Malaria prevention behaviour and risk awareness in French adult travellers

Travellers from Europe to tropical areas risk acquiring malaria against which they have no immunity. The objective of this study was to assess malaria protection measures in European travellers as a function of the risk of infection with malaria. This questionnaire-based, retrospective study evaluated 13,017 French adults. 3066 travellers to malaria-endemic countries were identified and data collected on duration and purpose of stay, knowledge of malaria, use of mechanical protection measures and chemoprophylaxis. Complete data on protection measures were available for 2225 travellers to malaria risk countries. Mechanical protection was used by 1735/2225 of travellers (94.9% of travellers to high-risk areas and 80.4% of travellers to low-risk areas). Appropriate chemoprophylaxis use rates were 47.6% for high-risk areas versus 9.5% for low-risk areas. Chemoprophylaxis compliance was low, even in the case of travellers to high risk areas (18.2%). Many travellers (38%) were unaware that malaria was potentially fatal. The only variables significantly associated with compliant use of appropriate chemoprophylaxis were awareness that malaria was serious (odds-ratio: 2.03; p=0.033) and receiving malaria information from a physician (odds-ratio: 3.01; p=0.042). Use of malaria chemoprophylaxis is very inadequate. Education campaigns are needed to improve the use of chemoprophylaxis and thus minimise the risk of acquiring malaria.