MALARIA ATTACKS AFTER RETURNING FROM ENDEMIC AREAS - FAILURE OF CHEMICAL PROPHYLAXIS OR PRESCRIPTION ERRORS

OBJECTIVE: Determine the causes of malaria attacks in subjects who hav e returned from endemic areas by assessing prescriptions for chemical prophylaxis and compliance. PATIENTS AND METHODS: All patients who dev eloped a paroxysmal episode of malaria diagnosed at the University of Nice hospital in 1995 answered specif questions concerning their anti- malaria prophylaxis, RESULTS: Thirty-three patients were hospitalized for paroxysmal episodes of malaria in 1995. In 32 cases (97%) the atta ck resulted from either the lack of any prophylaxis (17 cases, 52%), i nadequate prescription (11 cases, 12%) or poor compliance (4 cases, 12 %). The prescribed chemical prophylaxis was not adapted to the chloroq uinone-resistant area in 8 cases (24%) and medical recommendations con cerning administration rules were inadequate in 3 cases (9%). Only one patient developed a paroxysmal episode despite correct compliance to a chloroquine-resistant zone-adapted well-conducted prescription,The c ost of poor prophylaxis in terms oi human suffering and financial cost was high for this preventable disease. Four patients hac; to be hospi talized in the intensive care unit and one died during hospitalization . The cumulative cost of hospitalization far these 33 cases was evalua ted at 660 000 FF. CONCLUSION: Preventive measures for malaria must in clude better information for physicians on changing recommendations fo r chemical prophylaxis as well as better information for travelers pro vided by all those involved in organizing travel to endemic areas.