Malaria Prevention Strategies: Adherence Among Boston Area Travelers Visiting Malaria-Endemic Countries

Rhett J. Stoney Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts

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Lin H. Chen Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts

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Emily S. Jentes Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts

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Mary E. Wilson Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts

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Pauline V. Han Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts

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Christine M. Benoit Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts

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William B. MacLeod Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts

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Davidson H. Hamer Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts

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Elizabeth D. Barnett Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts

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DOI:
https://doi.org/10.4269/ajtmh.15-0565
Volume/Issue:
Volume 94: Issue 1
Page(s):
136–142
Restricted access
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We conducted a prospective cohort study to assess adherence to malaria chemoprophylaxis, reasons for nonadherence, and use of other personal protective measures against malaria. We included adults traveling to malaria-endemic countries who were prescribed malaria chemoprophylaxis during a pre-travel consultation at three travel clinics in the Boston area and who completed three or more surveys: pre-travel, at least one weekly during travel, and post-travel (2–4 weeks after return). Of 370 participants, 335 (91%) took malaria chemoprophylaxis at least once and reported any missed doses; 265 (79%) reported completing all doses during travel. Adherence was not affected by weekly versus daily chemoprophylaxis, travel purpose, or duration of travel. Reasons for nonadherence included forgetfulness, side effects, and not seeing mosquitoes. Main reasons for declining to take prescribed chemoprophylaxis were peer advice, low perceived risk, and not seeing mosquitoes. Of 368 travelers, 79% used insect repellent, 46% used a bed net, and 61% slept in air conditioning at least once. Because travelers may be persuaded to stop taking medication by peer pressure, not seeing mosquitoes, and adverse reactions to medications, clinicians should be prepared to address these barriers and to empower travelers with strategies to manage common side effects of antimalarial medications.

Author Notes

* Address correspondence to Rhett J. Stoney, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-03, Atlanta, GA 30329. E-mail: uyn2@cdc.gov

Financial support: This work was supported by a cooperative agreement [1 U19CI000508-01] between the Centers for Disease Control and Prevention and Boston Medical Center.

Authors' addresses: Rhett J. Stoney, Emily S. Jentes, and Pauline V. Han, Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: uyn2@cdc.gov, ejentes@cdc.gov, and pauline.han@gmail.com. Lin H. Chen, Travel Medicine Center, Mount Auburn Hospital, Cambridge, MA, E-mail: lchen@hms.harvard.edu. Mary E. Wilson, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, E-mail: mary_wilson@harvard.edu. Christine M. Benoit and Elizabeth D. Barnett, Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, MA, E-mails: christine.m.benoit@gmail.com and elizabeth.barnett@bmc.org. William B. MacLeod and Davidson H. Hamer, Center for Global Health and Development, Boston University School of Public Health, Boston, MA, E-mails: wmacleod@bu.edu and dhamer@bu.edu.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2016
Received:
06 Aug 2015
|
Accepted:
29 Aug 2015
|
Published Online:
06 Jan 2016
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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