July to September 2015). The majority of the respondents were female. The
mean age of respondents was 37 years old. The data is presented in table 1 and 2. Destinations varied from
European, African, Asian and American countries. A slight majority of respondents received information
about infectious disease before or during travelling as seen in table 3. Regarding knowledge about
Malaria, almost 90% of respondents were positive in their response. Information came mostly from school
as presented in table 4 and 5. When asked about the way this disease is transmitted, more than 95% of
passengers responded correctly. The results are presented in table 6. 71.72% of travellers denied taking
precautions against mosquito biting during their journeys, whether it was for business, pleasure or any
other kind of purpose, regardless of the destination.
Table 1. Distribution of participants by gender
Gender Frequency Percentage (%) Wilson 95% LCL Wilson 95% UCL
Female 327 53.96 49.98 57.89
Male 276 45.54 41.62 49.53
NA 3 0.50 0.17 1.45
Total 605 100 % 100 100
Table 2. Distribution of age
Age
Observation Mean Variable Standard
Deviation
Minimum 25
%
Median 75
%
Maximum Mode
605 37.01 253.31 15.92 7 25 34 48 87 27

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Table 4. Distribution of participants for the question “Have you ever heard of
malaria”
Frequency Percentage
(%)
Wilson 95%
LCL
Wilson 95%
UCL
No 62 10.28 8.10 12.96
Yes 541 89.76 87.04 91.90
Table 5 – Distribution of sources of information
Frequency Percentage (%)
School 399 65.95
My doctor 104 17.19
The internet 189 31.24
Table 3. Distribution of participants for the question “Do you have information on
infectious diseases while travelling”
Frequency Percentage (%) Wilson 95%
LCL
Wilson 95%
UCL
No 335 55.37 51.75 % 59.66 %
Yes 266 43.96 40.34 % 48.25 %
NA 4 0.66 0.17 % 1.45 %
Total 605 100 100 % 100 %

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Table 6. Distribution of participants for the question “Is malaria transmitted by
mosquito biting”
Frequency Percentage
(%)
Wilson 95%
LCL
Wilson 95%
UCL
No 12 2.16 1.24 3.74
Yes 543 97.84 96.26 98.76
Table 7. Distribution of participants for the question “Do you keep with you anti
mosquito protection while travelling”
Frequency Percentage
(%)
Wilson 95%
LCL
Wilson 95%
UCL
No 421 71.72 67.95 75.21
Yes 166 28.28 24.79 32.05
School
65,95%My doctor
17,19%
The internet
31,24%
Sources of information

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Discussion
The survey conducted in Tirana International Airport for a period of three months (from July till
September 2015) were attended by 605 people with the mean age being 37 years old and 53.96% of
participants being females (see Table 1) (see Table 2). The study was based on data obtained from
anonymous questionnaires compiled by Pëllumb Pipero, Ph.D professor at the University of Medicine in
Tirana and infectious disease specialist in University Hospital Centre “Mother Teresa”, Tirana. Only
Albanian travellers travelling abroad were chosen for this study.
Based on the answers obtained, the following conclusions were reached:
Most of the passengers (55.37 %) did not have information on infectious diseases while travelling (see
Table 3), in contrast with the results of a pilot survey conducted in nine European states airports in 2002-
2003 (Van Herck, et al., 2003), (Van Herck, et al., 2004). According to our survey, travellers, generally
knew about malaria and only approximately 10 % of them had not heard of the disease (see Table 4). Over
97% of the participants associated malaria with mosquito bite compared to a Mexican study where the
No
72%
Yes
28%
Do you keep with you anti mosquito protection
while travelling

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result for the same question was only 48% (Rodriguez et al., 2003). In 2004 a Turkish study was
published which revealed that knowledge about malaria in Turkey was insufficient as more than 30 % of
the participants in this study didn’t know how malaria was transmitted (Simsek & Kurcer, 2005).
Compared to both studies, Albanian travellers were well acquainted with the disease.
In regard to acquiring information, most of the participants referred to school as their main source. A less
influential source was the media. The National Health System was impactful in organized groups of
travellers such as Islamic religious who travelled to Mecca each year for their traditional pilgrimage or job
seekers in endemic areas. In Albania, each year, there are over 400 persons who travel to malaria endemic
areas for religious tourism or work (BotaSot, 2016). Such groups are obliged to get information and to be
provided with prophylaxis for malaria or other diseases present in the areas in which they will travel. The
centre of the organization of this work is the Tropical Disease Cabinet at the University Hospital Centre
“Mother Teresa” in Tirana.
Regarding travellers travelling in small groups or without sufficient information, such as over 50% of
TIA's Albanian travellers, the commitment to protective equipment is more limited. 71.72% of the
respondents stated that they did not take with them any kind of solution against mosquitos. In a study by
Schoepke, Steffen and Gratz only 2% of Europeans travelling to East Africa, an endemic region for
malaria (Omumbo et al., 2005), took all necessary measures to be protected against mosquitoes
(Schoepke, Steffen & Gratz, 1998). A significant percentage is seen in Albanian travellers, stating that
although information about malaria is present, practical awareness is insufficient.
Conclusions
As a conclusion, according to the study, the information that Albanian travellers possess of malaria is
sufficient to prevent both transmission and propagation of the disease but there is still a lack of practical

