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Malaria Journal

, 7:128

First Online: 14 July 2008Received: 31 March 2008Accepted: 14 July 2008


BackgroundFalciparum malaria remains a major occupational illness that accounts for several deaths per year and numerous lost working days among the expatriate population, working or living in high-risk malarious areas. Compliance to preventive strategies is poor in travellers, especially business travellers, expatriates and long-term travellers.

MethodsIn this cross-sectional, web-based study the adherence to and outcome of a preventive malaria programme on knowledge, attitudes and practices, including the practice of self-diagnosis and standby treatment curative malaria kit, CMK was evaluated in 2,350 non-immune expatriates, who had been working in highly malaria endemic areas.

ResultsOne-third N = 648 of these expatriates visited a doctor for malaria symptoms and almost half 29 of 68 of all hospitalizations were due to malaria. The mandatory malaria training for non-immunes was completed by 92% of those who visited or worked in a high risk malaria country; 70% of the respondents at risk also received the CMK. The malaria awareness training and CMK significantly increased malaria knowledge relative risk RR of 1.5, 95%CI 1.2–2.1, attitudes and practices, including compliance to chemoprophylaxis RR = 2.2, 95%CI 1.6–3.2. Hospitalization for malaria tended to be reduced by the programme RR = 0.4, 95%CI 0.1–1.1, albeit not significantly. Respondents who did not receive instructions on the rapid diagnostic test were two times RR = 2.3, 95%CI 1.6–3.3 more likely to have difficulties. Those who did receive instructions adhered poorly to the timing of repeating the test. Moreover, 6% 31 of 513 of those with a negative test result were diagnosed with malaria by a local doctor. 77% N = 393 of the respondents with a negative test result did not take curative medication. 57% 252 of 441 of the respondents who took the curative medication that was included in the kit did not have a positive self-test or clinical malaria diagnosis made by a doctor.

ConclusionThis survey demonstrated that a comprehensive programme targeting malaria prevention in expatriates can be effectively implemented and that it significantly increased malaria awareness.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2875-7-128 contains supplementary material, which is available to authorized users.

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Autor: Anna H Roukens - Johannes Berg - Alex Barbey - Leo G Visser


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