227 - Travel Health Screening in Pediatric Primary Care: Malaria Prevention Among West African Families in the South Bronx

Publication Number: 1216.227

Molly Dobelle, Albert Einstein College of Medicine, Bronx, NY, United States; Jenna Scholnick, The Children's Hospital at Montefiore, Bronx, NY, United States; Eleanor Bathory, Montefiore Medical Center, Bronx, NY, United States

Background: In New York City, over 200 cases of malaria are reported annually, nearly half in Bronx residents, and 18% in children. Travelers visiting friends and relatives (VFRs) in West Africa account for the majority of imported malaria cases in the US, partly due to limited access to pre-travel medical care. US-born children of West African immigrants are particularly vulnerable to infection given their lack of prior malaria exposure.

Objective: To evaluate the need for routine travel screening among West African families in a Bronx pediatric primary care practice by 1) describing VFR travel behaviors, 2) assessing malaria prevention knowledge and practices, 3) identifying caregiver factors associated with children's prophylaxis use and attendance at pre-travel visits, and 4) identifying barriers to obtaining pre-travel care.

Design/Methods: Between May 2023 - Oct 2025, caregivers of pediatric patients of West African heritage were recruited from a Federally Qualified Health Center in the South Bronx for an IRB-approved study. Standardized questionnaires assessed household travel history and plans, malaria knowledge, prophylaxis use, and barriers to pre-travel care for the caregiver and all co-resident children aged ≤20 years.

Results: Of 60 enrolled households, 47 (78%) reported prior travel, and 37 (62%) plan to travel in the next 2 years. Among 139 enrolled children, 123 (88%) were US-born. Of the 72 US-born children with travel history, 36% had never attended a pre-travel health visit, 35% had never used malaria prophylaxis, and 17% had contracted malaria while traveling [Table 1]. Caregivers answered a mean of 3/4 malaria knowledge questions correctly [Table 2]. A univariate clustered logistic regression showed caregivers' own preventive behaviors were significantly associated with their children's pre-travel care and prophylaxis use, while fewer years since caregiver immigration was independently associated with lower pediatric prophylaxis use. Caregiver malaria knowledge scores and prior personal malaria infection were not significant predictors [Table 3]. Barriers to prophylaxis were reported by nearly half (29/60) of caregivers, and included limited awareness (n=18), difficulty obtaining the medication (n=13), and administration challenges (n=6).

Conclusion(s): Many West African families in the Bronx travel frequently. Caregivers have basic malaria knowledge, but report inadequate access to effective prevention. Caregiver engagement is a key driver of children's pre-travel care, thus integrating routine travel screening into primary care could improve prevention and reduce pediatric travel-related malaria.

Table 1: Characteristics of children with a history of travel to West Africa
‡ Non-US born children were all West Africa-born: Burkina Faso (1), Gambia (1), Ghana (4), Guinea (3), Ivory Coast (1), Mali (3), Senegal (3)

Table 2: Caregiver knowledge of malaria transmission and prevention (N=55)
‡ correct answer in bold text

Table 3: Univariate clustered logistic regression analysis of caregiver factors associated with pre-travel care and prophylaxis use among children with prior travel to West Africa
‡ significant at an α <.05