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Collaborating Authors
Malaria Chemoprophylaxis Compliance Improvement: A New Approach
Moynihan, Kelly J. (ExxonMobil Development Company) | Moreau, Jean-Marie M. (ExxonMobil Medicine and Occupational Health) | Shallenberger, Leba G. (ExxonMobil Medicine and Occupational Health) | Lindemann, Kenneth C. (ExxonMobil Medicine and Occupational Health) | Guibert, Philippe (International SOS (France) S.A.)
Abstract Awareness training, personal protection against mosquito bites, and vector control measures are all important in helping reduce Anopheles mosquito bites. However, these measures cannot completely eliminate the risk of contracting malaria. The prevention of malaria in non-immune individuals in sub-Saharan Africa relies heavily on the proper use of effective chemoprophylaxis. Compliance with effective chemoprophylactic regimens is problematic, especially in long-term expatriates who believe they have acquired natural immunity. In spite of implementing a comprehensive Malaria Control Program (MCP), with a goal of zero cases of malaria among non-immune individuals, the Chad Export Project experienced an increase in the number of malaria cases in the contractor non-immune workforce as construction activities in Chad and Cameroon accelerated. Several serious cases of Falciparum malaria were recorded, and four fatalities occurred. In response to this, a multidisciplinary team was formed to identify opportunities to enhance the effectiveness of the MCP. One of the team's key recommendations was to develop and implement a Malaria Chemoprophylaxis Compliance Program (MCCP) to address identified informational and behavioral shortcomings regarding malaria chemoprophylaxis use. The heart of the MCCP is awareness and education but compliance with chemoprophylaxis is further encouraged through collection of urine specimens from non-immune individuals for laboratory determination of effective anti-malaria medication usage. Data collected during the first 15 months that the MCCP was implemented in Chad and Cameroon show an overall low (i.e., <1%) rate of non-conforming specimens. After implementing the MCCP in Chad and Cameroon, the rate of malaria cases among non-immune workers decreased fifty percent and the program has been extended to other operating locations in Africa. Introduction ExxonMobil conducts business in over 100 countries worldwide. In some of these countries (especially those in sub-Saharan Africa, parts of south east Asia, and Latin America), one or more forms of malaria are endemic. In order to safeguard its employees from the ill effects of malaria, ExxonMobil developed and implemented a comprehensive Malaria Control Program (MCP) based on the following "ABCD" strategy:A wareness (Mosquito) B ite prevention. C hemoprophylaxis use by non-immune individuals. D iagnose and treat early. This paper discusses the Chad Export Project's implementation of the MCP and in particular the development and implementation of a Malaria Chemoprophylaxis Compliance Program (MCCP), a MCP enhancement aimed at ensuring effective malaria chemoprophylaxis use by non-immune individuals in order to achieve the MCP's goal of zero non-immune malaria cases. Chad Export Project - Background Project Description and Background Information. The $US 3.5 billion Chad Export Project (the Project) is currently the largest private sector investment in sub-Saharan Africa. Over the Project's anticipated 25–30 year life, approximately one billion barrels of crude oil will be produced from three oilfields in the Doba basin region of southern Chad for export to world markets, with peak production being 225,000 barrels per day. A map providing some geographic context for the Project is provided in Figure 1.
