Improving compliance with malaria chemoprophylaxis in Afghanistan

• Published in: Military medicine 2012-12, Vol.177 (12), p.1539-1542
• Main Authors: Brisson, Paul, Woll, Michael, Brisson, Michael
• Format: Article
• Language: English
• Subjects: Afghan Campaign 2001; Afghanistan; Antimalarials - therapeutic use; Chemoprevention; Doxycycline - therapeutic use; Humans; Malaria - prevention & control; Medication Adherence - statistics & numerical data; Military Personnel; United States
• ISSN: 0026-4075; 1930-613X
• DOI: 10.7205/MILMED-D-12-00215

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. 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. 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. Personalized in-theater briefings and consultations by knowledgeable providers may improve compliance with malaria chemoprophylaxis in MSM in Afghanistan.