Travel-Health Behaviour and Self Reported Travel-Related Illness Among International Medical Students In A Tropical Destination: A Cross Sectional Survey From Indonesia

Authors

  • Made Ayunda Apti Chandra Apsari Medical Faculty, Universitas Udayana, Bali, Indonesia
  • Wayan Citra Wulan Sucipta Putri Publich Health Department, Medical Faculty, Universitas Udayana, Bali, Indonesia
  • A.A. Sagung Sawitri Publich Health Department, Medical Faculty, Universitas Udayana, Bali, Indonesia
  • Ni Luh Putu Ariastuti Publich Health Department, Medical Faculty, Universitas Udayana, Bali, Indonesia

Keywords:

Bali, International Medical Students, Pre-Travel Preparation, Preventive Practices, Travel-Health Behaviour, Travel-Related Illness

Abstract

Background: International travelers are at risk of travel-related illness (TRI), particularly when visiting tropical and developing regions such as Indonesia. Bali, as a major international destination, presents increased exposure to infectious diseases and environmental health risks. International medical students are especially vulnerable due to prolonged stays and high levels of social interaction. Objective: This study aimed to describe travel-health behaviour and the occurrence of travel-related illness among international medical students in tropical LMICs. Methods: This study employed a descriptive cross-sectional design conducted from January to September 2025, collected using a structured questionnaire administered through in-person and online interviews. A total 60 participants from international medical students, Udayana University using convenience sampling. The study assessed travel-health behaviour : pre-travel preparation, pre-travel advice–seeking behaviour, preventive practices during travel, and travel-health kit utilization. In addition, travel-related illness was evaluated, defined as any self-reported health problems experienced during travel. Results: Most participants showed good pre-travel health preparation (31-58,3%), including professional consultation, and possession of travel-health kits. Preventive practices during travel were generally good (68,3%) but did not consistently increase with higher preparation levels. Despite this, a high proportion of participants experienced travel-related illness (78,3%), mainly gastrointestinal (55%) and respiratory conditions (31,7%). Professional pre-travel advice and good preventive practices were associated with lower illness proportions. Conclusion: Despite high pre-travel preparation, travel-related illness remained common among international medical students, likely influenced by ongoing environmental exposure and situational behaviours during prolonged stays in tropical settings, reducing the effectiveness of pre-departure preparation.

References

[1] Kristina M. Angelo, DO, MPH&TM , Phyllis E. Kozarsky, MD , Edward T. Ryan, MD, Lin H. Chen, MD , Mark J. Sotir P. What proportion of international travellers acquire a travel-related illness? A review of the literature. J Travel Med. 2017;24(5). DOI: https://doi.org/10.1093/jtm/tax046

[2] Robert Steffen M. Epidemiology of travellers’ diarrhea. J Travel Med. 2017;24(1). DOI: https://doi.org/10.1093/jtm/taw072

[3] Riddle MS, Connor BA, Beeching NJ, Dupont HL, Hamer DH, Kozarsky P, et al. Guidelines for the prevention and treatment of travelers ’ diarrhea : a graded expert panel report. 2017;24. DOI: https://doi.org/10.1093/jtm/tax026

[4] Ani LS, Suwiyoga K. Traveler’s diarrhea risk factors on foreign tourists in Denpasar Bali-Indonesia. 2016;5(1):152–6. DOI: https://doi.org/10.15562/bmj.v5i1.284

[5] Jong W De, Rusli M, Bhoelan S, Rohde S, Fedik A, Noeryoto PA, et al. Critical Reviews in Microbiology Endemic and emerging acute virus infections in Indonesia : an overview of the past decade and implications for the future. Crit Rev Microbiol [Internet]. 2018;44(4):487–503. DOI: https://doi.org/10.1080/1040841X.2018.1438986

[6] Sudaryati IMAUSEL. One Health approach and zoonotic diseases in Indonesia: Urgency of implementation and challenges. Pubmed. 2023;2. DOI: https://doi.org/10.52225/narra.v3i3.257

