Chapter 3 – Prevention-Bite protection measures and malaria education: Canadian recommendations for the prevention and treatment of malaria

An Advisory Committee Statement (ACS) from the
Committee to Advise on Tropical Medicine and Travel (CATMAT)

Updated 2017

Table of contents

Preamble

The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides the Public Health Agency of Canada (PHAC) with ongoing and timely medical, scientific, and public health advice relating to tropical infectious disease and health risks associated with international travel. PHAC acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and medical practices, and is disseminating this document for information purposes to both travellers and the medical community caring for travellers.

Persons administering or using drugs, vaccines, or other products should also be aware of the contents of the product monograph(s) or other similarly approved standards or instructions for use. Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) or other similarly approved standards or instructions for use by the licensed manufacturer(s). Manufacturers have sought approval and provided evidence as to the safety and efficacy of their products only when used in accordance with the product monographs or other similarly approved standards or instructions for use.

Box 1: Advice for travellers

Travellers can greatly reduce their risk of developing malaria by using antimalarial prophylactic drugs (see Chapter 4) and mosquito bite protection measures. To optimize protection, health care providers should emphasize the importance of adhering to recommended malaria prevention practices, including mosquito bite protection, at the pre-travel consultation.

For patients who develop malaria, early diagnosis and treatment are critical. (For more information see Chapter 6 and Chapter 7). All travellers should be informed before travelling to an endemic area that malaria could be the reason for any fever (of unknown etiology) that develops while travelling and for up to one year after returning. If fever occurs, travellers should seek medical attention as soon as possible, irrespective of whether they used chemoprophylaxis. Likewise, health care providers should take a travel history from the presenting patient to help determine the correct diagnosis.

Background

There are a number of safe and efficacious interventions that can be used by travellers to reduce the risk of developing malaria. Their utility, however, is constrained by suboptimal adherence. This chapter discusses education as relates to prevention of malaria, and the values and preferences of travellers that may influence their adherence to preventive measures. It also provides an overview of personal protective measures (PPM) for protection against mosquito bites. More detailed recommendations for PPM are available in the Committee to Advise on Tropical Medicine and Travel (CATMAT)’s Statement on Personal Protective Measures to Prevent Arthropod BitesReference 1.

Methods

General

This chapter of the CATMAT malaria guidelines was developed by a working group comprised of volunteers from the CATMAT committee. Criteria outlined in the CATMAT Statement on Evidence based process for developing travel and tropical medicine related guidelines and recommendationsReference 2, were used to decide whether a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodological approach would be required for this chapter. Malaria education and bite protection interventions utilize approaches that: have no sensible alternative (e.g., it makes no sense to advise travellers not to use bite prevention interventions where such are indicated); and/or, present little or no risk of harm with the potential for substantial benefit (e.g., use of bed nets and repellents to prevent bites). Additionally, and for bite protection specifically, CATMAT already has reviewed the evidence and published a guidelineReference 1. We do not believe that the effort required to apply GRADE in these circumstances is worth its potential payoff; therefore, the committee chose to develop recommendations without GRADE or to base them on existing guidelines (i.e. bite prevention methods). While prudent from the perspective of making best use of limited resources, this decision reduces our ability to make quantitative estimates of harms and benefits, e.g., absolute benefit of an intervention or numbers needed to treat to prevent a case of malaria.

The working group, with support from the secretariat, was responsible for: literature retrieval, synthesis and analysis; development of key questions and draft recommendations; and chapter writing. Based on the evidence compiled as well as expert opinion, recommendations for interventions were made and are summarized in table 3.1.

Systematic literature search

We identified, through committee discussion and consensus, a single key question for which a systematic literature review was undertaken:

  • What are the values and preferences of travellers related to malaria prevention measures (e.g., bed nets, clothing, and window screens)?
  • The following databases were searched for relevant evidence: Ovid MEDLINE, Embase, PubMed, Cochrane, and Scopus. The full search strategy is described in the appendix. Studies were included if (through review of abstracts): the target population(s) included travellers; the intervention(s) included individually-applied measures intended to prevent mosquitoes from biting (chemoprophylaxis was excluded); and, the interventions were intended to reduce exposure to malaria-infected mosquitoes. Evidence developed with/from residents of malaria endemic regions was excluded, as were factsheets, case studies or overviews targeting travellers and/or clinicians. We also used this systematic search to update evidence related to adherence to recommended malaria prevention practices.

