” Investigating pre-travel advice,11 some participants misunderstood the difference between malaria prevention and treatment, and so the term “received vaccinations” was used as a proxy for seeking pre-travel advice, a method not used by other authors. A definition of what constitutes accurate knowledge of malaria transmission is required to overcome the striking difference between numbers of respondents who were considered to know how malaria was transmitted in the two studies cited. Knowledge

of malaria transmission and the presence of malaria in the country visited did not appear to relate to the uptake of chemoprophylaxis find more among VFRs. Importantly, perceptions of a reduced personal risk (due to factors such as sustained immunity

and lack of susceptibility) were apparent among some VFRs. Understanding that a risk existed did not correlate to their perceived personal risk. Knowledge and experience acquired while living in Africa may have influenced these beliefs. A better understanding of the false paradox could provide useful background for those providing pre-travel malaria advice. The finding that many believed they had received a vaccination Hydroxychloroquine reflects confusion among some VFRs. Some might mistake yellow fever vaccination for a malaria vaccination. Alternatively, vaccination may be considered as a term that includes oral chemoprophylaxis, thus creating misunderstanding between respondents and researchers. Perhaps surprisingly, in two of the three studies reviewed in this analysis, the reported use of chemoprophylaxis was fairly high—almost 70% in the Dutch study (69%) and over 60% among those reporting the lowest use in the French study. However, it was only in the French study that data were available

on the reported appropriate use of chemoprophylaxis (drug, use, and duration) and this showed that the proportion of VFRs using chemoprophylaxis appropriately was considerably lower (ranging from 12% among those who had used a travel agent to 41% among those who had used a travel C1GALT1 clinic). The range of beliefs influencing compliance to chemoprophylaxis including individual concerns such as the bitter taste are cited in two other studies of pediatric imported malaria.15,16 Respondents focus on concerns about health care services, including a distrust of doctors, and structural barriers to health, when traveling at short notice. Migrants in many European countries often live in areas of high socioeconomic deprivation,17,18 and money spent on travel may take priority over the expense of chemoprophylaxis. Some migrants may be unwilling to engage with the formal health care services.