Determinants of compliance with malaria chemoprophylaxis among French soldiers during missions in inter-tropical Africa.
BACKGROUND
The effectiveness of malaria chemoprophylaxis is limited by the lack of compliance whose determinants are not well known.


METHODS
The compliance with malaria chemoprophylaxis has been estimated and analysed by validated questionnaires administered before and after the short-term missions (about four months) in five tropical African countries of 2,093 French soldiers from 19 military companies involved in a prospective cohort study. "Correct compliance" was defined as "no missed doses" of daily drug intake during the entire mission and was analysed using multiple mixed-effect logistic regression model.


RESULTS
The averaged prevalence rate of correct compliance was 46.2%, ranging from 9.6%to 76.6% according to the companies. Incorrect compliance was significantly associated with eveningness (p = 0.028), a medical history of clinical malaria (p < 0.001) and a perceived mosquito attractiveness inferior or superior to the others (p < 0.007). Correct compliance was significantly associated with the systematic use of protective measures against mosquito bites (p < 0.001), the type of military operations (combat vs. training activities, p < 0.001) and other individual factors (p < 0.05).


CONCLUSIONS
The identification of circumstances and profiles of persons at higher risk of lack of compliance would pave the way to specifically targeted strategies aimed to improve compliance with malaria chemoprophylaxis and, therefore, its effectiveness.
Institute for Biomedical Research of the French Army & URMITE UMR6236, Allée du Médecin Colonel Jamot, Parc du Pharo, Marseille cedex 07, France.
Noémie
N
Resseguier
Vanessa
V
Machault
Lénaick
L
Ollivier
Eve
E
Orlandi-Pradines
Gaetan
G
Texier
Bruno
B
Pradines
Jean
J
Gaudart
Alain
A
Buguet
Catherine
C
Tourette-Turgis
Christophe
C
Rogier
D000328:Adult; D000349:Africa; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005602:France; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D008921:Religious Missions; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000962:Antimalarials