Factors determining use of pre-travel preventive health services by West African immigrants in The Netherlands.

OBJECTIVE: To determine for what reasons West African immigrants, who contribute the largest single group of malaria cases in the Netherlands, visit pre-travel preventive health services and whether use of such services is likely to improve use of preventive measures. METHODS: Semi-structured interviews with eligible participants recruited through West African churches and societies and at a large festival. RESULTS: A total of 70% of the total non-random sample of 292 participants said that they always use pre-travel preventive health services before travelling. Being from Ghana (OR = 2.5), having legal residency status (OR = 2.5), visiting friends and relatives rather than going for business or funeral (OR = 6.7), and living in Amsterdam (OR = 5.1) were all independently associated with using pre-travel preventive health services, as were taking general preventive measures (OR = 3.0), and self-reported use of malaria prophylaxis. Higher use of pre-travel preventive health services was not associated with better knowledge of malaria as such. CONCLUSIONS: West Africans, in particular non-Ghanaians, illegal immigrants and West African immigrants leaving at short notice should be encouraged to use pre-travel preventive health services. Adequate methods to reach these groups need to be developed, including health education on the importance of prevention in general.

Atovaquone-proguanil versus chloroquine-proguanil for malaria prophylaxis in nonimmune pediatric travelers: results of an international, randomized, open-label study.

Atovaquone-proguanil has been shown to be effective and well tolerated for malaria prophylaxis in residents of countries of endemicity and in nonimmune adult travelers, but data about traveling children are limited. In a randomized, open-label, multicenter prophylaxis trial, 221 nonimmune pediatric travelers (age, 2-17 years) received either atovaquone-proguanil or chloroquine-proguanil. Safety and clinical outcome were evaluated 7, 28, and 60 days after travel. By posttravel day 7, a total of 39 (35%) of 110 atovaquone-proguanil and 41 (37%) of 111 chloroquine-proguanil recipients reported > or =1 adverse event. The data indicate that, over the course of treatment, fewer atovaquone-proguanil recipients had treatment-related adverse events (8% vs. 14%), including gastrointestinal complaints (5% vs. 10%). Two subjects discontinued prophylaxis because of drug-related adverse events; both had received chloroquine-proguanil. Observed compliance with prophylaxis was similar before and during travel, but it was higher for atovaquone-proguanil in the posttravel period. No study participant developed malaria. Atovaquone-proguanil was well tolerated and is an important addition to the limited arsenal of prophylactic agents available to children.

Utilisation of malaria prophylaxis: the effect of changes in guidelines in The Netherlands, 1993-1998.

INTRODUCTION: The increase in international travelling from temperate zones to tropical countries and increasing drug resistance of Plasmodium falciparum has resulted in a growing number of travellers that are at risk for contracting malaria. The objective of this study was to obtain insight into dispensing patterns of malaria chemoprophylaxis and to determine whether health care providers have followed changes in guidelines. METHODS: Data on prescriptions of proguanil and mefloquine were obtained from the Dutch 'Foundation for Pharmaceutical Statistics' (SFK) covering the period 1 January 1993 up to 31 December 1998. From Statistics Netherlands (SN), we obtained the number of travellers to endemic areas during the years 1994-1998. RESULTS: There were 420,963 prescriptions for mefloquine and 464,904 for proguanil dispensed during the study period. The total number of prescriptions for malaria chemoprophylaxis increased during the period 1993-1997 from 98,325 (of which 14,427 (14.7%) for mefloquine and 83,898 (85.3%) for proguanil) to 168,452 (of which 90,232 (53.6%) for mefloquine and 78,220 (46.4%) for proguanil). The number of prescriptions per 1000 travellers decreased over the years for proguanil from 169 to 118 but remained stable for mefloquine at 126. The average duration for which mefloquine was prescribed remained stable, whereas the average duration for which proguanil was prescribed decreased over time. We observed differences in the prescription rate of prescriptions for mefloquine between geographical regions in the Netherlands. CONCLUSION: Changes in the guidelines of malaria prophylaxis with respect to type and duration were generally followed by health care providers. Nevertheless there are variations between the regions in the proportion of prescribed courses of mefloquine.