To reduce the rate of imported malaria, specific educational tools should be developed RO4929097 supplier for those at high risk to make them understand and become compliant with chemoprophylaxis. Malaria risk among travelers tends to decrease, but it remains a life-threatening risk at many destinations.1 Also in China,

the incidence rate of malaria decreased from 126.41/100,000 to 1.94/100,000 between 1950 and 2000, but morbidity has increased since the early 2000s mainly in two provinces, Yunnan and Hainan.2 Recently, malaria infections have been imported by Chinese international travelers from areas such as sub-Saharan Africa to provinces where malaria had been uncommon for many years.3–5 To evaluate the reasons for the increasing number of imported malaria see more cases among returning Chinese travelers, we conducted an airport-based questionnaire survey in different geographic areas of the People’s Republic of China.

Similarly to other knowledge, attitudes, and practices (KAP) studies relating to malaria and travel health,6–8 our study was conducted from December 2009 to April 2010 in the departure lounges of five airports: the Guangzhou Baiyun International Airport, Guangdong province; the Capital International Airport, Beijing; the Pudong International Airport, Shanghai; the Qingdao International Airport, Shandong province; and the Nanjing International Airport, Jiangsu province. Health quarantine staff at these airports distributed questionnaires to Chinese international travelers over 16 years of age with destinations in malaria endemic and nonmalarious countries. These questionnaires were derived from the ones used in previous studies,9,10 and were translated into Chinese, tested for ease of comprehension with a limited number of travelers. Further adjustments were made to the questionnaire to accommodate for the different educational Suplatast tosilate backgrounds of our travelers. As travelers may visit destinations anywhere in the countries visited, only countries were evaluated in

this survey; the exact location within the country was not investigated in the questionnaire. We divided the total population into two groups, those with destinations in malaria risk countries and those in malaria-free countries (control group). Malaria risk destinations were defined according to the latest Centers for Disease Control and Prevention (CDC) “Yellow Book” also taking into account malaria-free areas within the destination countries.11 The high-risk endemic areas refer to all the countries that are listed “all areas with malaria” in the section “malaria risk information and prophylaxis, by country”; however, we labeled countries as low-risk endemic areas in which only parts are endemic for malaria. Nonmalarious areas refer to the countries that are marked with “none” in that list.11 The questionnaires were collected from the travelers before they boarded the plane. Data were entered into the Epidata 3.1 (Jens M. Lauritsen, Odense, Denmark) and analyzed with the SPSS 12.