Compliance with long-term malaria prophylaxis in British expatriates.
BACKGROUND
There were 219 million cases of malaria with 600,000 deaths in 2010. Current UK guidance recommends malaria chemoprophylaxis for travellers to malaria endemic areas. Despite proven efficacy, compliance amongst long-term travellers with prophylaxis and personal protective strategies is sub-optimal. This survey assesses compliance rates amongst Foreign and Commonwealth Office employees on placement in malaria endemic areas and establishes the rationale for their decisions.


METHODS
A Survey Monkey questionnaire was circulated to Foreign and Commonwealth Office employees on long-term placement in endemic areas. This ascertained background knowledge of malaria, compliance with prevention strategies and the rationale for decisions made.


RESULTS
The response rate was 56.5% (327 of 579); responses showed a good knowledge of malaria. 59% of respondents continued their prophylaxis for 0-3 months only. No pregnant women reported compliance of greater than 95%. More than half of the individuals with a compliance of <25% cited concerns about long term safety. 39.5% of respondents reported significant side-effects to chemoprophylaxis. 12.8% reported contracting malaria.


CONCLUSIONS
Despite being well informed, poor adherence was reported, especially amongst pregnant respondents. The majority of individuals ceased medication within three months. Concern regarding the safety of long-term medication was the major barrier. Suggestions are made regarding optimisation of compliance or alternative strategies.
Sheffield Teaching Hospital NHS Foundation Trust, UK. Electronic address: Jane.cunningham@sth.nhs.uk.
Jane
J
Cunningham
University of Sheffield, School of Health and Related Research, UK.
Jason
J
Horsley
Foreign and Commonwealth Office, London, UK; The National Travel Health Network and Centre, London, UK; Centre for Occupational and Environmental Health, Manchester University, Manchester, UK.
Dipti
D
Patel
Sheffield Teaching Hospital NHS Foundation Trust, UK.
Anne
A
Tunbridge
Liverpool School of Tropical Medicine, UK.
David G
DG
Lalloo
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D008288:Malaria / Q000188:drug therapy / Q000208:ethnology / Q000517:prevention & control; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D011247:Pregnancy; D014195:Travel; D006113:United Kingdom / Q000208:ethnology; D055815:Young Adult; D016903:Drug Monitoring
D000962:Antimalarials
Expatriate; Long-term travellers; Malaria prophylaxis