- Research Report (0.67)
- Overview > Innovation (0.40)
Abstract A global Malaria Control Program (MCP) was implemented requiring non-immune workers to take malaria chemoprophy-laxis when traveling to and working in malarial areas. Despite intense health education efforts, four malaria deaths occurred in workers after they left malarial areas. A Malaria Chemo-prophylaxis Compliance Program (MCCP) was added to the MCP to verify the use of approved antimalarial medications in workers' urine. Results from MCCP tests suggest that there is a high level of medication compliance. Since the inception of the MCCP there have been questions regarding possible ad-verse side affects of taking long-term malaria chemoprophy-laxis. An alternative strategy to continued medication use would be to recommend that individuals carry stand-by treat-ment that could be used for early diagnosed cases. If stand-by treatment programs could achieve the same level of effective malaria control as programs that require long-term chemopro-phylaxis they could reduce the costs of prescribing medica-tions to large numbers of workers and the potential for these individuals to experience adverse health effects from taking the medications. The authors conducted an extensive litera-ture review and concluded that stand-by treatment alone could not be recommended for use in high risk P. falciparum areas unless the non-immune individuals were more fully trained in using all other protective strategies and supplies for prevention and treatment. We would also need to have access to reliable and updated malaria transmission data for the areas where our employees worked and lived before we could adjust chemo-prophylactic recommendations by region and season. Introduction: Malaria Control Program In 2001, our Company developed and implemented a compre-hensive Malaria Control Program (MCP) for workers living in or traveling to malarial areas. The goals of the MCP are to achieve zero cases of malaria in the non-immune worker population and zero serious cases of malaria among semi-immune workers. To achieve both program goals, all employees are expected to participate in the awareness/education initiatives, to adopt all available behaviors necessary to prevent mosquito bites and to be fully aware of malaria symptoms so they are prepared to seek early and effective diagnosis and treatment. In addition, all non-immunes are expected to take one of the approved chemoprophylaxis medications before, during and after travel to malarial areas, as required for medication effectiveness. Despite intensive health education efforts, four non-immune contractors working on behalf of the Company died from malaria after they left malarial areas. Root cause analyses suggested the individuals had not taken effective chemoprophylaxis as prescribed. This led to the development of the Malaria Chemoprophylaxis Compliance Program (MCCP). Alcohol and drug testing program strategies were used as a model to develop the MCCP, a random urine-testing program to verify the presence of approved anti-malaria medications in workers' urine. Results from more than 7000 MCCP analyzed specimens have shown there is a high level of medication compliance and the MCCP component appears to be contributing to a decreasing number of malaria cases in non-immunes.
- Africa (1.00)
- Asia (0.94)
- North America > United States > Texas (0.46)
- Research Report > Experimental Study (0.93)
- Research Report > Strength High (0.68)
Abstract A lot of information on malaria, some conflicting, is available to the international traveler from many sources. Between December 1994 and August 1997, 23 expatriates were treated for malaria in our clinic at the Escravos Termal. 17 of these were on malaria chemoprophyfaxis and 4 started after the attack. We recently noted a decline in the rate at which expatriates collected antimalarials from our clinic and this survey was carried out to find out the experience of our swamp/offshore expatriate staff with malaria preventive measures especially chemoprophylaxis. 200 questionnaires were sent out to determine among other things, pre-travel counseling, antimalarials taken, side effects, compliance and their perception of the maria issue. 136 questionnaires were returned, 53% of responders were Americans and 37.5% were Britons. 75% of responders had pre-travel counseling, 66% started on malaria chemoprophylaxis before traveling. 98 (72%) took antimalarials at one time or the other, and of these, 32% took chloroquinelpaludrine combination, 55% took mefloquine, 8% took proguanil only. 1% each took doxycycline and pyrimetlunine. Of the 98 who took antimalarials, 52 had stopped their medication for various reasons. Mefloquine was stopped in 60% of cases and chloroquine/proguanil in 270/e, of the 46 presently taking antimalarials 60% have taken drugs for 1 to 3 years. The most commonly experienced side effects for the various drugs are outlined, as well as respondents' perception of malaria and the various preventive measures advocated. Of the 136 respondents 27 (19.9 %) had had one or more attacks of malaria before. 61% will advise first time visitors to Nigeria to take prophylactic antimalarials. The second part of the study will compare these findings with the experience of our expatriate staff resident in Nigeria. The need to streamline malaria preventive measures and the information available to expatriates traveling to the tropics is stressed.
