Improving compliance with malaria chemoprophylaxis in Afghanistan. 2012

Paul Brisson, and Michael Woll, and Michael Brisson
Department of Surgery, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA. paul.brisson@us.army.mil

OBJECTIVE Historically, compliance with malaria chemoprophylaxis by military service members (MSM) has been notoriously low, ranging from 30 to 56%. Since 2002, 28 to 85 cases per year of malaria have occurred in MSM deployed to Afghanistan. During their deployment to Afghanistan, the authors identified a low compliance rate with malaria chemoprophylaxis. A performance improvement project was developed to improve compliance. METHODS In July 2011, a performance improvement plan was developed to improve malaria chemoprophylaxis compliance in MSM arriving on a remote base in western Afghanistan. The plan included a 15-minute briefing and a medical consultation for MSM who had discontinued their chemoprophylaxis because of side effects. At the conclusion of their deployment, the MSM were surveyed on their compliance. RESULTS Ninety-four MSM attended the briefings. Eighty (85%) MSM completed the survey in October 2011. Ninety-eight percent were taking doxycycline (n = 78). Ninety percent (n = 72) reported that they were compliant with their chemoprophylaxis. One entire unit (n = 29) was identified to be critically short of doxycycline, which initiated an emergency order for medication. Two noncompliant soldiers requested a consultation concerning side effects and were able to continue their chemoprophylaxis. CONCLUSIONS Personalized in-theater briefings and consultations by knowledgeable providers may improve compliance with malaria chemoprophylaxis in MSM in Afghanistan.

UI MeSH Term Description Entries
D008288 Malaria A protozoan disease caused in humans by four species of the PLASMODIUM genus: PLASMODIUM FALCIPARUM; PLASMODIUM VIVAX; PLASMODIUM OVALE; and PLASMODIUM MALARIAE; and transmitted by the bite of an infected female mosquito of the genus ANOPHELES. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high FEVER; SWEATING; shaking CHILLS; and ANEMIA. Malaria in ANIMALS is caused by other species of plasmodia. Marsh Fever,Plasmodium Infections,Remittent Fever,Infections, Plasmodium,Paludism,Fever, Marsh,Fever, Remittent,Infection, Plasmodium,Plasmodium Infection
D008889 Military Personnel Persons including soldiers involved with the armed forces. Air Force Personnel,Armed Forces Personnel,Army Personnel,Coast Guard,Marines,Navy Personnel,Sailors,Soldiers,Submariners,Military,Force Personnel, Air,Personnel, Air Force,Personnel, Armed Forces,Personnel, Army,Personnel, Military,Personnel, Navy,Sailor,Soldier,Submariner
D004318 Doxycycline A synthetic tetracycline derivative with similar antimicrobial activity. 2-Naphthacenecarboxamide, 4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,5,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-, (4S-(4alpha,4aalpha,5alpha,5aalpha,6alpha,12aalpha))-,Alpha-6-Deoxyoxytetracycline,Atridox,BMY-28689,BU-3839T,Doryx,Doxycycline Calcium,Doxycycline Calcium Salt (1:2),Doxycycline Hemiethanolate,Doxycycline Hyclate,Doxycycline Monohydrate,Doxycycline Monohydrochloride, 6-epimer,Doxycycline Monohydrochloride, Dihydrate,Doxycycline Phosphate (1:1),Doxycycline-Chinoin,Hydramycin,Oracea,Periostat,Vibra-Tabs,Vibramycin,Vibramycin Novum,Vibravenos,Alpha 6 Deoxyoxytetracycline,BMY 28689,BMY28689,BU 3839T,BU3839T,Doxycycline Chinoin,Doxycycline Monohydrochloride, 6 epimer,Vibra Tabs
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000346 Afghanistan Country located north and west of Pakistan, and east of Iran. The capital is Kabul.
D000962 Antimalarials Agents used in the treatment of malaria. They are usually classified on the basis of their action against plasmodia at different stages in their life cycle in the human. (From AMA, Drug Evaluations Annual, 1992, p1585) Anti-Malarial,Antimalarial,Antimalarial Agent,Antimalarial Drug,Anti-Malarials,Antimalarial Agents,Antimalarial Drugs,Agent, Antimalarial,Agents, Antimalarial,Anti Malarial,Anti Malarials,Drug, Antimalarial,Drugs, Antimalarial
D014481 United States A country in NORTH AMERICA between CANADA and MEXICO.
D055118 Medication Adherence Voluntary cooperation of the patient in taking drugs or medicine as prescribed. This includes timing, dosage, and frequency. Drug Adherence,Drug Compliance,Medication Compliance,Medication Nonadherence,Medication Non-Adherence,Medication Non-Compliance,Medication Noncompliance,Medication Persistence,Adherence, Drug,Adherence, Medication,Compliance, Drug,Compliance, Medication,Medication Non Adherence,Medication Non Compliance,Non-Adherence, Medication,Non-Compliance, Medication,Nonadherence, Medication,Noncompliance, Medication,Persistence, Medication
D055826 Afghan Campaign 2001- Multinational coalition military operation initiated in October 2001 to counter terrorism and bring security to AFGHANISTAN in collaboration with Afghan forces. Afghan War, 2001-,Operation Enduring Freedom,2001- Afghan War,2001- Afghan Wars,Afghan War, 2001,Afghan Wars, 2001-,Operation Enduring Freedoms,War, 2001- Afghan,Wars, 2001- Afghan
D018890 Chemoprevention The use of chemical compounds to prevent the development of a specific disease. Chemoprophylaxis

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