Performance of self-diagnosis and standby treatment of malaria in international oilfield service employees in the field

Malar J. 2008 Jul 14:7:128. doi: 10.1186/1475-2875-7-128.

Abstract

Background: Falciparum malaria remains a major occupational illness that accounts for several deaths per year and numerous lost working days among the expatriate population, working or living in high-risk malarious areas. Compliance to preventive strategies is poor in travellers, especially business travellers, expatriates and long-term travellers.

Methods: In this cross-sectional, web-based study the adherence to and outcome of a preventive malaria programme on knowledge, attitudes and practices, including the practice of self-diagnosis and standby treatment (curative malaria kit, CMK) was evaluated in 2,350 non-immune expatriates, who had been working in highly malaria endemic areas.

Results: One-third (N = 648) of these expatriates visited a doctor for malaria symptoms and almost half (29 of 68) of all hospitalizations were due to malaria. The mandatory malaria training for non-immunes was completed by 92% of those who visited or worked in a high risk malaria country; 70% of the respondents at risk also received the CMK. The malaria awareness training and CMK significantly increased malaria knowledge [relative risk (RR) of 1.5, 95%CI 1.2-2.1], attitudes and practices, including compliance to chemoprophylaxis [RR = 2.2, 95%CI 1.6-3.2]. Hospitalization for malaria tended to be reduced by the programme [RR = 0.4, 95%CI 0.1-1.1], albeit not significantly. Respondents who did not receive instructions on the rapid diagnostic test were two times [RR = 2.3, 95%CI 1.6-3.3] more likely to have difficulties. Those who did receive instructions adhered poorly to the timing of repeating the test. Moreover, 6% (31 of 513) of those with a negative test result were diagnosed with malaria by a local doctor. 77% (N = 393) of the respondents with a negative test result did not take curative medication. 57% (252 of 441) of the respondents who took the curative medication that was included in the kit did not have a positive self-test or clinical malaria diagnosis made by a doctor.

Conclusion: This survey demonstrated that a comprehensive programme targeting malaria prevention in expatriates can be effectively implemented and that it significantly increased malaria awareness.

MeSH terms

  • Adult
  • Antimalarials / therapeutic use
  • Chemoprevention
  • Cross-Sectional Studies
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Incidence
  • Internet
  • Malaria, Falciparum / diagnosis*
  • Malaria, Falciparum / epidemiology
  • Malaria, Falciparum / prevention & control*
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Self Administration*
  • Self-Examination*
  • Surveys and Questionnaires

Substances

  • Antimalarials