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Published on: July 17, 2014
[Malaria prevention: the general practitioners experience on the Reunion Island]
S Di Bernardo1, B Guihard, G Wartel
1CHR Félix-Guyon, Saint-Denis, La Réunion, France. serv-bert@orange.fr
Abstract:
Malaria has been officially eradicated from the Reunion Island since 1979. However, a potentially active vector of the disease - Anopheles arabiensis - persists on the island. The risk of resurgence is quite significant. More than 90%of the patients presenting a malarial infection in Reunion Island after a stay in Madagascar or in the Comoros had followed a chemoprophylaxis that was not in accordance with the guidelines. A survey, that included 100 general practitioners, wasconducted in the Reunion Island regarding their practices concerning the malaria prevention. The upshot of all this is that these doctors themselves do not follow the optimal malaria prevention practices during journeys, and neglect their protection against mosquito bites. Travelers' consultations with the doctors before a journey represent only a modest part of their activity. However, the general practitioner is considered to be the interlocutor of choice for these patients. During these consultations, they do not refer enough to the national references which, according to a number of practitioners, are difficult to obtain. On the contrary, they refer too much to the information delivered by the pharmaceutical industry. With regard to the prescriptions of prophylactic treatments, only 40% of the doctors respect the official recommendations. This gap in the recommendations is sometimes deliberate and justified by the very high cost of a number of treatments. However, a lack of up-to-date knowledge cannot be excluded. Finally, the promotion of the protection against mosquito bites remains very poor. According to these data, it seems important to promote networking between the doctors and the reference centers, which would enhance optimal practices concerning chemoprophylaxis and protection against mosquito bites, especially targeting the "at risk" patients.
Insights
Malaria prevention practices among Reunion Island general practitioners are suboptimal, with many not adhering to guidelines for chemoprophylaxis or mosquito bite protection. This increases the risk of malaria resurgence despite official eradication.
Area of Science:
- Medical Entomology
- Tropical Medicine
- Public Health
Background:
- Malaria officially eradicated from Reunion Island in 1979, but the persistent vector Anopheles arabiensis poses a resurgence risk.
- A significant proportion of malaria cases in Reunion Island are imported by travelers from endemic regions like Madagascar and Comoros.
- Many imported malaria cases involved patients who did not follow recommended chemoprophylaxis regimens.
Purpose of the Study:
- To assess the malaria prevention practices of general practitioners (GPs) in Reunion Island.
- To identify gaps in GPs' knowledge and adherence to malaria prevention guidelines, including chemoprophylaxis and mosquito bite protection.
- To understand factors influencing GPs' prescribing habits and information sources for malaria prevention.
Main Methods:
- A survey was conducted among 100 general practitioners on Reunion Island.
- The survey focused on their practices regarding malaria prevention, including patient consultations, chemoprophylaxis recommendations, and mosquito bite protection advice.
- Practices were compared against national guidelines and information sources were investigated.
Main Results:
- GPs themselves exhibit suboptimal malaria prevention practices, neglecting mosquito bite protection.
- Only 40% of GPs adhere to official recommendations for malaria chemoprophylaxis prescriptions.
- GPs rely heavily on pharmaceutical industry information and find national references difficult to access, sometimes deliberately deviating from guidelines due to treatment costs.
Conclusions:
- There is a critical need to improve malaria prevention practices among GPs in Reunion Island.
- Enhancing networking between GPs and reference centers is crucial for promoting optimal chemoprophylaxis and mosquito bite protection strategies.
- Targeted interventions are necessary, especially for high-risk travelers, to mitigate the risk of malaria resurgence.
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