Results

The systematic review yielded 83 studies. After removing duplicate records and screening titles and abstracts for relevance, we reviewed 34 full text articles for relevance. Most studies addressed knowledge, attitudes and practices (KAP) related to malaria prevention; however, they did not provide specific evidence related to the values and preferences of travellers for use of bite prevention measures against malaria. Ultimately only one study related to traveller values and preferences was retained.

Values and preferences

A single studyReference 3 that explicitly evaluated the values and preferences of travellers (in low or moderate risk areas) was identified. In this study, patients attending a clinic for a pre-travel consultation were provided with an opportunity to complete a self-administered questionnaire. As part of the assessment, each participant was provided with a decision aide that included information on the risk of malaria and the risk associated with use of preventive intervention. The decision aide is further described in a separate studyReference 4. Patients also received information on costs associated with preventive approaches and were asked to select one of four options for malaria prevention (doing nothing was not included as an option). There was substantial heterogeneity in the choices made by patients, with 26% opting for bite prevention measures alone. While the quality of this evidence is very low (very high risk of bias, very high risk of indirectnessFootnote a), the study highlighted that the values and preferences of patients might be highly divergent regarding preferred approaches for malaria prevention for travel to low or moderate risk areaReference 3. The implication is that informed travellers will make different choices for malaria prevention when risk is relatively modest.

Adherence – The Achilles’ heel of malaria prevention

Non-adherence to recommended malaria prevention practices is commonReference 5, Reference 6, Reference 7, Reference 8, Reference 9, Reference 10, Reference 11, Reference 12, Reference 13, Reference 14, Reference 15, Reference 16, Reference 17. Certain groups seem to be at higher risk for non-adherence, for example: backpacking travellers; travellers who do not have an a priori intent to use such practices; travellers who are not concerned about malaria; immigrants who return to their country of origin to visit friends and relatives (VFRs); and long-term and/or younger travellersReference 5, Reference 6, Reference 7, Reference 8, Reference 9, Reference 18, Reference 19, Reference 20, Reference 21, Reference 22, Reference 23, Reference 24, Reference 25, Reference 26, Reference 27. Explanations for non-adherence are varied and include: lack of knowledge about malaria and/or its prevention; fear of or past experience with adverse effects of antimalarials; the false belief that previous malaria infections have conferred long-term immunity; the cost of medications; confusion arising from contradictory recommendations; forgetfulness; and/or lack of interest in taking antimalarial medicationsReference 5, Reference 6, Reference 7, Reference 9, Reference 18, Reference 19, Reference 20, Reference 26, Reference 27, Reference 28.

While the issue of non-adherence is well documented, objective evidence on how to enhance adherence is scarce. Some research has evaluated text messages as a tool to improve uptake of malaria interventions. Used as a reminder for travellers, SMS texts failed to improve adherence in one studyReference 29, but was temporally associated with a reduction in malaria case reports in another studyReference 30. Text messaging also has been successfully employed to enhance adherence to malaria treatment and prevention guidelines among health professionalsReference 31. Other factors shown to improve adherence include receiving a pre-travel consultationReference 18, Reference 25, Reference 32 and having the pre-travel intent to use preventive measuresReference 25.

Education

Health care providers play a central role in educating travellers about health hazards and their prevention, including malariaReference 33. To this end, health care providers should develop and maintain their knowledge related to malaria in order to ensure up-to-date and appropriate advice is provided to their patients. Travellers should be advised of prevention measures as well as the importance of early diagnosis and treatment (see Box 1). Further, health care providers providing advice on malaria should take care to properly communicate risk, both of malaria and of the interventions used to prevent it, as this can influence the likelihood that a traveller will use a recommended practice(s)Reference 33.

Travellers should be made aware that quality of health care services at their destination(s) might differ from those in Canada. Ideally, travellers will take time before departure to identify where health care facilities are located at their destination(s), and will consider obtaining travel health insurance. Health care providers can direct patients to the Government of Canada’s webpage on sickness or injury when travelling abroadReference 34 for further advice on accessing medical assistance while travelling.

Prevention - personal protective measures

General

This topic is covered in detail in the CATMAT Statement on Personal Protective Measures to Prevent Arthropod BitesReference 1. The content of this statement, including its main recommendations, are summarized below.

