Determinants of compliance with anti-vectorial protective measures among non-immune travellers during missions to tropical Africa

• Published in: Malaria journal Vol. 10; no. 1; p. 232
• Main Authors: Sagui, Emmanuel, Resseguier, Noémie, Machault, Vanessa, Ollivier, Lénaïck, Orlandi-Pradines, Eve, Texier, Gaetan, Pages, Frédéric, Michel, Remy, Pradines, Bruno, Briolant, Sébastien, Buguet, Alain, Tourette-Turgis, Catherine, Rogier, Christophe
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.08.2011; BioMed Central; BMC
• Subjects: Adult; Africa; Animals; Antimalarials; Causes of; Cognitive ability; Cohort Studies; Compliance; Dosage and administration; Drug therapy; Family medical history; Female; Health aspects; Health risks; Human diseases; Humans; Immune response; Immunity; Insect bites; Insect Repellents; Insect Repellents - therapeutic use; Insecticide-Treated Bednets; Insecticide-Treated Bednets - utilization; Insecticides; Life Sciences; Malaria; Malaria - prevention & control; Male; Mosquito Control; Mosquito Control - methods; Nets; Patient Compliance; Patient Compliance - statistics & numerical data; Perception; Pest control; Prevention; Prospective Studies; Protective Clothing; Protective Clothing - utilization; Questionnaires; Regression analysis; Repellents; Studies; Surveys and Questionnaires; Tobacco; Training; Travel; Travellers; Tropical Climate; Tropical diseases; Variables; Vector-borne diseases; Africa; Djibouti; Gabon; United States > US; Senegal; Central African Republic; Ivory Coast
• DOI: 10.1186/1475-2875-10-232
• ISSN: 1475-2875

The effectiveness of anti-vectorial malaria protective measures in travellers and expatriates is hampered by incorrect compliance. The objective of the present study was to identify the determinants of compliance with anti-vectorial protective measures (AVPMs) in this population that is particularly at risk because of their lack of immunity. Compliance with wearing long clothing, sleeping under insecticide-impregnated bed nets (IIBNs) and using insect repellent was estimated and analysed by questionnaires administered to 2,205 French military travellers from 20 groups before and after short-term missions (approximately four months) in six tropical African countries (Senegal, Ivory Coast, Chad, Central African Republic, Gabon and Djibouti). For each AVPM, the association of "correct compliance" with individual and collective variables was investigated using random-effect mixed logistic regression models to take into account the clustered design of the study. The correct compliance rates were 48.6%, 50.6% and 18.5% for wearing long clothing, sleeping under bed nets and using repellents, respectively. Depending on the AVPM, correct compliance was significantly associated with the following factors: country, older than 24 years of age, management responsibilities, the perception of a personal malaria risk greater than that of other travellers, the occurrence of life events, early bedtime (i.e., before midnight), the type of stay (field operation compared to training), the absence of medical history of malaria, the absence of previous travel in malaria-endemic areas and the absence of tobacco consumption.There was no competition between compliance with the different AVPMs or between compliance with any AVPM and malaria chemoprophylaxis. Interventions aimed at improving compliance with AVPMs should target young people without management responsibilities who are scheduled for non-operational activities in countries with high risk of clinical malaria. Weak associations between compliance and history of clinical malaria or variables that pertain to threat perception suggest that cognition-based interventions referencing a "bad experience" with clinical malaria could have only a slight impact on the improvement of compliance. Further studies should focus on the cognitive and behavioural predictors of compliance with AVPMs.