[Malaria prophylaxis and self-care 1990--problems and current solutions]. / Malariaprophylaxe und Selbsttherapie 1990--Probleme und aktuelle Lösungen.

For successful malaria prophylaxis, future travelers need to be informed about the risks of infection and about systematic measures to be taken against mosquito bites. For visits in areas of high transmission, continuous chemoprophylaxis is recommended, whereas in regions with low transmission a stand-by medication for self-therapy is sufficient. Each of these four measures has some problems which are discussed here in addition to the recently published recommendations by the Swiss Working Group for Medical Advice to Travelers.

[Malaria prophylaxis of West German travelers to Africa]. / Malaria-Prophylaxe bundesdeutscher Afrikareisender.

From May 1985 to July 1988, 11,445 German residents who had travelled to Africa filled in a questionnaire during the return flight and a second questionnaire sent to them 3 months later. 92.6% of the travellers had been on holiday and 99.3% of these holiday-makers were aware of the risk of malaria. Before and during their stay in the tropics 10,955 travellers (95.7%) had taken the chemoprophylaxis correctly, though in some instances the drugs prescribed were not in accordance with the guidelines existing at the time. However, 3227 of them (35.5%) discontinued the drugs too early, i.e. less than four weeks after their return. Only 4.3% of the travellers had taken proper precautions against mosquito bites. In view of the ever increasing numbers of people travelling to countries where malaria is endemic, doctors and travelers should be provided with more information and should be given more consistent advice on malaria prophylaxis.

Malaria chemoprophylaxis among European tourists in tropical Africa: use, adverse reactions, and efficacy.

In order to determine knowledge, attitudes and practices towards malaria prophylaxis, as well as its side-effects and efficacy, a self-administered questionnaire was distributed to European travellers on return flights from tropical Africa to Europe. Between 1985 and 1988 the questionnaire was completed by 44,472 passengers (80.1% of those on board) on 242 flights. A follow-up questionnaire was completed by 42,202 (94.9%) of the same travellers 3 months later. Almost all knew about the risk of malaria, but 10% relied solely on advice from nonmedical sources. While 55.6% had taken at least one measure against mosquito bites, only 4.5% adopted three such measures (used repellents and insecticides and wore long clothing after dusk). Compliance with chemoprophylaxis use was reported by 57.0% of travellers who spent less than 3 months in Africa, compared with 29.2% who stayed 3-12 months. Depending on the antimalaria regimen taken, 11-44% of the travellers experienced adverse effects, while four deaths were attributed to the chemoprophylaxis. The incidence of malaria per month of exposure for travellers who took no chemoprophylaxis was 15.2 per 1000 in East Africa and 24.2 per 1000 in West Africa. In East Africa, the prophylactic efficacy of the currently recommended antimalaria regimens (relative to that of no chemoprophylaxis) was zero for a chloroquine dosage of 300 mg base per week (4 malaria fatalities), 64.1% for a chloroquine dosage of 600 mg base per week (P = 0.03), and 94.0% for mefloquine (P = 0.003).

Malaria chemoprophylaxis among European tourists in tropical Africa : use; adverse reactions; and efficacy

In order to determine knowledge, attitudes and practices towards malaria prophylaxis, as well as its side-effects and efficacy, a self-administered questionnaire was distributed to European travellers on return flights from tropical Africa to Europe. Between 1985 and 1988 the questionnaire was completed by 44,472 passengers (80.1% of those on board) on 242 flights. A follow-up questionnaire was completed by 42,202 (94.9%) of the same travellers 3 months later. Almost all knew about the risk of malaria, but 10% relied solely on advice from nonmedical sources. While 55.6% had taken at least one measure against mosquito bites, only 4.5% adopted three such measures (used repellents and insecticides and wore long clothing after dusk). Compliance with chemoprophylaxis use was reported by 57.0% of travellers who spent less than 3 months in Africa, compared with 29.2% who stayed 3-12 months. Depending on the antimalaria regimen taken, 11-44% of the travellers experienced adverse effects, while four deaths were attributed to the chemoprophylaxis. The incidence of malaria per month of exposure for travellers who took no chemoprophylaxis was 15.2 per 1000 in East Africa and 24.2 per 1000 in West Africa. In East Africa, the prophylactic efficacy of the currently recommended antimalaria regimens (relative to that of no chemoprophylaxis) was zero for a chloroquine dosage of 300 mg base per week (4 malaria fatalities), 64.1% for a chloroquine dosage of 600 mg base per week (P = 0.03), and 94.0% for mefloquine (P = 0.003)