Malaria prophylaxis in long-term expatriate mineworkers in Ghana.

The role of malaria chemoprophylaxis for long-term expatriates has not been re-evaluated since the emergence of widespread multidrug resistance. A survey of 106 expatriates working in a mine in Ghana (holoendemic for malaria) was conducted to determine the compliance with malaria chemoprophylaxis. Overall 64 per cent took regular chemoprophylaxis. Of the long-term expatriates (5 or more years in areas with holoendemic malaria), 48.4 per cent either took malaria prophylaxis very irregularly or not at all. The main reasons for failing to comply were fear of long-term side effects and conflicting advice on prophylaxis. This reluctance to take long-term chemoprophylaxis highlights the need to re-emphasise the importance of anti-mosquito measures, prompt treatment of fevers, and perhaps consider abandoning chemoprophylaxis in those expatriate workers with ready access to hospital care.