Compliance of malaria chemoprophylaxis among travelers to India

Background: Compliance is an important issue in malaria chemoprophylaxis. The objective of the study was to determine reasons for noncompliance with chemoprophylaxis among international travelers to India. Methods: A group of 452 subjects traveling in the subcontinent were interviewed by directly administered questionnaire at two selected locations in Calcutta during October 1992. Full compliance was defined as the uninterrupted use of drugs, as per the World Health Organization (WHO) schedule, during travel up to the date of interview. Results: Overall, the sample had a male preponderance (61%), with 155 (34%) being business travelers and 56% traveling for more than 3 weeks. Of the 158 (35%) reporting illness during travel, 5 persons tested positive for malaria. Compliance with chemoprophylaxis noted among 320 (71%) respondents in comparison to 21 (5%) found taking inadequate dosage or incorrect medication and 111 (24%) travelers being without any drugs. Backpackers and ethnic travelers as a group reported lower usage. Female, first visit and long-term travelers were less compliant. Inadequacy in pretravel advice, discontinuation due to side effects and active decision despite pretravel advice were common reasons for noncompliance. Past travel experience, concern for side effects, perceived uselessness and confusion arising from alternative regimens were also found to have influenced the decision making. Conclusion: We need to address the identified areas of conflict especially during pretravel counseling since improving compliance is our primary goal in malaria prevention among travelers today.