Factors associated with malaria chemoprophylaxis compliance among French service members deployed in Central African Republic

Marie-Aude Créach (1) , Guillaume Velut (1) , Franck De Laval (1, 2) , Sébastien Briolant (3, 4, 5) , Luc Aigle , Catherine Marimoutou (1, 2) , Xavier Deparis (2, 1) , Jean-Baptiste Meynard (6, 1, 2, 7) , Bruno Pradines (3, 8) , Fabrice Simon (9) , Remy Michel (1) , Aurélie Mayet (2, 1)

1 CESPA - Centre d'épidémiologie et de santé publique des armées [Marseille]
2 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
3 URMITE - Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes
4 Direction Interarmées du Service de Santé [Cayenne, Guyane française]
5 Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie
6 Institut Pasteur de la Guyane
7 EVDG - École du Val de Grâce
8 Centre National de Référence du Paludisme
9 Service de Pathologie Infectieuse et Tropicale [HIA Laveran, Marseille]

Background: Malaria is a public health concern in the French armed forces, with 400-800 cases reported every year and three deaths in the past 2 years. However, lack of chemoprophylaxis (CP) compliance is often reported among service members. The aim of this study was to explore factors associated with CP compliance. Methods: A retrospective study (1296 service members) was carried out among troops deployed in Central African Republic. Determinants of CP were collected by self-questionnaire. Socio-demographic variables, behavioural characteristics, belief variables, operational determinants such as troops in contact (TIC) and number of nights worked per week and peer-to-peer reinforcement were studied. Relationships between covariates and compliance were explored using logistic regressions (outcome: compliance as a dummy variable). Results: Chemoprophylaxis compliance was associated with other individual preventive measures against mosquito bites (bed net use, OR (odds ratio) = 1.41 (95 % CI [1.08-1.84]), and insecticide on clothing, OR = 1.90 ([1.43-2.51]) and malaria-related behaviours (taking chemoprophylaxis at the same time every day, OR = 2.37 ([1.17-4.78]) and taking chemoprophylaxis with food, OR = 1.45 ([1.11-1.89])). High perceived risk of contracting malaria, OR = 1.59 ([1.02-2.50]), positive perception of CP effectiveness, OR = 1.62 ([1.09-2.40]) and the practice of peer-to-peer reinforcement, OR = 1.38 ([1.05-1.82]) were also associated with better compliance. No association was found with TIC and number of nights worked. Conclusions: This study, which shows a positive relationship between peer-to-peer reinforcement and CP compliance, also suggests the existence of two main personality profiles among service members: those who seek risks and those who are health-conscious. Health education should be expanded beyond knowledge, know-how and motivational factors by using a comprehensive approach based on identification of health determinants, development of psychosocial skills and peer-to-peer reinforcement.

Mots clés: Armed forces; Malaria; Chemoprophylaxis; Compliance; Health education; Peer-to-peer reinforcement

Domaines: Maladies infectieuses; Santé publique et épidémiologie

Marie-Aude Créach, Guillaume Velut, Franck De Laval, Sébastien Briolant, Luc Aigle, et al.. Factors associated with malaria chemoprophylaxis compliance among French service members deployed in Central African Republic. Malaria Journal, 2016, 15, pp.174. ⟨10.1186/s12936-016-1219-4⟩. ⟨hal-01459565⟩