Abstract Malaria is a major public health problem worldwide. It is estimated that 500 million clinical cases of malaria are recorded yearly resulting in about 3 million deaths. Malaria transmission is very high in the Niger Delta region where Shell Nigeria (SCiN) operates. The disease is listed as the most frequent cause of mortality and morbidity among the population of this region. The non-immunes among Shell hospitals eligible population (expatriate staff and their families, Nigerians returning from overseas postings, children under 5 years of age, Sicklers and pregnant women) are all prone to severe forms of malaria. Malaria control is therefore one of Shell's topmost health priorities as it is a high health risk that also has the potential to impact on reputation and profit. SCIN has developed an integrated and highly effective malaria control program to checkmate the malaria scourge among staff and their dependants. A Malaria Working Group coordinates this program. The programme has proven to be very effective at reducing malaria morbidity and mortality. Our overall case fatality rate (CFR) of 0.00005% (i.e. 1 in 20,000) over the last 10 years compared with 1 to 5% in the Nigerian population is a highly commendable achievement. The CFR among Shell Nigerian expatriate staff and their dependants is 0%. The national CFR target is <0.5%. External assessors have described the control programme as "world-class". This paper outlines the critical components in the Integrated Malaria Control Program and their interaction. It also addresses our approach to best-practice sharing, managing recurrent issues including inconsistent or inappropriate chemoprophylaxis advice, compliance with advised and mandatory prophylaxis and malaria occurring in non-immunes after departure from Nigeria. The application of a well-designed malaria control and recovery strategy is highly effective in controlling malaria even in hyper-endemic regions. Introduction Malaria is a major public health problem worldwide. It is estimated that about 500 million clinical cases of malaria are recorded yearly resulting in about 3 million deaths.[1] Unlike HIV that can stay in the body for years without symptoms, malaria is deadlier and can kill within 48 hours. Africa bears the brunt of the problem with 90% of the malaria cases coming from this continent. Conservatively, it is estimated that more than 1 million African children are lost to malaria annually. Survivors suffer from repeated anaemias, stunted growth, chronic kidney disease, seizures among others. On the economic front, more than 2 billion US$ is lost to malaria directly or indirectly. It has also been conservatively estimated that this disease has slowed economic growth in African countries by up to 1.3% per year. [2, 3] The Niger Delta region in southern Nigeria, where Shell Nigeria has its major oil and gas fields is in the malaria hyper-endemic zone. Malaria transmission is very high and occurs throughout the year with peaks during the raining season. The majority of our workers are drawn from the local Nigerian community. Because of the presence of high titres of naturally acquired malaria antibodies in this group of people, malaria illness is often mild-moderate. It is unlikely to lead to death, but frequently leads to sickness absences and low productivity. However, the pregnant spouses, children below 5 years and sicklers at all ages have low immunity and are therefore prone to the severe forms of malaria.[4, 5] Other eligible customers who also constitute a special vulnerable group are expatriate staff and their families from malaria-free countries. These people have zero immunity and are also vulnerable to severe malaria. Without early diagnosis and adequate treatment, complications can set in leading to significant morbidity and mortality.[6]
- Health & Medicine > Therapeutic Area > Infections and Infectious Diseases (1.00)
- Health & Medicine > Therapeutic Area > Immunology > HIV (0.35)
Abstract Global mobile workers risk serious disease and death from malaria while it is a curable and preventable disease. Organizations sending workers and their families into malarious areas are challenged by implementing efficient and consistent malaria control programs in the face of conflicting opinions, recommendations and perceptions regarding the necessity of malaria controls, especially regarding the use of chemoprophylaxis medications. Many of the issues related to malaria chemoprophylaxis have not been and are not likely to be studied in well-designed, randomized, double blinded clinical trials. In addition, country regulations differ and conflicting advice is provided by different health workers. To standardize advice and recommendations on malaria chemoprophylaxis, a list of issues was developed from questions frequently asked by managers, employees and contractors. During a two-day workshop, a world-renowned expert panel with extensive professional experience in infectious diseases, travel medicine, occupational medicine and health education, discussed the issues while reviewing the relevant literature and sharing their practical experience, to provide sound technical guidance. This paper provides scientific evidence-based malaria prevention guidance, balancing the precision of malaria protection with practical recommendations for chemoprophylaxis use, based on immune status and destination factors. The panel endorsed continued long-term use of chemoprophylaxis by individuals categorized as non-immune, traveling in high risk plasmodium falciparum areas. Specific guidelines were recommended for travelers to Mexico, Papua New Guinea and India. Guidance for travelers switching back and forth between various medications was provided to help individuals maintain protection and reduce the risk of adverse health affects from multiple drugs. Recommendations for offering medication breaks for offshore workers were not strongly endorsed due to unpredicted travel through high risk onshore locations and the difficulties in being able to effectively communicate and apply these guidelines.
- Africa (1.00)
- North America > United States (0.46)
- South America > Brazil (0.28)
- Research Report > Strength High (1.00)
- Research Report > Experimental Study (1.00)
- Health & Medicine > Therapeutic Area > Infections and Infectious Diseases (1.00)
- Health & Medicine > Therapeutic Area > Immunology > HIV (1.00)