Knowledge and practices of tour guides in Cuzco on the prevention and treatment of traveler's diarrhea

Abstract

Objectives: To describe the knowledge and practices among tour guides in Cuzco, Peru regarding prevention and treatment of traveler's diarrhea.

Methods: The main tour guide association in Cuzco organized a mandatory re-certification course for tour guides in February 2004. We invited tour guides attending this course to participate in the study. Those aged 18 to 50 who had worked as a tour guide for at least one year were asked to complete a brief anonymous questionnaire.

Results: A total of 173 questionnaires were returned; 137 met the inclusion criteria and were included in the analysis. The median age was 31 years (interquartile range (IQR): 28-34 years), and 56.7% were male. The median number of foreign languages spoken by subjects included was 1, being English (91.9%) the most common, followed by French (17.9%) and Italian (16.8%). The median time working as a tour guide was 4 years (IQR: 2-8 years). Tour guidance was a full-time job for 47.1% of the subjects, and for 82.4% Inca Trail was the most commonly covered route.

Traveler's diarrhea was considered a food-borne disease by 85.4%, but only 60.6% considered it a water-borne disease. The majority of subjects identified raw salads (84.4%), cold sauces (81.5%) and tap water (81.1%) as risky products whereas hot soups (77 8%) and bread (75.0%) were mainly considered as safe. Most of the tour guides considered bloody stools (84.8%) and fever (60.6%) as indications to seek medical attention. The medications most frequently recommended by tour guides were oral re-hydration solutions ( 85.1%), trimethoprim-sulphamethoxazole (26.1%) and loperamide (20.1%). Conclusions: Tour guides have a basic knowledge about traveler's diarrhea. However, more training is necessary to improve management while trekking outside of Cuzco The recommendation to seek pharmacists should be particularly addressed.