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

Abstract

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 malariaendemic 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.

Knowledge, Attitude, and Practice among Egyptian Travelers: Pre-travel Vaccination and Malaria Prophylaxis

“…The barriers described in other studies included sleeping in air conditioning accommodations and forgetfulness. 25,30 It is known that a part of the social norms and culture in Egypt is fatalism; that can explain why 37.1% and 53.2%, respectively, stated that they trust in God as a main reason for neither receiving the drugs nor using other measures.…”

Malaria after international travel: a GeoSentinel analysis, 2003–2016

“…However, even among travellers who do receive pre-travel care, some may be non-adherent to chemoprophylaxis due to forgetfulness or medication side-effects, or they may decline to take chemoprophylaxis due to cost, peer advice or low perceived risk [7]. Furthermore, travellers may be prescribed a medication ineffective for the intended travel area [5].…”

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

“…Forgetting to take the medication was reported as a reason for non-adherence in four studies [15,33,37,40,42]. 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].…”

“…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.…”