title: Determinants of compliance with anti-vectorial protective measures among non-immune travellers during missions to tropical Africa.
abstract: BACKGROUND
  The effectiveness of anti-vectorial malaria protective measures in travellers and expatriates is hampered by incorrect compliance. The objective of the present study was to identify the determinants of compliance with anti-vectorial protective measures (AVPMs) in this population that is particularly at risk because of their lack of immunity.
  
  
  METHODS
  Compliance with wearing long clothing, sleeping under insecticide-impregnated bed nets (IIBNs) and using insect repellent was estimated and analysed by questionnaires administered to 2,205 French military travellers from 20 groups before and after short-term missions (approximately four months) in six tropical African countries (Senegal, Ivory Coast, Chad, Central African Republic, Gabon and Djibouti). For each AVPM, the association of "correct compliance" with individual and collective variables was investigated using random-effect mixed logistic regression models to take into account the clustered design of the study.
  
  
  RESULTS
  The correct compliance rates were 48.6%, 50.6% and 18.5% for wearing long clothing, sleeping under bed nets and using repellents, respectively. Depending on the AVPM, correct compliance was significantly associated with the following factors: country, older than 24 years of age, management responsibilities, the perception of a personal malaria risk greater than that of other travellers, the occurrence of life events, early bedtime (i.e., before midnight), the type of stay (field operation compared to training), the absence of medical history of malaria, the absence of previous travel in malaria-endemic areas and the absence of tobacco consumption.There was no competition between compliance with the different AVPMs or between compliance with any AVPM and malaria chemoprophylaxis.
  
  
  CONCLUSIONS
  Interventions aimed at improving compliance with AVPMs should target young people without management responsibilities who are scheduled for non-operational activities in countries with high risk of clinical malaria. Weak associations between compliance and history of clinical malaria or variables that pertain to threat perception suggest that cognition-based interventions referencing a "bad experience" with clinical malaria could have only a slight impact on the improvement of compliance. Further studies should focus on the cognitive and behavioural predictors of compliance with AVPMs.
authors.affiliation: Field Infectiology Department, Institute for Biomedical Research of the French Armed Forces (IRBA) & URMITE UMR6236, Allée du Médecin Colonel Jamot, Parc du Pharo, BP60109, 13262 Marseille Cedex 07, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sagui
authors.forename: Noémie
authors.initials: N
authors.lastname: Resseguier
authors.forename: Vanessa
authors.initials: V
authors.lastname: Machault
authors.forename: Lénaïck
authors.initials: L
authors.lastname: Ollivier
authors.forename: Eve
authors.initials: E
authors.lastname: Orlandi-Pradines
authors.forename: Gaetan
authors.initials: G
authors.lastname: Texier
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pages
authors.forename: Remy
authors.initials: R
authors.lastname: Michel
authors.forename: Bruno
authors.initials: B
authors.lastname: Pradines
authors.forename: Sébastien
authors.initials: S
authors.lastname: Briolant
authors.forename: Alain
authors.initials: A
authors.lastname: Buguet
authors.forename: Catherine
authors.initials: C
authors.lastname: Tourette-Turgis
authors.forename: Christophe
authors.initials: C
authors.lastname: Rogier
mesh_terms: D000328:Adult; D000349:Africa; D000818:Animals; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007302:Insect Repellents / Q000627:therapeutic use; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D009032:Mosquito Control / Q000379:methods*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011481:Protective Clothing / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014195:Travel; D014329:Tropical Climate
chemical_list: D007302:Insect Repellents