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Nurses concerned by lack of compliance with antimalarials

A survey of travel health nurses conducted by GlaxoSmithKline at a recent malaria study day organised by the Royal College of Nursing and the British Travel Health Association reveals that 25 of the 38 nurses questioned rarely, if ever, learn whether patients complete their course of antimalarial treatment.

In response to the survey, Jane Chiodini, a travel health specialist nurse, has called for better information on compliance among travellers who have been prescribed antimalarials.

Moreover, the same number of nurses admitted when questioned that they were also not likely to hear if a patient caught malaria on their travels: 25 out of the 38 said that they would 'never', 'rarely' or only 'sometimes' expect to learn if one of their patients became infected.

One of the nurses surveyed explained that it is often difficult to monitor how well patients fare on a particular antimalarial and there is therefore limited opportunity to learn from cases where a treatment is discontinued:

"If I work in a GP's surgery then very often my patients come back for further travel [advice] so I would get to ask them and to find out if they had any contraindications or side effects that stopped them taking their antimalarial. But if I work in a private clinic it is a bit like buying something from a supermarket: very often a patient will come in, buy their antimalarials and they are not going to come back."

Encouragingly, all of the nurses surveyed rated completing a course of antimalarials as important or very important in protection against malaria.

Although they correctly recognised that completing a full course of treatment is essential (the malaria parasite can exist in the body some time after infection), they also believed that many of their patients fail to do this in reality – two of the nurses surveyed even estimated that four out of every five patients do not actually manage to complete their antimalarial treatment. 

"More needs to be done to ensure that nurses have an accurate picture of compliance among travellers who are prescribed malaria prevention tablets and the possible reasons for non-compliance," explained Jane Chiodini.

"This information would enable us to communicate the extreme importance of completing the chosen course and provide more effective education. It would also help inform us to advise which antimalarial would best suit the individual traveller thus offering the greatest protection against this potentially lethal disease."

British Travel Health Association