EFFECTIVENESS OF CHEMOPROPHYLAXIS AND OTHER DETERMINANTS OF MALARIA IN TRAVELERS TO KENYA

OBJECTIVE To investigate the effectiveness of chemoprophylaxis and the determinants of malaria importation from Kenya. METHOD In a populatio n-based case-control study,51 travellers from Bavaria diagnosed with f alciparum malaria imported from Kenya (cases) and a sample of 383 heal thy Bavarian travellers returning from Kenya (controls) were interview ed. Data were analysed by multiple logistic regression. RESULTS Mefloq uine (OR = 0.055; 95% CI 0.019-0.16) and chloroquine combined with pro guanil (OR = 0.128; 95% CI 0.039-0.419) were highly protective against P. falciparum malaria, whereas other drugs were ineffective (OR = 1.2 25; 95% CI 0.536-2.803). Ineffective prophylaxis (10.4%) and non-proph ylaxis (11.2%) were the main reasons for malaria importation. Travelli ng alone or with friends, male sex, and travel duration over 4 weeks c ould be identified as additional risk factors. The main reason for ina dequate chemoprophylaxis was inappropriate medical advice (87.5%). Pro phylaxis refusal occurred frequently despite correct advice (58.1%). D iagnosis was often delayed unnecessarily (27.5%). CONCLUSION Malaria i mportation from Kenya could be reduced substantially (34%) by eliminat ing inappropriate medical advice.