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Following re-emergence of malaria in Evrotas, Laconia, in 2009–12, a malaria-control programme was implemented in 2011–12 targeting migrants from malaria-endemic countries, including house-to-house active case detection, health education and distribution of mosquito protection items. In June 2013, we surveyed migrants in Evrotas to assess their malaria knowledge, attitudes and practices to guide prevention activities. We selected participants using simple random sampling and interviewed them, using structured questionnaires. We defined mosquito protection practices (MPPs) as the use of full-length clothes/topical repellent, mosquito screens, fans or air-conditioning, and insecticides. We calculated prevalence ratios (PRs) using Poisson regression and we allowed for clustering of participants in a residence. Of 654 migrants, we invited 132 and 130 participated (all men; 120 (92%) from Pakistan). Of the 130, 56 (43%) identified fever as a malaria symptom; those who were aware of this had higher level of education (PR: 3.2; 95% confidence interval (CI): 1.2–9.0). A total of 111 (85%) used insecticide-treated bednets and 95 (73%) used more than two MPPs. Poor housing conditions (warehouses/shacks: PR: 0.8; 95% CI: 0.6–0.9), were associated with use of up to two MPPs. Despite extensive interventions in Evrotas, the level of malaria awareness among migrants remained suboptimal and poor housing conditions hindered effective mosquito protection. We recommend culturally adapted health education and improvement of housing conditions to minimise the risk of new cases and re-establishment of malaria in Greece.


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  1. World Health Organization (WHO). World malaria report: 2013. Geneva: WHO; 2013. Available from: http://www.who.int/malaria/publications/world_malaria_report_2013/report/en/
  2. European Centre for Disease Prevention and Control (ECDC). Assessing the burden of key infectious diseases affecting migrant populations in the EU/EEA. Stockholm: ECDC; 2014. Available from: http://www.ecdc.europa.eu/en/publications/Publications/assessing-burden-disease-migrant-populations.pdf
  3. World Health Organization (WHO) Regional Office for Europe (WHO-Europe). Malaria. Centralized information system for infectious diseases (CISID) database. Copenhagen: WHO-Europe. [Accessed 17 Jul 2014]. Available from: http://data.euro.who.int/cisid/?TabID=369773
  4. Sainz-Elipe S, Latorre JM, Escosa R, Masià M, Fuentes MV, Mas-Coma S, et al. Malaria resurgence risk in southern Europe: climate assessment in an historically endemic area of rice fields at the Mediterranean shore of Spain. Malar J. 2010;9(1):221.  https://doi.org/10.1186/1475-2875-9-221  PMID: 20673367 
  5. Sudre B, Rossi M, Van Bortel W, Danis K, Baka A, Vakalis N, et al. Mapping environmental suitability for malaria transmission, Greece. Emerg Infect Dis. 2013;19(5):784-6.  https://doi.org/10.3201/eid1905.120811  PMID: 23697370 
  6. Marangi M, Di Tullio R, Mens PF, Martinelli D, Fazio V, Angarano G, et al. Prevalence of Plasmodium spp. in malaria asymptomatic African migrants assessed by nucleic acid sequence based amplification. Malar J. 2009;8(1):12.  https://doi.org/10.1186/1475-2875-8-12  PMID: 19138412 
  7. Bruce-Chwatt L, Draper C, Avramidis D, Kazandzoglou O. Sero-epidemiological surveillance of disappearing malaria in Greece. J Trop Med Hyg. 1975;78(9):194e200. PMID: 772232
  8. Spanakos G, Alifrangis M, Schousboe ML, Patsoula E, Tegos N, Hansson HH, et al. Genotyping Plasmodium vivax isolates from the 2011 outbreak in Greece. Malar J. 2013;12(1):463.  https://doi.org/10.1186/1475-2875-12-463  PMID: 24373457 
  9. Danis K, Lenglet A, Tseroni M, Baka A, Tsiodras S, Bonovas S. Malaria in Greece: historical and current reflections on a re-emerging vector borne disease. Travel Med Infect Dis. 2013;11(1):8-14.  https://doi.org/10.1016/j.tmaid.2013.01.001  PMID: 23434287 
  10. Hellenic Centre for Disease Control and Prevention (HCDCP), Laboratory of Hygiene and Epidemiology. [Deliverable P1.32 Report of the results of malaria active case detection in immigrants] Larisa: HCDCP & Laboratory of Hygiene and Epidemiology, School of Health Sciences, Faculty of Medicine; 2013. Greek. Available from: http://www.malwest.gr/Portals/0/%CE%A0%CE%B1%CF%81%CE%B1%CE%B4%CE%BF%CF%84%CE%AD%CE%BF_%CE%A01.32.pdf
