Enabling Factors for Improved Malaria Chemoprophylaxis Compliance

The article, “Compliance with Antimalaria Chemoprophylaxis in a Combat Zone,” confirmed the limited adherence to such preventive measures among military service members. The authors analyzed the reasons for noncompliance while presenting measures undertaken to address them. These measures include education and training, supply of medicines before departure, directly observed therapy, and an established discipline policy with consequences rarely applied but supported by the laws of the Uniform Code of Military Justice. Given the importance of malaria chemoprophylaxis, solutions are needed urgently to address this critical weakness in malaria prevention and control systems, not just for troops but all other non-immune travelers and residents. Poor compliance affects the health of individuals improperly taking the medications. It has the potential to roll back the current gains in malaria control efforts in endemic countries by creating resistance and allowing the re-emergence of parasites in areas that have seen an impressive decline in parasitemia. For more than a decade, ExxonMobil has assigned thousands of non-immune workers in malaria-endemic countries. They face the same compliance challenges as the United States military service members and other long-term travelers. In 2003, at the inception of our operations in malaria-endemic locations, more than 200 malaria cases were reported. Our strategic response to this was the implementation of a comprehensive malaria program and its integration into the health and safety procedures of our company organizations. As a result, malaria cases decreased to < 15 per year. The workplace malaria program measures are targeted at individual employees and contractors; they are also embedded into the verification and reporting systems of company operations. They include: