Malaria chemoprophylaxis for West Africa — DTM&H MCQ

Correct answer: E — Atovaquone-proguanil

Atovaquone-proguanil (option A) is correct because Ghana is a chloroquine-resistant Plasmodium falciparum area with high transmission year round, worsened during the rainy season, so a highly effective causal prophylactic active against resistant falciparum strains is required. Atovaquone-proguanil combines a mitochondrial electron transport inhibitor with a dihydrofolate reductase inhibitor, giving reliable activity against multidrug-resistant falciparum, and current UK guidance lists it as a first line option for sub-Saharan Africa including West Africa. It suits a short 6 week trip well because it only needs to be started 1 to 2 days before travel and stopped 7 days after leaving, unlike longer tail regimens, and there are no contraindications here (not pregnant, no psychiatric history, no renal impairment stated). Why the other options are wrong: B Primaquine: this is used for terminal prophylaxis against Plasmodium vivax and ovale hypnozoites or as a second line causal prophylactic in specific settings, it is not a standard recommended chemoprophylaxis regimen for falciparum-predominant West Africa and requires G6PD testing first. C Albendazole: this is an anthelmintic used for soil transmitted helminths and some tissue parasites, it has no activity against Plasmodium species and plays no role in malaria prevention. D Chloroquine: chloroquine resistance is now widespread throughout sub-Saharan Africa including Ghana, so chloroquine (with or without proguanil) is no longer effective or recommended for this region. E Azithromycin: this is not a licensed or recommended malaria chemoprophylactic in UK guidance; it has some antimalarial activity used in specific research or pregnancy contexts abroad but is not a standard option here. Key point: For travel to chloroquine-resistant falciparum regions such as rural Ghana, atovaquone-proguanil (or alternatively doxycycline or mefloquine where suitable) is recommended, while chloroquine based regimens are obsolete for this region.

Reference: UKHSA, Guidelines for malaria prevention in travellers from the UK, 2024, https://assets.publishing.service.gov.uk/media/67f7c23ac6046b50261bc7f3/guidelines-for-malaria-prevention-in-travellers-from-the-UK-2024.pdf