  11. Hellenic Centre for Disease Control and Prevention (HCDCP). Epidemiological surveillance report. Malaria in Greece, 2012. Athens: HCDCP; 2013. Available from: http://www.keelpno.gr/Portals/0/Files/English%20files/Malaria%20reports/Malaria%20Report_2012_FINAL_23-82013_EN.pdf
  12. Hellenic Centre for Disease Control and Prevention (HCDCP). Epidemiological surveillance report. Malaria in Greece, 2013. Athens: HCDCP, Department of Epidemiological Surveillance and Intervention; 2014. Available from: http://www.keelpno.gr/Portals/0/Files/English%20files/Malaria%20reports/2013/Malaria%20annual%20report_2013_June%202014.pdf
  13. Hellenic Statistical Authority. (EL.STAT.). 2011 Population and Housing Census. De jure (registered) population. Athens. EL.STAT.; 2014. Available from: http://www.statistics.gr/portal/page/portal/ESYE/BUCKET/General/dejure_population_census2011rev_en.xls
  14. Hadjinicolaou J, Betzios B. Resurgence of Anopheles sacharovi following malaria eradication. Bull World Health Organ. 1973;48(6):699-703. Available from:  PMID: 4544780 
  15. Department of Parasitology, Entomology and Tropical Diseases, National School of Public Health (NSPH), Laboratory of Microbiology, Faculty of Medicine, National and Kapodistrian University of Athens, Section of Biotechnology and Applied Biology, Biology department, University of Crete. [Deliverable P1.22 Report of the results of the detection of West Nile virus and malaria plasmodiums and genetic identification of mosquitoes]. Larisa: Department of Parasitology, Entomology and Tropical Diseases, NSPH, Laboratory of Microbiology, Faculty of Medicine, National and Kapodistrian University of Athens, Section of Biotechnology and Applied Biology, Biology department, University of Crete; 2013. Greek. Available from: http://www.malwest.gr/Portals/0/%CE%A0%CE%B1%CF%81%CE%B1%CE%B4%CE%BF%CF%84%CE%AD%CE%BF%20%CE%A01.22.pdf
  16. Al-Adhroey AH, Nor ZM, Al-Mekhlafi HM, Mahmud R. Opportunities and obstacles to the elimination of malaria from Peninsular Malaysia: knowledge, attitudes and practices on malaria among aboriginal and rural communities. Malar J. 2010;9(1):137.  https://doi.org/10.1186/1475-2875-9-137  PMID: 20497543 
  17. Opiyo P, Mukabana WR, Kiche I, Mathenge E, Killeen GF, Fillinger U. An exploratory study of community factors relevant for participatory malaria control on Rusinga Island, western Kenya. Malar J. 2007;6(1):48.  https://doi.org/10.1186/1475-2875-6-48  PMID: 17456231 
  18. Paulander J, Olsson H, Lemma H, Getachew A, San Sebastian M. Knowledge, attitudes and practice about malaria in rural Tigray, Ethiopia. Glob Health Action. 2009;2(0).  https://doi.org/10.3402/gha.v2i0.1839  PMID: 20027277 
  19. Launiala A. How much can a KAP survey tell us about people's knowledge, attitudes and practices? Some observations from medical anthropology research on malaria in pregnancy in Malawi. Anthropology Matters Journal. 2009;11(1). Available from: http://www.anthropologymatters.com/index.php/anth_matters/article/view/31/53
  20. Kengeya-Kayondo JF, Seeley JA, Kajura-Bajenja E, Kabunga E, Mubiru E, Sembajja F, et al. Recognition, treatment seeking behaviour and perception of cause of malaria among rural women in Uganda. Acta Trop. 1994;58(3-4):267-73.  https://doi.org/10.1016/0001-706X(94)90020-5  PMID: 7709865 
  21. Wangroongsarb P, Satimai W, Khamsiriwatchara A, Thwing J, Eliades JM, Kaewkungwal J, et al. Respondent-driven sampling on the Thailand-Cambodia border. II. Knowledge, perception, practice and treatment-seeking behaviour of migrants in malaria endemic zones. Malar J. 2011;10(1):117.  https://doi.org/10.1186/1475-2875-10-117  PMID: 21554711 
  22. Ahmed SM, Haque R, Haque U, Hossain A. Knowledge on the transmission, prevention and treatment of malaria among two endemic populations of Bangladesh and their health-seeking behaviour. Malar J. 2009;8(1):173.  https://doi.org/10.1186/1475-2875-8-173  PMID: 19640282 
