Malaria in the Republic of Djibouti, 1998-2009.

Historically, native populations in the Republic of Djibouti have experienced only low and unstable malaria transmission and intermittent epidemics. In recent years, efforts at malaria control have been aggressively pursued. This study was performed to inform revised malaria prevention recommendations for military service members and international travelers to the country. Laboratory-confirmed cases of malaria documented at large medical facilities and within military and civilian health care systems in the Republic of Djibouti from 1998 to 2009 were reviewed. In recent years, fewer than 5% of febrile cases among the three largest passive surveillance systems were laboratory-confirmed as malaria, and incidence of confirmed malaria was well below 1/1,000 persons/year. As efforts in the Republic of Djibouti progress toward elimination, and in conjunction with continued efforts at surveillance, emphasizing mosquito-avoidance measures and standby emergency treatment will become reasonable recommendations for malaria prevention.

Use of short message service (SMS) to improve malaria chemoprophylaxis compliance after returning from a malaria endemic area.

BACKGROUND: Malaria chemoprophylaxis compliance is suboptimal among French soldiers despite the availability of free malaria chemoprophylaxis and repeated health education before, during and after deployment to malaria endemic areas. METHODS: In 2007, a randomized controlled study was performed among a cohort of French soldiers returning from Côte d'Ivoire to assess the feasibility and acceptability of sending a daily short message service (SMS) reminder message via mobile device to remind soldiers to take their malaria chemoprophylaxis, and to assess the impact of the daily reminder SMS on chemoprophylaxis compliance. Malaria chemoprophylaxis consisted of a daily dose of 100 mg doxycycline monohydrate, which began upon arrival in Côte d'Ivoire and was to be continued for 28 days following return to France. Feasibility and acceptability were assessed by questionnaire. Cohort members were followed for a 28 day period, with compliance assessed by use of an electronic medication monitoring device, from which several indicators were developed: daily proportion of compliant individuals, average number of pills taken, and early discontinuation. RESULTS: Among 424 volunteers randomized to the study, 47.6% were assigned to the SMS group and 52.3% to the control group. Approximately 90% of subjects assigned to the SMS group received a daily SMS at midday during the study. Persons of the SMS group agreed more frequently that SMS reminders were very useful and that the device was not annoying. Compliance did not vary significantly between groups across the compliance indicators. CONCLUSION: SMS did not increase malaria chemoprophylaxis compliance above baseline, likely because the persons did not benefit from holidays after the return and stayed together. So the reminder by SMS was noted by all subjects of the study. Another study should be done to confirm these results on soldiers going on holidays from employment after return or with individual travellers.

Chemoprophylaxis compliance in a French battalion after returning from malaria-endemic area.

Incidence of malaria is increasing in travelers and soldiers. In 2006, a survey was performed in a French battalion returning from a malaria-endemic area. According to the chemoprophylaxis plasma concentration and the individuals' reports, the noncompliance rates were high, respectively, 63.4 and 54.7%.

Health indicators in children from Meulaboh, Indonesia, following the tsunami of December 26, 2004.

The French Army medical service carried out an epidemiological survey to estimate health indicators in children living in Meulaboh, Indonesia, in the weeks following the tsunami of December 26, 2004, within a sample from refugee camps, schools, and quarters of the town. Thirty-four percent of the children in camps, 21.9% in schools, and 49.5% from quarters presented psychological trauma. Malnutrition affected 20.5% in camps and 34.4% in the town between 6 and 59 months, 11.3% in camps, and 7.6% in schools between 6 and 15 years. The children had suffered various symptoms since the tsunami; access to care was possible for 53.9% in the camps, 23.8% from schools, and 39.3% from the town. Those results have been subsequently used by the local health authorities to improve child health care. The method used for this survey could be applied for future disaster scenarios.