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March 8, 1995

Malaria in Somalia: Lessons in Prevention-Reply

Author Affiliations

Naval Medical Center San Diego, Calif

JAMA. 1995;273(10):775. doi:10.1001/jama.1995.03520340028023

In Reply.  —We wish to applaud the efforts of the navy preventive medicine community for their efforts in Operation Restore Hope. As noted by Dr Ledbetter and colleagues, aggressive prophylactic measures were taken to reduce the incidence of malaria in our troops. The success of this extraordinary effort is reflected in a malaria acquisition rate of only 1% in the 13 500 Marines initially deployed.Despite this success, there were some problems with prophylactic measures taken in the subset of patients who acquired malaria. Because our series included only those patients who were diagnosed with malaria, we acknowledge that our sample cannot be extrapolated to those marines who did not develop malaria. Our cohort of malaria patients is obviously more likely either to have been noncompliant with prophylaxis or to have been offered a suboptimal prophylactic regimen. As we noted, one half of all patients with imported malaria reported receiving

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