title: Factors associated with malaria chemoprophylaxis compliance among French service members deployed in Central African Republic.
abstract: BACKGROUND
  Malaria is a public health concern in the French armed forces, with 400-800 cases reported every year and three deaths in the past 2 years. However, lack of chemoprophylaxis (CP) compliance is often reported among service members. The aim of this study was to explore factors associated with CP compliance.
  
  
  METHODS
  A retrospective study (1296 service members) was carried out among troops deployed in Central African Republic. Determinants of CP were collected by self-questionnaire. Socio-demographic variables, behavioural characteristics, belief variables, operational determinants such as troops in contact (TIC) and number of nights worked per week and peer-to-peer reinforcement were studied. Relationships between covariates and compliance were explored using logistic regressions (outcome: compliance as a dummy variable).
  
  
  RESULTS
  Chemoprophylaxis compliance was associated with other individual preventive measures against mosquito bites (bed net use, OR (odds ratio) = 1.41 (95% CI [1.08-1.84]), and insecticide on clothing, OR = 1.90 ([1.43-2.51]) and malaria-related behaviours (taking chemoprophylaxis at the same time every day, OR = 2.37 ([1.17-4.78]) and taking chemoprophylaxis with food, OR = 1.45 ([1.11-1.89])). High perceived risk of contracting malaria, OR = 1.59 ([1.02-2.50]), positive perception of CP effectiveness, OR = 1.62 ([1.09-2.40]) and the practice of peer-to-peer reinforcement, OR = 1.38 ([1.05-1.82]) were also associated with better compliance. No association was found with TIC and number of nights worked.
  
  
  CONCLUSIONS
  This study, which shows a positive relationship between peer-to-peer reinforcement and CP compliance, also suggests the existence of two main personality profiles among service members: those who seek risks and those who are health-conscious. Health education should be expanded beyond knowledge, know-how and motivational factors by using a comprehensive approach based on identification of health determinants, development of psychosocial skills and peer-to-peer reinforcement.
authors.affiliation: French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France. marieaude.juzan@gmail.com.
authors.forename: Marie-Aude
authors.initials: MA
authors.lastname: Créach
authors.affiliation: French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Velut
authors.affiliation: French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.|INSERM, UMR912 (SESSTIM), 13006, Marseille, France.
authors.forename: Franck
authors.initials: F
authors.lastname: de Laval
authors.affiliation: Inter-Army Health Service Directorate, Cayenne, French Guiana, France.|Parasitology Laboratory, Institut Pasteur of French Guiana, Cayenne, French Guiana, France.|Research Unit on Emerging Infectious and Tropical Diseases, Aix Marseille University, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Briolant
authors.affiliation: Operation Sangaris, Bangui, Central African Republic.
authors.forename: Luc
authors.initials: L
authors.lastname: Aigle
authors.affiliation: French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.|INSERM, UMR912 (SESSTIM), 13006, Marseille, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Marimoutou
authors.affiliation: French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.|INSERM, UMR912 (SESSTIM), 13006, Marseille, France.|Ecole du Val-de-Grâce, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Deparis
authors.affiliation: French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.|INSERM, UMR912 (SESSTIM), 13006, Marseille, France.|Ecole du Val-de-Grâce, Paris, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Meynard
authors.affiliation: Research Unit on Emerging Infectious and Tropical Diseases, Aix Marseille University, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France.|Parasitology and Entomology Unit, Department of Infectious Diseases, Armed Forces Biomedical Research Institute, Brétigny sur Orge, France.|National Reference Centre for Malaria, Marseille, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pradines
authors.affiliation: Parasitology and Entomology Unit, Department of Infectious Diseases, Armed Forces Biomedical Research Institute, Brétigny sur Orge, France.|Department of Infectious and Tropical Diseases, Laveran Armed Forces Teaching Hospital, Marseille, France.|Ecole du Val-de-Grâce, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Simon
authors.affiliation: French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.|Department of Infectious and Tropical Diseases, Laveran Armed Forces Teaching Hospital, Marseille, France.
authors.forename: Rémy
authors.initials: R
authors.lastname: Michel
authors.affiliation: French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.|INSERM, UMR912 (SESSTIM), 13006, Marseille, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Mayet
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D002488:Central African Republic; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D005602:France; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000962:Antimalarials
keywords: Armed forces; Chemoprophylaxis; Compliance; Health education; Malaria; Peer-to-peer reinforcement