Malaria mosquitos

Only Anopheles mosquitoes transmit malaria. These mosquitoes are often most active during the evening and, at least for the most efficient vectors, bite and rest indoors. However, some malaria vectors can or even prefer to bite outside and can feed at various times of the day, including during the late afternoon and early morning. Information about the major malaria vector(s) in a given geographic area can be useful to develop risk management strategies. For example, knowing that A. albimanus, an important vector in parts of the Americas, can bite earlier in the evening and often outside can be used to emphasize the importance of preventive modalities that are effective in that context, for example, insecticide-treated clothing and topical skin repellents.

More information on malaria and other vectors can be found in the CATMAT Statement on Personal Protective Measures to Prevent Arthropod Bites, especially “Appendix 1: Summary information for some important arthropod vectors” and its referencesReference 1.

Preventing malaria mosquitoes from biting

An individual can do several things to reduce the risk of malaria before travelling. These include planning activities for those periods when risk is reduced (daytime, or outside the malaria season) or going to areas where transmission is less likely, for example, urban centers. Ideally, the traveller will also prepare themselves before travel by acquiring and becoming familiar with the interventions described below.

Once the traveller is in a malaria-endemic area, the focus should be on preventing mosquito bites. The main approaches are use of physical and/or chemical barriers. These approaches are not mutually exclusive; rather, they work together and often are combined into a single intervention. For example, treated netting and clothing provides a physical and a chemical barrier.

Physical barriers

There are a variety of physical means to reduce contact between vectors and their human hosts. Recommended approaches are:

  • Protect work and accommodation areas: Screening on doors, windows and eaves (the open area between the roof and wall) protects against mosquito entry as does closing holes in roofs, walls and other gaps in the building envelopeReference 35, Reference 36, Reference 37;
  • Use of bed net: In addition to being a chemical barrier (see below), bed nets are a physical barrier against mosquitoes. They also protect against other pests like bed bugs, rodents and snakes; and,
  • Wear appropriate clothing: Full-length, loose-fitting and light-coloured clothing can help to reduce exposure to mosquito bites. Ideally, sleeves should be rolled down and pants legs tucked into socksReference 38, Reference 39, Reference 40.

Chemical barriers

Chemical barriers act in several ways, including by repelling and/or by killing mosquitoes. Recommended approaches are:

  • Use topical repellents on exposed areas of skinReference 41, Reference 42. Products registered in Canada and that contain 20%–30% DEET or 20% icaridin should be the first choice because they are expected to provide relatively long lasting protection. If used properly, these repellents afford very high levels of protection against the bites of malaria and other mosquitoes (e.g., >90%).
  • Repellents that contain p-menthane-3,8-diol should be considered second-choice topical repellents for adults and children aged three years or older.
  • Use insecticide-treated bed netsReference 43.
  • Use insecticide-treated clothing to protect against the bites of malaria mosquitoes, other vectors and nuisance arthropodsReference 44, Reference 45, Reference 46, Reference 47.

Other interventions

Avoid approaches that are ineffective or that have not been convincingly shown to be effective against malaria mosquitoes and other vectors. These include: electronic (ultrasonic) devicesReference 48, Reference 49; wristbands, neckbands and ankle bands impregnated with topical repellentReference 50; electrocuting devices (“bug zappers”)Reference 48, Reference 50; odour-baited mosquito traps; Citrosa plant (a type of geranium houseplant)Reference 52, Reference 53, Reference 54; orally administered vitamin B1 Reference 55; and skin moisturizers that do not contain a recommended repellent.

Recommendations

Recommendations (Table 3.1) were not developed using GRADE methodology. Rather, they comprise non-GRADE recommendations made in other CATMAT guidelines; reflect expert judgment informed by synthesis of the evidence, and/or good practice statementsReference 2. Recommendations are summarized in Table 3.1.

The recommendations identify interventions that can provide bite protection with very low potential for serious harms and low financial cost for use. These recommendations are limited by:

  1. The absence of direct evidence to indicate that the recommended interventions reduce the likelihood of relevant patient important outcomes (e.g., clinical malaria) among travellers;
  2. The paucity of evidence related to travellers values and preferences related to use of effective personal bite preventions measures such as repellents and bednets; and
  3. The relative consistency of evidence to indicate that adherence to recommended practices among travellers is suboptimal.

