This is a factor that needs to be considered both in getting to the destination as well as travelling around whilst abroad. Travel poses a variety of risks including accidents resulting from poor driving standards, or poorly maintained roads and vehicles along with the possibility of assault and robbery.

Certain groups of patients may be unable to fly, including those who have recently undergone surgery or women who are within the third trimester of pregnancy.

Prolonged periods of immobility whilst travelling by air, sea or road combined with inadequate fluid intake, dehydration and pre-existing medical conditions can all increase the risk of thrombosis. Patients should be advised on how to reduce the risk of DVT, including:

• Maintaining adequate hydration and avoiding salty or spicy snacks that cause dehydration.
• Keeping mobile whilst travelling, flexing or extending the ankles and calf muscles.
• Avoiding excess alcohol consumption.
• Avoiding sedative drugs or sleeping during travel.
• Wearing compression hosiery or flight socks where appropriate.

Patients who have an increased risk of a DVT should be referred to their GP prior to travel.

Risks associated with travel will vary between urban and rural areas. Accidents will be more common in urban areas, but access to medical facilities will also be better. Rural areas will have poorer access to clean water, adequate sanitation, medical facilities and accommodation.

Travel itineraries will commonly include both urban and rural destinations and it is important to consider this when advising on the health risks. It is also important to consider how patients will travel between their destinations as this will impact on their health risk. For example a person travelling to India who is intending to visit Kolkata (formerly Calcutta) and then travel to Mumbai by plane would be unlikely to enter a malaria zone. Whereas a patient who has decided to travel by road or rail is likely to travel through a high risk malaria zone and require chemoprophylaxis.

This demonstrates that to provide accurate advice it is essential to understand the patient's precise travel plans.