Effectiveness of chemoprophylaxis and other determinants of malaria in travellers to Kenya.
OBJECTIVE
To investigate the effectiveness of chemoprophylaxis and the determinants of malaria importation from Kenya.


METHODS
In a population-based case-control study, 51 travellers from Bavaria diagnosed with falciparum malaria imported from Kenya (cases) and a sample of 383 healthy Bavarian travellers returning from Kenya (controls) were interviewed. Data were analysed by multiple logistic regression.


RESULTS
Mefloquine (OR = 0.055; 95% CI 0.019-0.16) and chloroquine combined with proguanil (OR = 0.128; 95% CI 0.039-0.419) were highly protective against P. falciparum malaria, whereas other drugs were ineffective (OR = 1.225; 95% CI 0.536-2.803). Ineffective prophylaxis (10.4%) and non-prophylaxis (11.2%) were the main reasons for malaria importation. Travelling alone or with friends, male sex, and travel duration over 4 weeks could be identified as additional risk factors. The main reason for inadequate chemoprophylaxis was inappropriate medical advice (87.5%). Prophylaxis refusal occurred frequently despite correct advice (58.1%). Diagnosis was often delayed unnecessarily (27.5%).


CONCLUSIONS
Malaria importation from Kenya could be reduced substantially (34%) by eliminating inappropriate medical advice.
Muehlberger
N
N
Department of Public Health and Epidemiology, University of Munich, Germany.
Jelinek
T
T
Schlipkoeter
U
U
von Sonnenburg
F
F
Nothdurft
H D
HD
D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D016022:Case-Control Studies; D002738:Chloroquine / Q000627:therapeutic use; D006801:Humans; D007630:Kenya; D016778:Malaria, Falciparum / Q000517:prevention & control*; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use; D010963:Plasmodium falciparum / Q000187:drug effects*; D002727:Proguanil / Q000627:therapeutic use; D012307:Risk Factors; D014195:Travel
D000962:Antimalarials; D002738:Chloroquine; D002727:Proguanil; D015767:Mefloquine