Assessment of Adherence to Atovaquone‐Proguanil Prophylaxis in Travelers: Table 1

DePetrillo, John C.; Singer, Carol; Bergagnini, Isabella; Kolakowski, Patricia; Edwards, Barbara; Smith, Miriam A.

doi:10.1111/j.1708-8305.2010.00426.x

Cited by 24 publications

(15 citation statements)

References 18 publications

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“…Adherence to chemoprophylaxis found in our study is in agreement with self reported treatment adherence found in other studies, which ranged from 70%–89% for atovaquone-proguanil and 72%–95% for mefloquine [14], [15], [24], [25]. Travelers to Africa were more adherent to chemoprophylaxis, which is also consistent with other studies [14], [20], [26].…”

Section: Discussionsupporting

confidence: 93%

“…Travelers to Africa were more adherent to chemoprophylaxis, which is also consistent with other studies [14], [20], [26]. Even though in our travel consultation we do not communicate differences in risk between different high-endemic continents, it is possible that travelers know that malaria risk in Africa is higher than in other continents and therefore are more cautious.…”

Section: Discussionsupporting

confidence: 89%

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Adherence to Chemoprophylaxis and Plasmodium falciparum Anti-Circumsporozoite Seroconversion in a Prospective Cohort Study of Dutch Short-Term Travelers

et al. 2013

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BackgroundWe conducted a prospective study in a cohort of short-term travelers assessing the incidence rate of anti-circumsporozoite seroconversion, adherence to chemoprophylaxis, symptoms of malaria during travel, and malaria treatment abroad.MethodsAdults were recruited from the travel clinic of the Public Health Service Amsterdam. They kept a structured daily travel diary and donated blood samples before and after travel. Blood samples were serologically tested for the presence of Plasmodium falciparum anti-circumsporozoite antibodies.ResultsOverall, the incidence rate (IR) of anti-circumsporozoite seroconversion was 0.8 per 100 person-months. Of 945 travelers, 620 (66%) visited high-endemic areas and were advised about both chemoprophylaxis and preventive measures against mosquito bites. Most subjects (520/620 = 84%) took at least 75% of recommended prophylaxis during travel. Travel to Africa, use of mefloquine, travel duration of 14–29 days in endemic areas, and concurrent use of DEET (N,N-diethyl-meta-toluamide) were associated with good adherence practices. Four travelers without fever seroconverted, becoming anti-circumsporozoite antibody-positive. All four had been adherent to chemoprophylaxis; two visited Africa, one Suriname, one India. Ten subjects with fever were tested for malaria while abroad and of these, three received treatment. All three were adherent to chemoprophylaxis and tested negative for anti-circumsporozoite antibodies.ConclusionTravel to Africa, using mefloquine, travel duration of 14–29 days in endemic areas, and use of DEET were associated with good adherence to chemoprophylaxis. The combination of chemoprophylaxis and other preventive measures were sufficient to protect seroconverting travelers from clinical malaria. Travelers who were treated for malaria abroad did not seroconvert.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 89%

Adherence to Chemoprophylaxis and Plasmodium falciparum Anti-Circumsporozoite Seroconversion in a Prospective Cohort Study of Dutch Short-Term Travelers

et al. 2013

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“…In areas of intense malaria transmission, malaria chemoprophylaxis remains the most important strategy for preventing malaria in travellers [3], but its use may be associated with adverse outcomes and even death [4]. These potentially severe adverse effects may undermine compliant use of malaria chemoprophylaxis in travellers, in particular when considering that these travellers were usually healthy when commencing travel [5-9]. An additional difficulty with malaria chemoprophylaxis is that all drug regimens must be taken meticulously during and for one or more weeks after leaving the malaria-endemic area [10].…”

Section: Introductionmentioning

confidence: 99%

Severity of imported malaria: protective effect of taking malaria chemoprophylaxis

