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Am J Trop Med Hyg. 2016 Jan;94(1):136-42. doi: 10.4269/ajtmh.15-0565. Epub 2015 Oct 19.

Malaria Prevention Strategies: Adherence Among Boston Area Travelers Visiting Malaria-Endemic Countries.

Author information

1
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts uyn2@cdc.gov.
2
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.

Abstract

We conducted a prospective cohort study to assess adherence to malaria chemoprophylaxis, reasons for nonadherence, and use of other personal protective measures against malaria. We included adults traveling to malaria-endemic countries who were prescribed malaria chemoprophylaxis during a pre-travel consultation at three travel clinics in the Boston area and who completed three or more surveys: pre-travel, at least one weekly during travel, and post-travel (2-4 weeks after return). Of 370 participants, 335 (91%) took malaria chemoprophylaxis at least once and reported any missed doses; 265 (79%) reported completing all doses during travel. Adherence was not affected by weekly versus daily chemoprophylaxis, travel purpose, or duration of travel. Reasons for nonadherence included forgetfulness, side effects, and not seeing mosquitoes. Main reasons for declining to take prescribed chemoprophylaxis were peer advice, low perceived risk, and not seeing mosquitoes. Of 368 travelers, 79% used insect repellent, 46% used a bed net, and 61% slept in air conditioning at least once. Because travelers may be persuaded to stop taking medication by peer pressure, not seeing mosquitoes, and adverse reactions to medications, clinicians should be prepared to address these barriers and to empower travelers with strategies to manage common side effects of antimalarial medications.

PMID:
26483125
PMCID:
PMC4710418
DOI:
10.4269/ajtmh.15-0565
[Indexed for MEDLINE]
Free PMC Article

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