Summary of recommendations

  • Health care providers should remind travellers that it is important to adhere to malaria prevention practices, e.g., use of chemoprophylaxis and bite prevention measures.
  • Health care providers should remind patients that it is important to seek medical attention for a febrile illness of unexplained etiology that occurs during travel or within 12 months of return from a malaria endemic area.
  • Health care providers should take a travel history from all patients to help rule in (or out) the potential diagnosis of malaria (and other travel-associated diseases).
  • Health care providers should develop and maintain their knowledge so as to be able to provide appropriate and traveller-specific guidance related to malaria prevention.
  • Protect work and accommodations from mosquito entry by using screening on doors, windows, and eaves (the open area between the roof and wall), eliminating holes in roofs and walls, and closing other gaps in the building envelopeReference 35, Reference 36, Reference 37.
  • Wear appropriate clothing, e.g. full-length, loose-fitting and light-coloured clothing with sleeves rolled down and pants tucked in to socks or bootsReference 38, Reference 39, Reference 40.
  • Use topical repellents on exposed areas of skinReference 41, Reference 42. Products registered in Canada and that contain 20%–30% DEET or 20% icaridin should be the first choice. Repellents that contain p-menthane-3,8-diol should be considered second-choice topical repellents for adults and children aged three years or older.
  • Use insecticide-treated bed netsReference 43.
  • Use insecticide-treated clothingReference 44, Reference 45, Reference 46, Reference 47.

Acknowledgements

This chapter was prepared by: Schofield S, and approved by CATMAT.

References

Reference 1

Committee to Advise on Tropical Medicine and Travel. Statement on personal protective measures to prevent arthropod bites. Can Commun Dis Rep 2012;38(ASC-3):1-18.

Return to reference 1 referrer

Reference 2

Committee to Advise on Tropical Medicine and Travel (CATMAT). Evidence Based Process for developing travel and tropical medicine related guidelines and recommendations. 2017; Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/evidence-based-process-developing-travel-tropical-medicine-guidelines-recommendations.html. Accessed January 9, 2018.

Return to reference 2 referrer

Reference 3

Voumard R., Berthod D., RambaudAlthaus C., D'Acremont V., Genton B. Recommendations for malaria prevention in moderate to low risk areas: Travellers' choice and risk perception. Malaria Journal 2015;14(1) (pagination):Arte Number: 139. ate of Pubaton: 01 Ar 2015.

Return to reference 3 referrer

Reference 4

Auer R, Voumard R, Benaroyo L, Genton B. [Risk communication in travel medicine]. Rev Med Suisse 2015 1008-11; May 6;11(473):1006-11.

Return to reference 4 referrer

Reference 5

Chatterjee S. Compliance of malaria chemoprophylaxis among travelers to India. J Travel Med 1999 Mar;6(1):7-11.

Return to reference 5 referrer

Reference 6

Laver SM, Wetzels J, Behrens RH. Knowledge of malaria, risk perception, and compliance with prophylaxis and personal and environmental preventive measures in travelers exiting Zimbabwe from Harare and Victoria Falls International airport. J Travel Med 2001 Nov-Dec;8(6):298-303.

Return to reference 6 referrer

Reference 7

Landry P, Iorillo D, Darioli R, Burnier M, Genton B. Do travelers really take their mefloquine malaria chemoprophylaxis? Estimation of adherence by an electronic pillbox. J Travel Med 2006 Jan-Feb;13(1):8-14.

Return to reference 7 referrer

Reference 8

Banerjee D, Stanley PJ. Malaria chemoprophylaxis in UK general practitioners traveling to South Asia. J Travel Med 2001;8(4):173-175.

Return to reference 8 referrer

Reference 9

Molle I, Christensen KL, Hansen PS, Dragsted UB, Aarup M, Buhl MR. Use of medical chemoprophylaxis and antimosquito precautions in Danish malaria patients and their traveling companions. J Travel Med 2000 Sep-Oct;7(5):253-258.

Return to reference 9 referrer

Reference 10

Pistone T, Ezzedine K, Gaudin AF, Hercberg S, Nachbaur G, Malvy D. Malaria prevention behaviour and risk awareness in French adult travellers. Travel Med Infect Dis 2010 Jan;8(1):13-21.

Return to reference 10 referrer

Reference 11

Ollivier L, Michel R, Carlotti MP, Mahe P, Romand O, Todesco A, et al. Chemoprophylaxis compliance in a French battalion after returning from malaria-endemic area. J Travel Med 2008 Sep-Oct;15(5):355-357.

Return to reference 11 referrer

Reference 12

Queyriaux B, Texier G, Ollivier L, Galoisy-Guibal L, Michel R, Meynard JB, et al. Plasmodium vivax Malaria among military personnel, French Guiana, 1998-2008. Emerg Infect Dis 2011 Jul;17(7):1280-1282.

