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Malaria is common at certain times of the year in all low lying areas of Afghanistan. But protection measures for soldiers serving there are chaotic and often inconsistent with the available evidence, according to a survey. Representatives from 28 of the 36 nations contributing troops described 27 different combinations of drugs and other measures to prevent malaria. France and the Republic of Ireland were the only two nations with identical protocols (prophylaxis with chloroquine and proguanil). Mefloquine was the most common prophylactic agent (15 nations, 54%). Only five nations recommended evidence based prophylaxis with either atovaquone-proguanil or doxycycline. Six still recommended chloroquine, despite resistance in local Plasmodium falciparum.
Almost half the respondents (13, 46%) said their troops wore uniforms treated with insecticide, and 11 (39%) issued treated bed nets, which are also likely to work. But troops from four nations used only mosquito coils or electronic buzzers, which aren't. Romania offers its 750 soldiers no protection at all.
The authors say there have been 85 reports of malaria (all P vivax) in British, German, and US troops in Afghanistan since 2002. Better international agreement over effective preventive measures could help prevent more cases.