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Effectiveness of chemoprophylaxis and other determinants of malaria in travellers to Kenya

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Summary objective To investigate the effectiveness of chemoprophylaxis and the determinants of malaria importation from Kenya.

method In a population-based case-control study, 51 travellers from Bavaria diagnosed with falciparum malaria imported from Kenya (cases) and a sample of 383 healthy Bavarian travellers returning from Kenya (controls) were interviewed. Data were analysed by multiple logistic regression.

results Mefloquine (OR = 0.055; 95% Cl 0.019-0.16) and chloroquine combined with proguanil (OR = 0.128; 95% CI 0.039-0.419) were highly protective against P. falciparum malaria, whereas other drugs were ineffective (OR = 1.225; 95% CI 0.536-2.803). Ineffective prophylaxis (10.4%) and non-prophylaxis (11.2%) were the main reasons for malaria importation. Travelling alone or with friends, male sex, and travel duration over 4 weeks could be identified as additional risk factors. The main reason for inadequate chemoprophylaxis was inappropriate medical advice (87.5%). Prophylaxis refusal occurred frequently despite correct advice (58.1%). Diagnosis was often delayed unnecessarily (27.5%).

conclusion Malaria importation from Kenya could be reduced substantially (34%) by eliminating inappropriate medical advice.
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Keywords: Plasmodium falciparum; imported malaria; malaria chemoprophylaxis; malaria prevention

Document Type: Research Article

Affiliations: 1: Department of Public Health and Epidemiology, University of Munich, Germany 2: National Research Centre for Environment and Health, Institute of Medical Informatics and Health Services Research, Neuherberg, Germany 3: Department of Infectious Diseases and Tropical Medicine, University of Munich, Germany

Publication date: 1998-05-01

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