Return to reference 12 referrer

Reference 13

Unger HW, McCallum AD, Ukachukwu V, McGoldrick C, Perrow K, Latin G, et al. Imported malaria in Scotland–an overview of surveillance, reporting and trends. Travel medicine and infectious disease 2011;9(6):289-297.

Return to reference 13 referrer

Reference 14

Vliegenthart-Jongbloed K, de Mendonca Melo M, van Wolfswinkel ME, Koelewijn R, van Hellemond JJ, van Genderen PJ. Severity of imported malaria: protective effect of taking malaria chemoprophylaxis. Malar J 2013;12:265.

Return to reference 14 referrer

Reference 15

Siikamaki H, Kivela P, Lyytikainen O, Kantele A. Imported malaria in Finland 2003-2011: prospective nationwide data with rechecked background information. Malar J 2013 Mar 14;12:93-2875-12-93.

Return to reference 15 referrer

Reference 16

Luthi B, Schlagenhauf P. Risk factors associated with malaria deaths in travellers: a literature review. Travel Med Infect Dis 2015 Jan-Feb;13(1):48-60.

Return to reference 16 referrer

Reference 17

Angelin M., Evengard B., Palmgren H. Travel health advice: Benefits, compliance, and outcome. Scand J Infect Dis 2014 June 2014;46(6):447-453.

Return to reference 17 referrer

Reference 18

Lobel HO, Baker MA, Gras FA, Stennies GM, Meerburg P, Hiemstra E, et al. Use of malaria prevention measures by North American and European travelers to East Africa. Journal of Travel Medicine 2001 2001;8(4):167-172.

Return to reference 18 referrer

Reference 19

Leonard L, VanLandingham M. Adherence to travel health guidelines: the experience of Nigerian immigrants in Houston, Texas. J Immigr Health 2001 Jan;3(1):31-45.

Return to reference 19 referrer

Reference 20

Morgan M, Figueroa-Munoz JI. Barriers to uptake and adherence with malaria prophylaxis by the African community in London, England: focus group study. Ethn Health 2005 Nov;10(4):355-372.

Return to reference 20 referrer

Reference 21

Alon D, Shitrit P, Chowers M. Risk behaviors and spectrum of diseases among elderly travelers: a comparison of younger and older adults. Journal of Travel Medicine 2010;17(4):250-255.

Return to reference 21 referrer

Reference 22

Toovey S, Moerman F, Van Gompel A. Special infectious disease risks of expatriates and long-term travelers in tropical countries. Part II: Infections other than malaria. Journal of Travel Medicine 2007 January/February 2007;14(1):50-60.

Return to reference 22 referrer

Reference 23

Baggett HC, Graham S, Kozarsky PE, Gallagher N, Blumensaadt S, Bateman J, et al. Pretravel health preparation among US residents traveling to India to VFRs: Importance of ethnicity in defining VFRs. Journal of Travel Medicine 2009 March-April 2009;16(2):112-118.

Return to reference 23 referrer

Reference 24

Piyaphanee W, Wattanagoon Y, Silachamroon U, Mansanguan C, Wichianprasat P, Walker E. Knowledge, attitudes, and practices among foreign backpackers toward malaria risk in Southeast Asia. Journal of Travel Medicine 2009 March-April 2009;16(2):101-106.

Return to reference 24 referrer

Reference 25

Goldstein I, Grefat R, Ephros M, Rishpon S. Intent-to-adhere and adherence to malaria prevention recommendations in two travel clinics. J Travel Med 2015;22(2):130-132.

Return to reference 25 referrer

Reference 26

Sagui E, Resseguier N, Machault V, Ollivier L, Orlandi-Pradines E, Texier G, et al. Determinants of compliance with anti-vectorial protective measures among non-immune travellers during missions to tropical Africa. Malar J 2011;10:232.

Return to reference 26 referrer

Reference 27

Schofield S, Crane F, Tepper M. Good interventions that few use: Uptake of insect bite precautions in a group of Canadian Forces personnel deployed to Kabul, Afghanistan. Mil Med 2012;177(2):209-215.

Return to reference 27 referrer

Reference 28

Brisson M, Brisson P. Compliance with antimalaria chemoprophylaxis in a combat zone. Am J Trop Med Hyg 2012 Apr;86(4):587-590.