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application of the knowledge by travellers, especially those who visit endemic areas. In Albania, a lot of
work is done in this department and a lot is yet to be done in order to keep this disease under control.
By continuously keeping the health personnel up to date with the latest reports about malaria and by
raising awareness in the population, there is the chance for the goals of WHO for this disease to be
achieved faster.
Acknowledgements
The permission of Tirana International Airport “Mother Teresa” for letting us in and giving us the
possibility of conducting the survey is gratefully acknowledged especially of the Border Unit of Health
Inspectorate Services. Only the authors are responsible for the interpretation of the data.
References
Aliu, I. (2014, January 14). Malaria.Retrieved from http://www.mjeku24.com/malaria/
BotaSot.info. (2016, September 10). Sot, dita e parë e Haxhit. Në Mekë, në mesin e 2 milionë
myslimanëve edhe 7 mije shqiptarë. Retrieved from http://www.botasot.info/religjion-kultura/575855/sot-
dita-e-pare-e-haxhit-ne-meke-ne-mesin-e-2-milione-myslimaneve-edhe-7-mije-shqiptare/
Gautret, P., Cramer, J. P., Field, V., Caumes, E., Jensenius, M., Gkrania-Klotsas, E.,&Schlagenhauf, P.
(2012).Infectious diseases among travellers and migrants in Europe, EuroTravNet 2010. Euro
Surveillance, 17(26), 20205.
Herck, K., Castelli, F., Zuckerman, J., Nothdurft, H., Damme, P., Dahlgren, A. L.& Walker, E. (2004).
Knowledge, attitudes and practices in travel‐related infectious diseases: the European airport
survey. Journal of travel medicine, 11(1), 3-8.
Herck, K., Zuckerman, J., Castelli, F., Damme, P., Walker, E., & Steffen, R. (2003).Travelers' knowledge,
attitudes, and practices on prevention of infectious diseases: results from a pilot study. Journal of Travel
Medicine, 10(2), 75-78.
INSTAT. (2015, February 10). Albanian Population, 2015, January First. Retrieved
fromhttp://www.instat.gov.al/al/publications/njoftim-p%C3%ABr-media/njoftim-p%C3%ABr-media-
popullsia-e-shqip%C3%ABris%C3%AB-1-janar-2015.aspx

11. Durreesamin Journal (ISSN: 2204-9827)
11
Omumbo, J. A., Hay, S. I., Snow, R. W., Tatem, A. J., & Rogers, D. J. (2005).Modelling malaria risk in
East Africa at high‐spatial resolution. Tropical Medicine & International Health, 10(6), 557-566.
Rodríguez, A. D., Penilla, R. P., Henry-Rodríguez, M., Hemingway, J., Betanzos, A. F., & Hernández-
Avila, J. E. (2003). Knowledge and beliefs about malaria transmission and practices for vector control in
Southern Mexico. saludpública de méxico, 45(2), 110-116.
Butt, S. M., & Navarro, K. F. (2016). Review Paper on Nutritional Information Using Mobile Augmented
Reality Technology. Lecture Notes in Electrical Engineering Information Science and Applications
(ICISA) 2016, 1439-1445. doi:10.1007/978-981-10-0557-2_137
Sachs, J., &Malaney, P. (2002).The economic and social burden of malaria. Nature, 415(6872), 680-685.
Schoepke, A., Steffen, R., & Gratz, N. (1998). Effectiveness of personal protection measures against
mosquito bites for malaria prophylaxis in travelers. Journal of travel medicine, 5(4), 188-192.
Simsek, Z., &Kurcer, M. A. (2005). Malaria: knowledge and behaviour in an endemic rural area of
Turkey. Public health, 119(3), 202-208.
Sot. (2016, August 24). Rikthehet Malaria ne Shqiperi. Retrieved from
https://sot.com.al/sh%C3%ABndeti/rikthehet-malaria-n%C3%AB-shqip%C3%ABri.
World Health Organization.(2017). World Malaria Report 2017.World Health Organization 2017, 33-34.
Zuckerman, J. N., Brunette, G., & Leggat, P. (2015). Essential Travel Medicine.John Wiley & Sons.