Volume 86, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Compliance with malaria chemoprophylaxis by military service members (MSMs) is notoriously low, ranging from 30% to 56%. Our objective was to determine the rate of compliance and reasons for non-compliance with malaria chemoprophylaxis among healthy US MSMs in Afghanistan. An eight-question, anonymous online survey was used to collect data regarding the compliance of healthy MSMs with malaria chemoprophylaxis. E-mail surveys were sent to 1,200 MSMs; 528 (44%) MSMs completed the survey. One-time daily doxycycline was the most commonly prescribed chemoprophylaxis (90%); 60% ( = 318) responded that they were compliant with their chemoprophylaxis as prescribed, whereas 40% ( = 221) indicated that they were not compliant. Compliance with daily dosing was 61% and weekly dosing was 38%. The most common reasons for non-compliance were gastrointestinal effects (39%), forgetfulness (31%), and low perception of risk (24%). Malaria chemoprophylaxis compliance by healthy MSMs in Afghanistan is poor. Side effects, forgetfulness, and lack of education are contributing factors. Commanders bear the primary responsibility for the health of their soldiers, and the individual MSM bears personal responsibility; however, additional public health interventions could possibly have a positive impact on prevention.


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  1. Armed Forces Health Surveillance Center, 2011. Update: Malaria,U.S. Armed Forces, 2010. Medical Surveillance Monthly Report. Available at: http://afhsc.army.mil/viewMSMR?file=2011/v18_n01.pdf. Accessed May 21, 2011. [Google Scholar]
  2. Ohre C, , 1997. Mefloquine compared to doxycycline for prophylaxis of malaria in Indonesian soldiers. Ann Intern Med 126: 963972.[Crossref] [Google Scholar]
  3. Tan KR, Magill AJ, Parise ME, Arguin PM, , 2011. Doxycycline for malaria chemoprophylaxis and treatment. Report from the CDC expert meeting on malaria chemophylaxis. Am J Trop Hyg. 84: 517531.[Crossref] [Google Scholar]
  4. CENTCOM, 2002. Individual Protection and Individual/Unit Deployment Policy (MOD10).15.H.1.B. Washington, DC: Deputy Chief of Staff, Army G-1. [Google Scholar]
  5. Department of Defense Directive, 2007. Force Health Protection. Number 6200.04, October 9, 2004. Certified Current, April 23, 2007. Washington, DC: Office of the Secretary of Defense. [Google Scholar]
  6. Whitman TJ, Coyne PE, Magill AJ, Blazes DL, Green MD, Milhous WK, , 2010. An outbreak of Plasmodium falciparum malaria in US Marines deployed to Liberia. Am J Trop Med Hyg 83: 258265.[Crossref] [Google Scholar]
  7. Kotwal RS, Wenzel RB, Sterling RA, Porter WD, Jordan NN, Petruccelli BP, , 2005. An outbreak of malaria in US Rangers returning from Afghanistan. JAMA 293: 212216.[Crossref] [Google Scholar]
  8. Newton JA, Jr Schnepf GA, Wallace MR, Lobel HO, Kennedy CA, Oldfield EC, 3rd, 1994. Malaria in US Marines returning from Somolia. JAMA 272: 397399.[Crossref] [Google Scholar]
  9. Barrett O, Skrzypek G, Datel W, Goldstein JD, , 1969. Malaria imported to the United States from Vietnam: chemoprophylaxis evaluated in returning soldiers. Am J Trop Med Hyg 18: 495499. [Google Scholar]
  10. Centers for Disease Control and Prevention, 2010. Travelers' Health. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria-risk-information-andprophylaxis/Afghanistan.aspx. Accessed May 21, 2011. [Google Scholar]
  11. Brooker S, , 2011. Malaria Atlas Project. Available at: http://www.map.ox.ac.uk/. Accessed October 8, 2011. [Google Scholar]
  12. Kolaczinski J, Graham K, Fahim A, Brooker S, Rowland M, , 2005. Malaria control in Afghanistan: progress and challenges. Lancet 365: 15061512.[Crossref] [Google Scholar]
  13. World Health Organization, 2011. World Malaria Report for Afghanistan. Available at: http://www.who.int/malaria/publications/country-profiles/en/index.html. Accessed October 8, 2011. [Google Scholar]
  14. Islamic Republic of Afghanistan Ministry of Public Health, 2009. Annual Report 1387. Available at: http://moph.gov.af/Content/Media/Documents/HNSS-Report-ENG-v4-1281220101156987.pdf. Accessed May 21, 2011. [Google Scholar]
  15. Doolan DL, Dobano C, Baird JK, , 2009. Acquired immunity to malaria. Clin Microbiol Rev 22: 1336.[Crossref] [Google Scholar]
  16. National Center for Medical Intelligence, 2011. Available at: https:www.intelink.gov/ncmi/document.php?id=99003. Accessed October 8, 2011.
  17. Greenberg RN, , 1984. Overview of patient compliance with medication dosing. Clin Ther 6: 592599. [Google Scholar]
  18. Eisen SA, Miller DK, Woodward RS, Spitznagel E, Przybeck TR, , 1990. The effect of prescribed daily dose on patient medication compliance. Arch Intern Med 150: 18811884.[Crossref] [Google Scholar]
  19. Graves PM, Levine MM, , eds., 2006. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Available at: http://www.nap.edu/catalog.php?record_id=11656. Accessed May 21, 2011. [Google Scholar]
  20. The American Society of Tropical Medicine and Hygiene, 2010. Tropical Disease and Military Preparedness Issue Brief. Available at: http://www.astmh.net/AM/Template.cfm?Section=Issue_Briefs&Template=/CM/ContentDisplay.cfm&ContentID=2522. Accessed May 21, 2011. [Google Scholar]
  21. Lamar JE, , 2000. Navy Medical Department Pocket Guide to Malaria Prevention and Control. Technical Manual NEHC-TM PM 6250.1. Norfolk, VA: Navy Environmental Health Center. [Google Scholar]
  22. Slim W, , 1956. Defeat into Victory. London, UK: Cassell. [Google Scholar]
  23. Department of Defense, 2009. Department of Defense Active Duty Military Personnel by Rank and Grade. Available at: http://siadapp.dmdc.osd.mil/personnel/MILITARY/rg0902.pdf. Accessed June 14, 2011. [Google Scholar]
  24. Croft AM, Darbyshire AH, Jackson CJ, van Thiel PP, , 2007. Malaria prevention measures in coalition troops in Afghanistan. JAMA 297: 21972200.[Crossref] [Google Scholar]
  25. Hamilton MB, , 2003. Online Survey Response Rates and Times: Background and Guidance for Industry. Tercent, Inc. Available at: http://www.supersurvey.com/papers/supersurvey_white_paper_response_rates.htm. Accessed June 10, 2011. [Google Scholar]
  • Received : 07 Aug 2011
  • Accepted : 18 Jan 2012
  • Published online : 01 Apr 2012

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