Travellers' diarrhoea and the effect of pre-travel health advice in general practice.

BACKGROUND Rates of travel-related diarrhoea vary from 8% to 50% depending on the country visited. Travellers' diarrhoea has social, health and economic costs. The impact of these may be reduced by relevant pre-travel advice. Little is known of the effect of pre-travel advice on the incidence of diarrhoea among travellers abroad. AIM To determine the 'true' attack rate of travellers' diarrhoea and to assess the effectiveness of pre-travel health advice in reducing the incidence of diarrhoea and the need for subsequent GP consultation. METHOD A retrospective study was carried out in a general practice in Stirling, Scotland, using a standardized, structured questionnaire to obtain demographic details and patients' home and foreign health experience in the previous 12 months. The questionnaire was administered to a 20% sample (n = 1771) of practice patients aged 16 years or over, stratified by age and sex. Main outcome measures were reported diarrhoeal illness while abroad, its management and outcome, and a record of diarrhoea in the two weeks prior to responding to the questionnaire. RESULTS The response rate was 97% (n = 1649). Of those responding, 44% had travelled abroad in the past 12 months; 39% of travellers reported having diarrhoea while abroad, while 6% of the same group reported diarrhoea in the two weeks prior to being questioned; 9.7% of non-travellers reported diarrhoea in the two weeks prior to being questioned. Travellers were 6.5 times more likely to experience diarrhoea while abroad than when spending a comparable 2-week period at home. Travellers who had sought pre-travel advice were more likely to be travelling to a high-risk destination (P < 0.0001) and were more likely to suffer diarrhoea while abroad (P < 0.05); however, they were less likely to need medical help while abroad or on their return (P < 0.0001). The results indicate a markedly higher attack rate of diarrhoea in patients travelling abroad than would be expected if they stayed at home. CONCLUSION Pre-travel advice does reduce the need for medical assistance while abroad; it also reduces GP work-load in terms of post-travel health consultations with returning travellers.