Preventing malaria in international travellers: an evaluation of published English-language guidelines

Background: People intending to travel may seek information on malaria prevention from a range of sources. To ensure the best protection, this information needs to be reliable, up-to-date, consistent, and useful to their decision making. This study appraises current international and national guidelines written in English for malaria prevention in travellers, and whether any recommendations conflict. Methods: We systematically identified national or international English-language guidelines on malaria prevention in travellers to July 2013 using standard and multiple searching methods. We critically appraised guidelines using the AGREE II tool, and report inconsistent recommendations within guidelines. Results: We identified five sets of English-language guidelines on preventing malaria for travellers. Assessment against AGREE II indicate that all of the guidelines fall short of internationally accepted standards in guideline development: none include a transparent description of methods; only one describes sources of funding or potential conflicts of interest; and only one includes formal presentation of the evidence alongside transparent assessment of the quality of that evidence. There were a number of important discrepancies between guidelines, and some omit information about effectiveness, safety and adverse effects of chemoprophylaxis options. Conclusions: The methods used for developing guidelines for malaria prevention in travellers lags behind current internationally recognized standards. Healthcare professionals as well as travellers themselves could be better informed if guidelines were more systematic and transparent summaries of the current knowledge on drug interventions in relation to effects, safety, administration and contra-indications.