[7] Kain D, Findlater A, Lightfoot D, Maxim T, Kraemer MUG, Brady OJ, et al. Factors Affecting Pre-Travel Health Seeking Behaviour and Adherence to Pre-Travel Health Advice: A Systematic Review. J Travel Med. 2019;26(6):1–14. DOI: https://doi.org/10.1093/jtm/taz059

[8] Freedman DO. Isolation , quarantine , social distancing and community containment : pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. 2020;1–4. DOI: https://doi.org/10.1093/jtm/taaa020

[9] Kuehnert MJ, Belay E, Brown C, Cowling BJ, Kong H, Fiore A, et al. Zoonotic Infections December 2025. 2025. Available from: https://www.mdpi.com/2813-0227/5/4

[10] Wayan N, Sri M, Wirawan IMA, Hendrayana MA. Risks factors for diarrhea among travellers visiting Bali. 2019;7(2):121–6. DOI: https://doi.org/10.53638/phpma.2019.v7.i2.p08

[11] Paudel P, Raina C, Zwar N, Seale H, Worth H, Sheikh M, et al. Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia. 2018;(March):1–7. DOI: https://doi.org/10.1093/jtm/tax044

[12] UNESCO. Global flow of tertiary-level students. Montreal. Available from: https://databrowser.uis.unesco.org/

[13] Johnston N, Sandys N, Geoghegan R, Donovan DO, Flaherty G. Protecting the health of medical students on international electives in low-resource settings. 2018;(January):1–9. DOI: https://doi.org/10.1093/jtm/tax092

[14] Mehta N, Fernandes C, Llerena C, Weine S, Bosland MC. Developing a global medicine student pre- and post-travel curriculum. 2023;1–7. DOI: https://doi.org/10.1186/s12909-023-04606-5

[15] Marcantonio TL, Jozkowski KN, Joppa DJAM. Students ’ Alcohol Use , Sexual Behaviors , and Contraceptive Use While Studying Abroad. J Community Health [Internet]. 2018;0(0):0. DOI: http://dx.doi.org/10.1007/s10900-018-0554-5

[16] Udayana U. International student admission report. Denpasar; 2023.

[17] Kevin K.C. Hung, MBChB, MPH , Agatha K.Y. Lin, RN, MPH , Calvin K.Y. Cheng, MmedSc, PhD , Emily Y.Y. Chan, MD, SM PIH , Colin A. Graham, MD M. Travel Health Risk Perceptions and Preparations Among Travelers at Hong Kong International Airport. J Travel Med. 2014;21(4):288–91. DOI: https://doi.org/10.1111/jtm.12112

[18] Vlot JA, Blanter AI, Jonker EFF, Korse NS, Hack E, Visser LG, et al. Travel preparation and health risks in Dutch and Belgian medical students during an elective in low- or middle-income countries : A prospective self- reporting cohort study. Travel Med Infect Dis [Internet]. 2020;37(June):101779. DOI: https://doi.org/10.1016/j.tmaid.2020.101779

[19] Le TH. Journal of Hospitality and Tourism Management Cross-cultural gender differences in cruising risk perceptions : A study of young adults. J Hosp Tour Manag [Internet]. 2021;49(September):296–303. DOI: https://doi.org/10.1016/j.jhtm.2021.09.023

[20] WHO. International travel and health. 2022. Available from: https://www.who.int/health-topics/travel-and-health#tab=tab_1

[21] D HWMM. The Pretravel Consultation: Recent Updates [Internet]. The American Journal of Medicine. Elsevier Inc.; 2020. DOI: https://doi.org/10.1016/j.amjmed.2020.02.005

[22] Ericsson CD. Travellers with pre-existing medical conditions. 2003;21. DOI: https://doi.org/10.1016/s0924-8579(02)00288-1

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Published

2026-01-22

How to Cite

Apsari, M. A. A. C., Putri, W. C. W. S., Sawitri, A. S., & Ariastuti, N. L. P. (2026). Travel-Health Behaviour and Self Reported Travel-Related Illness Among International Medical Students In A Tropical Destination: A Cross Sectional Survey From Indonesia. Primary Care Science and Practice (PCSP), 1(1), 24–38. Retrieved from https://ejournal.linkglobal.co.id/pcsp/article/view/17

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Section

Original Research