Abstract
BackgroundThe effectiveness of malaria chemoprophylaxis is limited by the lack of compliance whose determinants are not well known.MethodsThe compliance with malaria chemoprophylaxis has been estimated and analysed by validated questionnaires administered before and after the short-term missions (about four months) in five tropical African countries of 2,093 French soldiers from 19 military companies involved in a prospective cohort study. "Correct compliance" was defined as "no missed doses" of daily drug intake during the entire mission and was analysed using multiple mixed-effect logistic regression model.ResultsThe averaged prevalence rate of correct compliance was 46.2%, ranging from 9.6%to 76.6% according to the companies. Incorrect compliance was significantly associated with eveningness (p = 0.028), a medical history of clinical malaria (p < 0.001) and a perceived mosquito attractiveness inferior or superior to the others (p < 0.007). Correct compliance was significantly associated with the systematic use of protective measures against mosquito bites (p < 0.001), the type of military operations (combat vs. training activities, p < 0.001) and other individual factors (p < 0.05).ConclusionsThe identification of circumstances and profiles of persons at higher risk of lack of compliance would pave the way to specifically targeted strategies aimed to improve compliance with malaria chemoprophylaxis and, therefore, its effectiveness.
Highlights
The effectiveness of malaria chemoprophylaxis is limited by the lack of compliance whose determinants are not well known
Non-immune travellers should be protected from malaria by chemoprophylaxis and prophylactic measures against mosquito bites, including insecticide-impregnated bed nets (IIBN), repellents and insecticide-treated long-sleeved clothes and pants
A total of 17 clinical malaria cases occurred during the mission among the 2,093 soldiers, which corresponds to an incidence rate of 0.81 cases per 100 soldier-missions (2.37 cases per 100 soldier-years)
Summary
The effectiveness of malaria chemoprophylaxis is limited by the lack of compliance whose determinants are not well known. Non-immune civilians and military personnel traveling in malaria-endemic areas are at risk of getting malaria and may become clinically ill during or after their travel. In the UK, the incidence of imported clinical malaria among civilian travellers visiting West Africa varied from 196 cases to 52 cases/1,000 traveller-years between 2003 and 2006 [2]. Non-immune travellers should be protected from malaria by chemoprophylaxis and prophylactic measures against mosquito bites, including insecticide-impregnated bed nets (IIBN), repellents and insecticide-treated long-sleeved clothes and pants. In malaria-endemic areas, the use of most of these prophylactic measures is mandatory for nonimmune soldiers of Western armies or for non-immune employees of most major international groups. The effectiveness of chemoprophylaxis is limited by lack of compliance with drug intake, even if the regimen is adapted to the chemosusceptibility of P. falciparum [6,7]
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