Compliance with antimalarial chemoprophylaxis and malaria infection : a case-control study

Objective. To determine if there is a difference in compliance with antimalarial chemoprophylaxis between travellers with and without malaria. Secondarily, to determine if clinical presentation can be used in predicting malaria infection.Design. Case-control study.Subjects. 157 patients with malaria and recent travel to a malaria-endemic area and 157 matched controls.Results. 152 (48%) of all patients had antimalarial chemoprophylaxis prescribed. Chemoprophylaxis use was correlated with region and purpose of travel. Cases were less likely to have been compliant (53%) than controls (76%) (OR = 0.35 (0.27,0.73)).Fever pattern, symptom duration, temperature, splenomegaly, and platelet count were correlated with malaria infection. These criteria, either singly, or in combination, had low sensitivity.Conclusions. Compliance with antimalarial chemoprophylaxis is protective against the subsequent development of malaria. Travel agents and health practitioners should provide travellers with adequate information about chemoprophylaxis.Because no criterion could accurately predict the presence of malaria, testing for malaria should be done in all symptomatic patients with a history of travel to a malaria-endemic area