Incidence and impact of travelers' diarrhea among foreign backpackers in southeast Asia: A result from Khao San Road, Bangkok

Background. Travelers' diarrhea is the most common disease reported among travelers visiting developing countries, including Southeast Asia, a region visited by large numbers of backpackers each year. Currently, the knowledge of travelers' diarrhea among this group is limited. This study aimed to determine the incidence and impact of travelers' diarrhea in this group. Method. Foreign backpackers in Khao San road, Bangkok, Thailand, were invited to fill out a study questionnaire, in which they were queried about their demographic background, travel characteristics, pretravel preparations and actual practices related to the risk of travelers' diarrhea. For backpackers who had experienced diarrhea, the details and impact of each diarrheal episode were also assessed. Results. In the period April to May 2009, 404 completed questionnaires were collected and analyzed. Sixty percent of participants were male; overall, the median age was 26 years. Nearly all backpackers (96.8%) came from developed countries. Their main reason for travel was tourism (88%). The median stay was 30 days. More than half of the backpackers (56%) carried some antidiarrheal medication. Antimotility drugs were the most common medications carried by backpackers, followed by oral rehydration salts (ORS), and antibiotics. Their practices were far from ideal; 93.9% had bought food from street vendors, 92.5% had drunk beverages with ice-cubes, and 33.8% had eaten leftover food from a previous meal. In this study, 30.7% (124/404) of backpackers had experienced diarrhea during their trip. Most diarrhea cases (88%) were mild and recovered spontaneously. However, 8.8% of cases required a visit to a doctor, and 3.2% needed hospitalization. Longer duration of stay and drinking beverages with ice-cubes were associated with higher risk of diarrhea. Conclusions. About one third of the foreign backpackers in Southeast Asia had experienced diarrhea during their trip. Their current practices related to the risk of travelers' diarrhea were inadequate and should be improved.