Rationale:

• Many cases of traveler's malaria are due to underestimation of the disease, which can lead to laxity in following the prescribed prophylaxis regimens and delay in seeking medical attention for malarial symptoms.

Evidence:

• A questionnaire-based study of 203 travelers departing from John F. Kennedy International airport in New York City to high-risk destinations for malaria showed that although 73% of travelers perceived malaria as a health risk, only 46% of them carried an antimalarial drug (145).
• In 2000 and 2001, 38% of oral artesunate purchased in shops in Vietnam, Cambodia, Laos, and Myanmar did not contain active drug (26).
• In 2001 and 2002, 284 samples of three antimalarial drugs from 132 unofficial vendors in Cameroon were tested for authenticity. A total of 38% of chloroquine, 74% of quinine, and 12% of sulfadoxine-pyrimethamine samples had either no active ingredient, an insufficient active ingredient, the wrong ingredient, or unknown ingredient(s) (146).

Comments:

• None.