BEHAVIORAL-ASPECTS OF TRAVELERS IN THEIR USE OF MALARIA PRESUMPTIVE TREATMENT

The use of stand-by treatment for malaria by travellers depends on the ir knowledge, attitudes and behaviour. We examined the behavioural asp ects of a cohort of travellers from Switzerland to low-risk malarial a reas who, on recruitment, were provided with a kit containing medicati on for stand-by treatment, guidelines on the diagnosis of malaria, and materials for collection of blood samples for later confirmation of m alaria. All subjects were urged to seek medical advice at the first si gns of possible malarial symptoms. Illness (fever as the main indicato r) was reported by 123 of the 1187 participants, often accompanied by shivering/chills (36.6%), headache (35.0%), gastrointestinal symptoms (69.9%), and myalgia and/or arthralgia (41.5%). Two-thirds of those il l failed to seek medical attention despite their symptoms and pretrave l advice. Only 9 (7.3%) were actually beyond the reach of medical atte ntion. The stand-by treatment was self-administered by 6 travellers, o nly one of whom had confirmed malaria. Two nonserious adverse events w ere reported. All users consulted a physician after administering the presumptive treatment. This stand-by approach is limited by inappropri ate behaviour and poor malaria awareness among travellers. These negat ive factors can be mitigated by development of an improved kit contain ing a simple test for self-diagnosis.