Anti-Malarial Chemoprophylaxis Following Evacuation from Afghanistan

Abstract

UK forces deployed to Afghanistan between March and November are prescribed anti-malarial chemoprophylaxis (AMC). In 2007 an audit showed poor pre-injury AMC compliance and a prescription rate of 50% amongst those casualties evacuated to Role 4. We re-audited the post-deployment AMC prescribing practice for casualties from Afghanistan for the 2008 and half of the 2009 malaria season. Using the Role 4 prescribing information and communication system (PICS), a retrospective AMC search for Proguanil, Chloroquine, Doxycycline, Mefloquine and Malarone was performed on these casualties. Only five out of 305 (1.64%) inpatients were prescribed appropriate post-deployment AMC medication. Awareness of the need to prescribe AMC following evacuation remains poor, and may be improved by recording AMC compliance in field medical records and modifying the PICS software.

Compliance with Antimalarial Chemoprophylaxis Recommendations for Wounded United States Military Personnel Admitted to a Military Treatment Facility

“…Among wounded British military personnel evacuated from Afghanistan, prescription of appropriate antimalarial chemoprophylaxis after MTF admission has been reported to be low; compliance ranged from 1.64% (5 of 305 patients) to 50% (4 of 8 patients) in various analyses. 11,12 Although our analysis reported greater adherence to antimalarial chemoprophylaxis guidelines than the British studies, compliance was still poor, particularly for primaquine and possibly the result of a low perception of malaria risk by the clinicians.…”

“…10 Few studies are available on antimalarial chemoprophylaxis and primaquine prescribed to trauma patients after admission to medical facilities. 11,12 The objective of our analysis was to evaluate antimalarial chemoprophylaxis compliance, as prescribed by clinicians, among wounded U.S. military personnel evacuated from Afghanistan after arrival at Landstuhl Regional Medical Center (LRMC) in Germany and subsequent U.S. military treatment facilities (MTFs).…”