Malaria Prevention Strategies: Adherence Among Boston Area Travelers Visiting Malaria-Endemic Countries.
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 malaria-endemic 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.
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts uyn2@cdc.gov.
Rhett J
RJ
Stoney
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.
Lin H
LH
Chen
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.
Emily S
ES
Jentes
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.
Mary E
ME
Wilson
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.
Pauline V
PV
Han
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.
Christine M
CM
Benoit
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.
William B
WB
MacLeod
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.
Davidson H
DH
Hamer
Elizabeth D
ED
Barnett
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000008:administration & dosage* / Q000494:pharmacology*; D001900:Boston; D005260:Female; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D014195:Travel; D055815:Young Adult; D016903:Drug Monitoring
D000962:Antimalarials