Knowledge, attitudes and practices of expatriates towards malaria chemoprophylaxis and personal protection measures on a mine in Mali.

A questionnaire survey of malaria chemoprophylaxis knowledge, attitudes, and practices of 90 expatriates on a Mali mine yielded 68 (75.5%) responses. A total of 49 (72%) subjects took perennial chemoprophylaxis, 6 (9%) were children <5 years. Out of 68, 13 (19%) took chemoprophylaxis during the high transmission season only and 10 (15%) never took chemoprophylaxis. Reasons advanced for not taking chemoprophylaxis were concern over adverse effects, presumed immunity from long term residence in Africa, and on site access to quality medical care. Chemoprophylactics used were: atovaquone-proguanil 1 (2%); chloroquine and proguanil 15 (30%); doxycycline 16 (33%); mefloquine 17 (35%). Thirteen out of 49 (27%) subjects admitted to missing chemoprophylaxis doses and 15/68 (22%) had suffered malaria while on chemoprophylaxis. Fifteen out of 49 (31%) low season chemoprophylaxis users and 4/19 (21%) non-users contracted low season malaria (chi(2), p=0.63). A total of 46 (68%) used insect repellants, 50 (74%) used insecticide sprays or coils in rooms, 9 (13%) slept under insecticide treated nets. Malaria control in expatriates requires improvement; additional strategies for consideration that require reduced compliance requirements by expatriates are suggested, including residual spraying, seasonal chemoprophylaxis use, and emergency stand by medication.