PREVENTION AND TREATMENT OF MALARIA IN EX PATRIATES IN CONGO - TRENDSBETWEEN 1989 AND 1992

The modalities of prevention and treatment of malaria in expatriates r esiding in Brazzaville, capital of the Congo, have been studied in Mar ch 1989, April 1990 and April 1992. These surveys of the type Behavior , Attitude, Practice have been carried out in the Ecole Francaise wher e the same questionnaire has been distributed among the primary school children to complete by their parents. Only the data pertaining to Eu ropeans, Lebanese, and North-Americans are presented. The proportion o f French expatriates is 80%. A progressive decrease is noticed in the regular taking of chemoprophylaxis: the percentage varies between 86 a nd 43% according ot the duration of residence in 1989, to between 57 a nd 16% in 1992. Chloroquine alone remains the most widely used product , especially in long term expatriates. The association chloroquine-pro guanil is mentioned only by a quarter or respondents. Apparently effic ient, it is especially taken by people exposed for less than 4 years. Amodiaquine, although contra-indicated for prevention purposes, is cit ed in 1992 by 9% of subjects taking regular chemoprophylaxis; other pr oducts are only exceptionnally used. In curative treatment, which gene rally is presumptive, halofantrine is since 1990 the most widely used drug, especially in children. In contrast, a relative disclaimer is no ted for the amino-4-quinoleines, due to resistance, but also and with no justification, for the association sulfadoxine-pyrimethamine and, t o a lesser degree, for quinine. The occurrence of attacks considered t o be malarial and their frequency, remained stable during the period o f study. They seem to be equivalent in parents and children, depending on the conditions (use of bednets is rare; air conditioning is custom ary), on the use of mosquito repulsives and/or insecticides, and on th e duration of residence in tropical regions (with comparable preventiv e measures). The only significant exposal factor retrieved is a histor y of travel in rural areas.