Compliance with long-term malaria prophylaxis in British expatriates

Cunningham, Jane; Horsley, J. Stephen; Patel, Dipti; Tunbridge, Anne; Lalloo, David G.

doi:10.1016/j.tmaid.2013.12.006

Cited by 19 publications

(32 citation statements)

References 18 publications

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“…In our study, 73% of Volunteers reported adherence to antimalarial drugs; a relatively high proportion when compared to other studies of malaria prophylaxis in long term travelers with observed adherence between 59–62% of participants [5,15,16]). Volunteers younger than 26 years and with more than 1 year of Peace Corps experience had increased odds of non-adherence to prophylaxis.…”

Section: Discussioncontrasting

confidence: 49%

“…It is unclear what proportion of symptoms attributed to prophylaxis are truly side effects of the medicine rather than normal events related to long-term travel: in a randomized, double-blinded, placebo-controlled study of mefloquine versus atovaquone-proguanil in 1013 patients presenting to travel clinics in 1999, 62% of treatment-emergent adverse effects were determined by the investigators to be unrelated to the study drug [3]. Studies of adherence to long-term malaria prophylaxis in populations of travelers have shown that adherence is poor overall, and that fear of long-term adverse effects (LTAEs), conflicting advice, and complicated or daily dosing strategies are common reasons for non-adherence [4,5]. …”

Section: Introductionmentioning

confidence: 99%

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Adherence to malaria prophylaxis among Peace Corps Volunteers in the Africa region, 2013

Landman

Tan

Arguin

2015

Travel Medicine and Infectious Disease

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Background Although malaria can be prevented with prophylaxis, it is diagnosed in over 100 Africa-region Peace Corps Volunteers annually. This suggests that prophylaxis non-adherence is a problem in these non-immune travelers. Methods We investigated Volunteers’ knowledge, attitudes, and practices regarding prophylaxis using an internet-based survey during August 19–September 30, 2013. Adherence was defined as taking doxycycline or atovaquone-proguanil daily, or taking mefloquine doses no more than 8 days apart. Results The survey was sent to 3,248 Volunteers. Of 781 whose responses were analyzed, 514 (73%) reported adherence to prophylaxis. The most common reasons for non-adherence were forgetting (n=530, 90%); fear of long-term adverse effects (LTAEs; n=316, 54%); and experiencing adverse events that Volunteers attributed to prophylaxis (n=297, 51%). Two hundred fourteen (27%) Volunteers reported not worrying about malaria. On multivariate analysis controlling for sex and experiencing adverse events Volunteers attributed to prophylaxis, the factor most strongly associated with non-adherence was being prescribed mefloquine (OR 5.4, 95% confidence interval 3.2–9.0). Conclusions We found moderate adherence and a prevailing fear of LTAEs among Volunteers. Strategies to improve prophylaxis adherence may include medication reminders, increasing education about prophylaxis safety and malaria risk, and promoting prompt management of prophylaxis side effects.

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Section: Discussioncontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Adherence to malaria prophylaxis among Peace Corps Volunteers in the Africa region, 2013

Landman

Tan

Arguin

2015

Travel Medicine and Infectious Disease

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“…Travelers must understand the importance of following protective measures thoroughly. However, adherence to preventive strategies can be as low as 25%, tending to decrease in the long term [8][9][10] owing to lack of motivation, health beliefs, fear of side effects, or poor communication, resulting in limited understanding and forgetting the information provided 11,12 . Therefore, advisors' communication skills are critical.…”

Section: Time Spent During Appointmentmentioning

confidence: 99%

Preventing diseases in round-the-world travelers: a contemporary challenge for travel medicine advice

Rodrigues

Moreira

2018

Rev. Soc. Bras. Med. Trop.

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Providing advice for travelers embarking on long-term trips poses a challenge in travel medicine. A long duration of risk exposure is associated with underuse of protective measures and poor adherence to chemoprophylaxis, increasing the chances of acquiring infections. Recently, in our clinic, we observed an increase in the number of travelers undertaking round-the-world trips. These individuals are typically aged around 32 years and quit their jobs to embark on one-to-two-year journeys. Their destinations include countries in two or more continents, invariably Southeast Asia and Indonesia, and mostly involve land travel and visiting rural areas. Such trips involve flexible plans, increasing the challenge, especially with regard to malaria prophylaxis. Advising round-the-world travelers is time-consuming because of the amount of information that must be provided to the traveler. Advisors must develop strategies to commit the traveler to his/her own health, and verify their learnings on disease-prevention measures. Contacting the advisor after the appointment or during the trip can be helpful to clarify unclear instructions or diagnosis made and prescriptions given abroad. Infectious diseases are among the most frequent problems affecting travelers, many of which are preventable by vaccines, medicines, and precautionary measures. The dissemination of counterfeit medicines, particularly antibiotics and antimalarial medicines, emphasizes the need for travelers to carry medicines that they may possibly need on their trip. Additional advice on altitude, scuba diving, and other possible risks may also be given. Considering the difficulties in advising this group, we present a review of the main recommendations on advising these travelers.

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“…Studies of compliance in long-term expatriates have demonstrated that willingness to take long-term prophylaxis drops dramatically (to less than 40% of the population) beyond roughly three months of [16]. …”

Section: Prevention: 4 Steps To Successmentioning

confidence: 99%

Malaria in the Traveler

Hahn

Pottinger

2016

Medical Clinics of North America

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Malaria is the clinical syndrome when a patient experiences symptoms in response to infection with one of several strains of the Plasmodium parasite. This manuscript is intended for healthcare providers to become familiar with some of the basics of care of the patient who is travelling to or returning from an area with ongoing malaria transmission. The specific focus of is on patients from non-endemic areas who plan on travel for a finite period to an area where malaria is endemic. Emphasis will be on placed on prevention and diagnosis. Risk factors for malaria acquisition will be discussed. We will have an evidence-based discussion of personal protective equipment, choice of chemoprophylactic agent, and pre-departure counseling that includes a discussion of malaria in the immunosuppressed patient. We will also review when to suspect malaria in a patient returning from an endemic area and the importance of rapid diagnostic tests in the diagnostic investigations. Finally, we will discuss how malaria is a sepsis syndrome that can progress quickly in populations with no pre-existing immunity.

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Compliance with long-term malaria prophylaxis in British expatriates

Cited by 19 publications

References 18 publications

Adherence to malaria prophylaxis among Peace Corps Volunteers in the Africa region, 2013

Adherence to malaria prophylaxis among Peace Corps Volunteers in the Africa region, 2013

Preventing diseases in round-the-world travelers: a contemporary challenge for travel medicine advice

Malaria in the Traveler

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