Casburn-Jones, A.C.; Sabin, C.; Maybin, S.; Zuckerman, J.N.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA100
Academic Journal
Introduction: Gastrointestinal illness affecting the short term traveller to the developing world has been well studied, yet little attention has been paid to the long term traveller or temporary expatriate. Voluntary Service Overseas (VSO) volunteers were studied as a representative cohort. Objectives: To determine the incidence of gastrointestinal illness in a group of VSO volunteers and identification of associated risk factors. Method: A retrospective analysis was carried out on pre-travel medicals and post-travel health questionnaires of 2230 VSO volunteers, employed on 6 month to 2 year postings abroad, between 1992-1998. Recording of data: Epi Info 6 database. Statistical analysis: SAS. Results: 56% of volunteers were female. Median age was 28 years range 19-73). Pre-travel, 4.8% reported a current and 19.8% o past abdomina problem. During travel, 77.6% of volunteers reported diarrhoea, with 32% reporting more than 6 attacks during their posting. Multivariate logistic regression showed that allergy and or hay fever, no previous travel outside Europe, working in the Indian Subcontinent or Asia, younger age, and other infections abroad were independently predictive of an individual developing diarrhoea (p < 0.001). On return, a persistent health problem of any cause (9.8%) was positively associated with the incidence and frequency of diarrhoeal attacks abroad. 35.3% of all persistent health problems were related to the gastrointestinal tract, including a change in bowel habit, abdominal cramps, or pain. Conclusion: Gastrointestinal morbidity is high, during and after travel. This has implications for treatment but also health costs. Recommendations to reduce exposure to food and waterborne disease are known but other identified risk factors for diarrhoea are difficult to modify-younger age, allergy, country of stay. Pre-travel advice emphasises risk reduction and treatment strategies, applicable to the country of stay. Empiric treatment is controversial...


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