COMPLIANCE WITH MALARIA CHEMOPROPHYLAXIS AND PREVENTATIVE MEASURES AGAINST MOSQUITO BITES AMONG DUTCH TRAVELERS

Self-reported compliance with a malaria chemoprophylaxis regimen of pr oguanil (PG) plus chloroquine (CQ) was assessed in a cohort of 547 Dut ch travellers who visited a single travel clinic when travelling to va rious areas endemic for falciparum malaria. 503 (92%) had taken PG/CQ prophylaxis, but only 326 (60%) reported regular and uninterrupted use throughout the journey and 4 weeks afterwards. Compliance differed by travel destination and was 45% in South America, 52% in West Africa, 53% in South-east Asia, 60% in the Indian Subcontinent and 78% in Ease Africa. Parasitologically confirmed falciparum malaria occurred in 5 travellers (0.9%), including 3 of 24 non-compliant travellers to West Africa (12.5%). Apart from destination, independent risk factors for n on-compliance were young age, extensive travel experience and adventur ous' travel. Compliance with protection against mosquito bites was 80% for wearing long-sleeved shirts and long-legged trousers after sunset , 73% for use of repellents, 56% for sleeping under bednets and 37% fo r keeping the sleeping quarters free of mosquitoes. Although 440 trave llers (80%) reported to have taken two or more of these measures at le ast once, only 88 (16%) had done so on a daily basis. Daily use of bed nets was reported more frequently among subjects who were non-complian t with chemoprophylaxis. Compliance regarding malaria chemoprophylaxis should be improved, particularly in high-risk areas such as Sub-sahar an Africa, with extra attention to young, adventurous travellers. More emphasis should be placed on prevention of Anopheles bites.