Return to reference 28 referrer

Reference 29

Ollivier L, Romand O, Marimoutou C, Michel R, Pognant C, Todesco A, et al. Use of short message service (SMS) to improve malaria chemoprophylaxis compliance after returning from a malaria endemic area. Malar J 2009 Oct 23;8:236-2875-8-236.

Return to reference 29 referrer

Reference 30

Scott W, Weina PJ. Texting away malaria: a new alternative to directly observed therapy. Mil Med 2013;178(2):e255-e259.

Return to reference 30 referrer

Reference 31

Zurovac D, Sudoi RK, Akhwale WS, Ndiritu M, Hamer DH, Rowe AK, et al. The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial. The Lancet 2011;378(9793):795-803.

Return to reference 31 referrer

Reference 32

Tafuri S, Guerra R, Gallone MS, Cappelli MG, Lanotte S, Quarto M, et al. Effectiveness of pre-travel consultation in the prevention of travel-related diseases: a retrospective cohort study. Travel medicine and infectious disease 2014;12(6):745-749.

Return to reference 32 referrer

Reference 33

Muller JM, Simonet AL, Binois R, Muggeo E, Bugnon P, Liet J, et al. The respect of recommendations provided in an international travelers' medical service: far from the cup to the lips. J Travel Med 2013 Mar-Apr;20(2):78-82.

Return to reference 33 referrer

Reference 34

Government of Canada. Sickness or injury. 2016; Available at: https://travel.gc.ca/assistance/emergency-info/sick-injured. Accessed February 20, 2017.

Return to reference 34 referrer

Reference 35

Lindsay SW, Jawara M, Paine K, Pinder M, Walraven GEL, Emerson PM. Changes in house design reduce exposure to malaria mosquitoes. Tropical Medicine and International Health 2003;8(6):512-517.

Return to reference 35 referrer

Reference 36

Lindsay SW, Emerson PM, Charlwood JD. Reducing malaria by mosquito-proofing houses. Trends in Parisitology 2002;18(11):510-514.

Return to reference 36 referrer

Reference 37

Njie M, Dilger E, Lindsay S, Kirby M. Importance of eaves to house entry by anopheline, but not culicine, mosquitoes. J Med Entomol 2009;46(3):505-10.

Return to reference 37 referrer

Reference 38

Christophers SR. Mosquito repellents; being a report of the work of the mosquito repellent inquiry, Cambridge, 1943-5. Journal of Hygiene 1947;45(2):176-231.

Return to reference 38 referrer

Reference 39

Schoepke A, Steffen R, Gratz N. Effectiveness of personal protection measures against mosquito bites for malaria prophylaxis in travelers. Journal of Travel Medicine 1998;5(4):188-192.

Return to reference 39 referrer

Reference 40

Joy RJT. Malaria in American troops in the South and Southwest Pacific in World War II. Med Hist 1999;43(02):192-207.

Return to reference 40 referrer

Reference 41

Maia M, Moore S. Plant-based insect repellents: a review of their efficacy, development and testing. Malaria Journal 2011;10:S11.

Return to reference 41 referrer

Reference 42

Moore SJ, Debboun M. History of insect repellents. In: Debboun M, Francis S, Strickman DA, editors. Insect repellents: Principles, methods and uses. 1st ed.: CRC Press; 2006. p. 3-29.

Return to reference 42 referrer

Reference 43

Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database of Systematic Reviews 2004;2(CD000363).

Return to reference 43 referrer

Reference 44

Schreck CE, Haile DG, Kline DL. The effectiveness of permethrin and deet, alone or in combination, for protection against Aedes taeniorhynchus. American Journal of Tropical Medicine and Hygiene 1984;33(4):725-730.

Return to reference 44 referrer

Reference 45

Schreck CE, Posey K, Smith D. Durability of permethrin as a potential clothing treatment to protect against blood-feeding arthropods. Journal of Economic Entomology 1978;71(3):397-400.

Return to reference 45 referrer

Reference 46

Vaughn MF, Meshnick SR. Pilot study assessing the effectiveness of long-lasting permethrin-impregnated clothing for the prevention of tick bites. Vector Borne and Zoonotic Diseases 2011;11(7):869-875.

Return to reference 46 referrer

Reference 47

Soto J, Medina F, Dember N, Berman J. Efficacy of Permethrin-Impregnated Uniforms in the Prevention of Malaria and Leishmaniasis in Colombian Soldiers. Clinical Infectious Diseases 1995 Sep.;21(3):599-602.