  23. Abate A, Degarege A, Erko B. Community knowledge, attitude and practice about malaria in a low endemic setting of Shewa Robit Town, northeastern Ethiopia. BMC Public Health. 2013;13(1):312.  https://doi.org/10.1186/1471-2458-13-312  PMID: 23566168 
  24. Bashar K, Al-Amin HM, Reza MS, Islam M, Asaduzzaman, Ahmed TU. Socio-demographic factors influencing knowledge, attitude and practice (KAP) regarding malaria in Bangladesh. BMC Public Health. 2012;12(1):1084.  https://doi.org/10.1186/1471-2458-12-1084  PMID: 23253186 
  25. Standard operating procedures (SoPs) for prevention and control of dengue. Lahore: Department of Health, Government of the Punjab; 2014. Available from: http://health.punjab.gov.pk/?q=system/files/SoPs+for+Prevention+and+Control+of+Dengue.pdf
  26. Simou E, Koutsogeorgou E. Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: a systematic review. Health Policy. 2014;115(2-3):111-9.  https://doi.org/10.1016/j.healthpol.2014.02.002  PMID: 24589039 
  27. Rechel B, Mladovsky P, Devillé W, Rijks B, Petrova-Benedict R, McKee M, editors. Migration and health in the European Union. European Observatory on Health Systems and Policies Series. Maidenhead: McGraw-Hill, Open University Press; 2011. http://www.euro.who.int/__data/assets/pdf_file/0019/161560/e96458.pdf
  28. Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev. 2004; (2):CD000363.  https://doi.org/10.1002/14651858.CD000363.pub2  PMID: 15106149 
  29. Ng’ang’a PN, Shililu J, Jayasinghe G, Kimani V, Kabutha C, Kabuage L, et al. Malaria vector control practices in an irrigated rice agro-ecosystem in central Kenya and implications for malaria control. Malar J. 2008;7(1):146.  https://doi.org/10.1186/1475-2875-7-146  PMID: 18667091 
  30. Biswas AK, Hutin YJ, Ramakrishnan R, Patra B, Gupte MD. Increased financial accessibility and targeted education messages could increase ownership and use of mosquito nets in Purulia District, West Bengal, India. Trans R Soc Trop Med Hyg. 2010;104(6):423-8.  https://doi.org/10.1016/j.trstmh.2010.01.001  PMID: 20153006 
  31. Lindsay SW, Emerson PM, Charlwood JD. Reducing malaria by mosquito-proofing houses. Trends Parasitol. 2002;18(11):510-4.  https://doi.org/10.1016/S1471-4922(02)02382-6  PMID: 12473368 
  32. Kirby MJ, Ameh D, Bottomley C, Green C, Jawara M, Milligan PJ, et al. Effect of two different house screening interventions on exposure to malaria vectors and on anaemia in children in The Gambia: a randomised controlled trial. Lancet. 2009;374(9694):998-1009.  https://doi.org/10.1016/S0140-6736(09)60871-0  PMID: 19732949 
  33. Ogoma SB, Kannady K, Sikulu M, Chaki PP, Govella NJ, Mukabana WR, et al. Window screening, ceilings and closed eaves as sustainable ways to control malaria in Dar es Salaam, Tanzania. Malar J. 2009;8(1):221.  https://doi.org/10.1186/1475-2875-8-221  PMID: 19785779 
  34. Okech BA, Mwobobia IK, Kamau A, Muiruri S, Mutiso N, Nyambura J, et al. Use of integrated malaria management reduces malaria in Kenya. PLoS ONE. 2008;3(12):e4050. Erratum in: PLoS One. 2009;4(2): 10.1371/annotation/e14952c5-b2db-4ff7-976d-6c794d275703.  https://doi.org/10.1371/journal.pone.0004050  PMID: 19115000 
  35. Hellenic Centre for Disease Control and Prevention (HCDCP). [Epidemiological surveillance report - Malaria in Greece, 2014]. Athens: HCDCP, 2014. Greek. Available from: http://www.keelpno.gr/Portals/0/%CE%91%CF%81%CF%87%CE%B5%CE%AF%CE%B1/%CE%95%CE%BB%CE%BF%CE%BD%CE%BF%CF%83%CE%AF%CE%B1/2015/Malaria_annual_report_2014_GR_final.pdf
  36. European Agency for the Management of Operational Cooperation at the External Borders of the Member States of the European Union (FRONTEX). Annual risk analysis 2015. Warsaw: FRONTEX; 2015. http://frontex.europa.eu/assets/Publications/Risk_Analysis/Annual_Risk_Analysis_2015.pdf
  37. European Centre for Disease Prevention and Control (ECDC). Local mosquitoes. Stockholm: ECDC. [Accessed 9 Aug 2015]. http://ecdc.europa.eu/en/healthtopics/vectors/mosquitoes/Pages/mosquitoes.aspx
  38. European Centre for Disease Prevention and Control (ECDC). Anopheles sacharovi. Stockholm: ECDC. [Accessed 9 Aug 2015]. http://ecdc.europa.eu/en/healthtopics/vectors/mosquitoes/Pages/anopheles-sacharovi-factsheet.aspx.

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