Antimosquito precautions and medical chemoprophylaxis in French children with malaria

Background. France is the European country with the highest number of imported malaria cases (7,500 in 2000). The aim of this prospective study was to evaluate the nature and efficacy of prophylactic measures in children under 15 years of age referred for malaria. Methods: Posttravel questionnaires were given to the parents of malarial children in the emergency room. The studytook place in two university hospitals in Marseilles, southern France, from August to October 2001. Results: Eighty-eight children under 15 years of age were included in this 3-month period. Most of them had been infected in Comoro archipelago. Almost two-thirds used bed nets, but only 47% did so every night. Sprayed bed nets were used by 23%. Average compliances with cutaneous repellents, bedroom repellents and long-sleeved clothing were 32%, 24% and 26%, respectively. Airconditioners were uncommon. Only 22% of the children used chemoprophylaxis correctly, according to French recommendations. Five percent did not use any chemoprophylaxis, and 61% reported nonrecommended drug use. Although all the children traveled to chloroquine-resistant areas, chemoprophylaxis with mefloquine was less common than that with chloroquine + proguanil. No child fully complied with French recommendations concerning both antimosquito measures and chemoprophylaxis. Conclusions: Insufficient use of antimalaria precautions by traveling families is associated with the high incidence of pediatric imported malaria in southern France. Travelers' education should be increased to allow the optimization of malaria prophylaxis.