Vliegenthart-Jongbloed

Melo

Wolfswinkel

et al. 2013

Malar J

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BackgroundAlthough chemoprophylaxis remains an important strategy for preventing malaria in travellers, its effectiveness may be compromised by lack of adherence. Inappropriate use of chemoprophylaxis is likely to increase the risk of acquiring malaria, but may probably also worsen the severity of imported cases. The aim of this study was to assess the impact of use of malaria chemoprophylaxis on clinical features and outcome of imported malaria.MethodsDemographic, clinical and laboratory data of patients included in the Rotterdam Malaria Cohort between 1998 and 2011 were systematically collected and analysed. Patients were classified as self-reported compliant or non-compliant users or as non-users of chemoprophylaxis. Severe malaria was defined using the 2010 WHO criteria.ResultsDetails on chemoprophylaxis were available for 559 of the 604 patients, of which 64.6% were non-users, 17.9% were inadequate users and 17.5% reported to be adequate users. The group of non-users was predominated by patients with African ethnicity, partial immunity and people visiting friends and relatives. The majority contracted Plasmodium falciparum malaria. In contrast, compliant users acquired non-falciparum malaria more frequently, had significant lower P. falciparum loads on admission, shorter duration of hospitalization and significant lower odds for severe malaria as compared with non-users. Patients with P. falciparum malaria were more likely to have taken their chemoprophylaxis less compliantly than those infected with non-P. falciparum species. Multivariate analysis showed that self-reported adequate prophylaxis and being a partially immune traveller visiting friends and relatives was associated with significantly lower odds ratio of severe malaria. In contrast, age, acquisition of malaria in West-Africa and being a non-immune tourist increased their risk significantly.ConclusionsCompliant use of malaria chemoprophylaxis was associated with significantly lower odds ratios for severe malaria as compared with non-compliant users and non-users of chemoprophylaxis. After correction for age, gender and immunity, this protective effect of malaria chemoprophylaxis was present only in individuals who adhered compliantly to use of chemoprophylaxis. Patients with P. falciparum malaria were more likely to have used their chemoprophylaxis less compliantly than patients with non-P. falciparum malaria who were more likely to have contracted malaria in spite of compliant use of chemoprophylaxis.

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“…Adherence rates varied widely, ranging from 0% for corporate workers placed in Ghana for over a year [27] to 89% for travellers from the USA [31].…”

Section: Adherence Ratesmentioning

confidence: 99%

“…Several studies also reported concerns with side-effects: this included concerns about the safety of long-term use of anti-malarial medication [12,21,40], as well as experienced (both past and present) or anticipated side-effects [15, 21, 23, 26-28, 31, 33, 37, 40, 42]. Other reasons included having too many pills to take [37]; not seeing any mosquitoes [28,37,42]; tiredness [37]; price [23,37,42]; lack of pills [37]; not thinking that prophylaxis was necessary [15,21,31]; being advised (for example, by a tour guide, locals or colleagues) that it was not necessary [15,21,27,31,42] and not liking to take medication [33,37]. A higher perceived risk of catching malaria was associated with greater adherence and having a self-reported low perceived risk [27,42] was associated with poor adherence.…”

Section: Self-reported Reasons For Non-adherencementioning

confidence: 99%

A systematic review of factors affecting adherence to malaria chemoprophylaxis amongst travellers from non-endemic countries

Ahluwalia

Brooks

Weinman

et al. 2020

Malar J

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Background: The aim of this systematic review was to identify predictors of actual or intended adherence with malaria chemoprophylaxis amongst travellers from non-endemic countries visiting endemic countries. Methods:A systematic review of the literature was conducted using MEDLINE, Embase, PsycINFO and Global Health databases for studies published up to April 2019. Studies were included if they assessed reasons for adherence among people travelling from a country where malaria was not endemic to a country where it was. Results:Thirty-two studies were included. Predictors of adherence were categorized as relating to either the nature of the travel or the traveller themselves. The three main predictors associated with nature of travel included: destination (e.g. country visited, urban vs rural areas), length of travel and type of travel (e.g. package vs backpacking holiday). The four main traveller-associated predictors were: age, reason for travel (e.g. business, leisure or visiting friends and relatives), perceived risk of catching malaria and experienced or expected medication effects. Conclusions:In order to improve adherence, clinicians should focus on travellers who are least likely to exhibit adherent behaviour. This includes travellers visiting destinations known to have lower adherence figures (such as rural areas), backpackers, business travellers, younger travellers and those travelling for longer periods of time. They should also check to ensure travellers' perceptions of the risks of malaria are realistic. Where appropriate, misperceptions (such as believing that curing malaria is easier than taking prophylaxis or that travellers visiting relatives have some level of innate immunity) should be corrected. All travellers should be informed of the potential side-effects of medication and given guidance on why it is nonetheless beneficial to continue to take prophylaxis. Further research is required to test interventions to improve adherence.

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Assessment of Adherence to Atovaquone‐Proguanil Prophylaxis in Travelers: Table 1

Abstract: Adherence with atovaquone-proguanil malaria prophylaxis is high among travelers from a non-endemic region. Adverse effects are minimal. Non-adherence was primarily attributable to travelers' perception of need.

Cited by 24 publications

References 18 publications

Adherence to Chemoprophylaxis and Plasmodium falciparum Anti-Circumsporozoite Seroconversion in a Prospective Cohort Study of Dutch Short-Term Travelers

Adherence to Chemoprophylaxis and Plasmodium falciparum Anti-Circumsporozoite Seroconversion in a Prospective Cohort Study of Dutch Short-Term Travelers

Severity of imported malaria: protective effect of taking malaria chemoprophylaxis

A systematic review of factors affecting adherence to malaria chemoprophylaxis amongst travellers from non-endemic countries

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