Return to reference 47 referrer

Reference 48

Surgeoner GA, Helson BV. A field evaluation of electrocutors for mosquito control in southern Ontario. Proceedings of the Entomological Society of Ontario 1977;108:53-57.

Return to reference 48 referrer

Reference 49

Enayati AA, Hemingway J, Garner P. Electronic mosquito repellents for preventing mosquito bites and malaria infection. Cochrane Database of Systematic Reviews 2007;2(CD005434).

Return to reference 49 referrer

Reference 50

Fradin MS, Day JF. Comparative Efficacy of Insect Repellents against Mosquito Bites. N Engl J Med 2002 07/04; 2014/02;347(1):13-18.

Return to reference 50 referrer

Reference 51

Nasci RS, Harris CW, Porter CK. Failure of an insect electrocuting device to reduce mosquito biting. Mosquito News 1983;43(2):180-184.

Return to reference 51 referrer

Reference 52

Jensen T, Lampman R, Slamecka MC, Novak RJ. Field efficacy of commercial antimosquito products in Illinois. Journal of American Mosquito Control Association 2000;16(2):148-152.

Return to reference 52 referrer

Reference 53

Matsuda BM, Surgeoner GA, Heal JD, Tucker AO, Maciarello MJ. Essential oil analysis and field evaluation of the citrosa plant "Pelargonium citrosum" as a repellent against populations of Aedes mosquitoes. Journal of American Mosquito Control Association 1996;12(1):69-74.

Return to reference 53 referrer

Reference 54

Cilek JE, Schreiber ET. Failure of the "mosquito plant", Pelargonium x citrosum 'van Leenii', to repel adult Aedes albopictus and Culex quinquefasciatus in Florida. Journal of American Mosquito Control Association 1994;10(4):473-476.

Return to reference 54 referrer

Reference 55

Khan AA, Maibach HI, Strauss WG, Fenley WR. Vitamin B1 is not a systemic mosquito repellent in man. Transactions of the St Johns Hospital Dermatological Society 1969;55(1):99-102.

Return to reference 55 referrer

Footnote

Footnote a

Very high risk that study sample is not representative; very high risk that exposure measurement (e.g., visual tools) were unreliable; ascertainment of the exposure and outcomes likely incomplete (i.e., non-validated methodology, informing risk estimates potentially inaccurate). See reference (2) for description of CATMAT approach to evidence appraisal.

Return to footnote a referrer

Appendices

Appendix 1: search strategy

Literature search question

What are the values and preferences for travellers related to malaria prevention measures (e.g., bed nets, clothing, window screens etc.)

Embase, 2009 to March 10, 2016 [Search (Results)]

  1. (Plasmodium ovale malaria/pc or malaria falciparum/pc or malaria/pc or Plasmodium knowlesi malaria/pc or Plasmodium vivax malaria/pc) and (prophylaxis/ or prevention/ or "prevention and control"/ or malaria control/) (2976)
  2. (Malaria adj (prophylaxis or prevent*)).ti. (804)
  3. Malaria prophylaxis.ab. /freq=2 (68)
  4. Malaria prevent*.ab. /freq=2 (176)
  5. Or/1-4 (3647)
  6. ((Travel* or tour* or visit* or sightseer) adj4 (option or favo?r or prefer* or deci* or select* or inclin* or value* or pick* or alternative or adhere* or determin* or choice or chose or choose)).mp. (7135)
  7. (Decision making/ or perception/ or high risk behavior/ or attitude to health/) and travel/ (856)
  8. 6 or 7 (7931)
  9. 5 and 8 (44)
  10. Limit 9 to ((english or french) and yr="2009 -Current") (24)

Ovid MEDLINE(R) in-process & other non-indexed citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), 2009 to March 10, 2016 [Search (Results)]

  1. *Malaria/pc or *malaria, cerebral/pc or *malaria, falciparum/pc or *malaria, vivax/pc (8532)
  2. (Malaria adj (prophylaxis or prevent*)).ti. (593)
  3. (Malaria adj (prophylaxis or prevent*)).ab. /freq=2 (225)
  4. Or/1-3 (8696)
  5. ((Travel* or tour* or visit* or sightseer) adj4 (option or favo?r or prefer* or deci* or select* or inclin* or value* or pick* or alternative or adhere* or determin* or choice or chose or choose)).mp. (4955)
  6. (Health Knowledge, Attitudes, Practice/ or decision making/ or risk taking/ or risk factors/ or attitude to health/ or perception/) and travel/ (2726)
  7. 5 or 6 (7574)
  8. 4 and 7 (187)
  9. Limit 8 to (yr="2009 -Current" and (english or french)) (52)

PubMed, January 1, 2009 to March 10, 2016 [Search (Results)]

((travel*[Title/Abstract] OR tour*[Title/Abstract] OR visit*[Title/Abstract]) AND (("malaria prophylaxis"[Title/Abstract] OR "malaria prevent*"[Title/Abstract]) OR ("Malaria/pc"[Mesh] OR "Malaria, Vivax/pc"[Mesh] OR "Malaria, Cerebral/pc"[Mesh] OR "Malaria, Falciparum/pc"[Mesh])) AND ((nets[Title/Abstract] OR netting[Title/Abstract] OR net[Title/Abstract] OR "ITN"[Title/Abstract] OR "LLIN"[Title/Abstract] OR repellent[Title/Abstract] OR insecticide[Title/Abstract] OR cloth*[Title/Abstract] OR air condition*[Title/Abstract] OR screen*[Title/Abstract] OR dusk[Title/Abstract]) OR (("health, attitude to"[Mesh] OR "attitude to health"[Mesh] OR "risk taking"[Mesh] OR "decision making"[Mesh]) AND ("*travel"[Mesh]))) AND (option[Title/Abstract] OR favour[Title/Abstract] OR favor[Title/Abstract] OR prefer*[Title/Abstract] OR deci*[Title/Abstract] OR select*[Title/Abstract] OR inclin*[Title/Abstract] OR value*[Title/Abstract] OR pick*[Title/Abstract] OR alternative[Title/Abstract] OR adhere*[Title/Abstract] OR determin*[Title/Abstract] OR choice OR chose OR choose)) AND (("2009/01/01"[PDat] : "2016/12/31"[PDat])) (12)

Cochrane, 2009 to March 10, 2016 [Search (Results)]

  1. MeSH descriptor: [Malaria] this term only and with qualifier(s): [Prevention & control - PC] (431)
  2. MeSH descriptor: [Malaria, Falciparum] this term only and with qualifier(s): [Prevention & control - PC] (330)
  3. MeSH descriptor: [Malaria, Cerebral] this term only and with qualifier(s): [Prevention & control - PC] (2)
  4. MeSH descriptor: [Malaria, Vivax] this term only and with qualifier(s): [Prevention & control - PC] (55)
  5. #1 or #2 or #3 or #4 (766)
  6. "Malaria prophylaxis" or "malaria prevent*":ti,ab,kw (Word variations have been searched) (216)
  7. #5 or #6 (895)
  8. MeSH descriptor: [Attitude to Health] this term only (2806)
  9. MeSH descriptor: [Risk-Taking] this term only (1090)
  10. MeSH descriptor: [Decision Making] this term only (1955)
  11. #8 or #9 or #10 (5673)
  12. MeSH descriptor: [Travel] this term only (294)
  13. #11 and #12 (2)
  14. Nets or netting or net or "ITN" or "LLIN" or repellent or insecticide or cloth* or air condition* or screen* or dsuk:ti,ab,kw (Word variations have been searched) (33938)
  15. Option or favour or favor or prefer* or deci* or select*OR inclin* or value* or pick* or alternative or adhere* or determin* or choice or chose or choose:ti,ab,kw (Word variations have been searched) (280470)
  16. #14 and #15 (14771)
  17. #13 or #16 (14772)
  18. #7 and #17 Publication Year from 2009 to 2016 (49)

Scopus, 2010 to March 10, 2016 [Search (Results)]

( TITLE-ABS-KEY ( malaria PRE/0 ( prophylaxis OR prevent* ) ) ) AND ( TITLE-ABS-KEY ( ( travel* OR tour* OR visit* OR sightseer ) W/4 ( option OR favo?r OR prefer* OR deci* OR select* OR inclin* OR value* OR pick* OR alternative OR adhere* OR determin* OR choice OR chose OR choose ) ) ) AND ( LIMIT-TO ( PUBYEAR , 2016 ) OR LIMIT-TO ( PUBYEAR , 2015 ) OR LIMIT-TO ( PUBYEAR , 2014 ) OR LIMIT-TO ( PUBYEAR , 2013 ) OR LIMIT-TO ( PUBYEAR , 2012 ) OR LIMIT-TO ( PUBYEAR , 2011 ) OR LIMIT-TO ( PUBYEAR , 2010 ) ) (23)

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