Malaria Alert : A guide for Malaysian travellers to Africa

Malaysia is one of the largest direct foreign investors in Africa and for a Malaysian business traveller to Africa, he or she may become exposed to malaria, which is prevalent in the region.

The African region has the highest malaria incidence globally, according to reports, and this figure is currently rising. In an analysis of over 8.7 million travellers to 220 countries (in the past three years) by International SOS – one of the world’s largest medical assistance companies – the trend shows a 61% increase in the number of malaria cases amongst business travellers. A staggering 82% of the malaria cases occurred in the African region, while 47% of these cases required medical evacuation to obtain a higher level of medical care.

The risks may be far reaching, but these could be prevented, according to Dr. Philippe Guibert, Regional Medical Director (Consulting Services for South & Southeast Asia) of the International SOS, who also shared with Healthcare Asia (HCA) some insights on the malaria endemic in Africa

HCA:  Is the trend illustrating an increase in malaria endemic in Africa?

Dr. Guibert: Malaria remains inextricably linked with poverty.  According to the World Health Organisation (WHO), the highest malaria mortality rates are being seen in countries that have the highest rates of extreme poverty (proportion of population living on less than US$1.25 per day).  90% of the fatality rate occurs in Africa.

It is a disease of underdevelopment: people living in environments favorable for mosquito breeding and having limited access to proper healthcare services. These expose the people to the severe consequences of the disease. The challenge of countering malaria globally is about fighting ignorance on its transmission and symptoms, controlling mosquito populations, and giving access to diagnostic and treatment to all.

HCA: Which countries in Africa have the highest malaria case reported amongst business travellers?

Dr. Philippe Guibert: According to the WHO, the six highest burden countries in the African region (in order of estimated number of cases) are: Nigeria, Democratic Republic of the Congo, United Republic of Tanzania, Uganda, Mozambique and Cote d’Ivoire. These six countries account for an estimated 103 million (or 47%) of malaria cases.

HCA: What precautions Malaysian companies should take to help its employees who are based in Africa?

Dr. Guibert: Travellers going to a malaria zone should see their health care provider in advance to find out the right type of prophylactic medication to take bring along. All anti-malarial will need to be taken after return from a destination with endemic malaria. These medications are to be prescribed by a health care practitioner according to the type of travel, the destination and the individual’s characteristics.

Once in the destination, individuals should look at vector control by:

• sleeping under insecticide-treated mosquito nets (ITNs);
• indoor spraying with residual insecticides;
• wearing appropriate clothing such as long sleeved shirts and socks;
• avoiding being outdoors during twilight and night time; and,
• using repellents such as DEET and permethrin.

Immediately seek diagnosis and treatment if a fever develops in one week or more (up to one month) after entering an area where there is a malaria risk.

HCA: What type of preventions or measures should companies take for travelling employees?

Dr. Guibert: It’s important for a company to define its policy towards malaria if they operate in an area with medium to high risk for malaria. Company policy should set out an approach to chemoprophylaxis, access to clinical services for malaria case management, access to proper diagnostics, and if and how employees should access standby emergency treatment kits for malaria. Education and training should be addressed especially around personal protection.

Malaria is complex and it is advisable to obtain specialist advice. For instance, on policy for malaria chemoprophylaxis – should it be mandated? What about non-immune workers? There needs to be deep understanding and discussion on testing, disciplinary procedures, cost and practicality.

HCA: Are business travellers to Africa aware and prepared against risks of contracting malaria? 

Dr. Guibert: Oil and gas, mining and non-governmental organisations have long-operated in Africa, and are largely aware of the impact of malaria. However, globalisation is bringing in new sectors that are often less prepared. We have seen an increase in travelling employees from finance, education, technology, manufacturing and the engineering sectors. Many of their employers are unprepared and unaware that even a short trip without the appropriate measures and chemoprophylaxis can be fatal.

While malaria is preventable, employers often struggle with the scope of their malaria programme. At a minimum, they may just send employees to a travel doctor for anti-malarial tablets and advice. However, many times this isn’t enough as employees don’t take their medicine and end up contracting malaria.

Having a consistent approach helps to mitigate risk, protect employees and the company’s reputation. Malaria control program in high risk areas may offer a strongly positive return on investment.

HCA: What is a malaria control programme? Why malaria programmes for travellers and expatriates are often inadequate?

Dr. Philippe Guibert: Malarial mosquitoes do not recognise boundaries between worksites and villages, so more and more companies are extending their malaria programs to include communities around their projects. Maintaining a healthy workforce is an essential element to overall productivity, and providing specifically designed community programs as an extension of a site program can boost the overall level of productivity, improve the health of the local population and meet corporate social responsibility targets.

For example, International SOS’ innovative malaria programmes in Africa:

• In Katanga, Democratic Republic of the Congo, we have partnered with the Ministry of Health and others to support a community malaria pilot project. In this effort, we are training local health volunteers on how to use rapid tests to diagnose malaria and how to administer drugs to treat the disease. It is anticipated this pilot programme will reduce malaria morbidity because as local residents often delay treatment as health facilities are many hours away. Providing early treatment reduces deaths and serious complications associated with people seeking treatment too late.
• In Fungurume, Democratic Republic of the Congo, we have an innovative programme to reduce mosquito breeding. Throughout the year, we breed sample local mosquito populations and test different indoor and outdoor insecticides to determine which are most effective for insect control. At the same site, we began to track the incidence of malaria in schools at the local villages. With this type of vector control programme, the incidence of malaria dropped by 80% in a four-year period.
• In Fort Dauphin, Madagascar, we implemented a full workplace and community education programme that reduced the incidence malaria to less than 1%. Training materials were developed in French and Malagasy, the local language. We provided classes on how to mosquito-proof house and use bed nets and reduce insect bites. And delivered a vector control programme to radically lessen the incidence of the disease.

HCA: What are medical kits for malaria? How can they be helpful in critical situations?

Dr. Guibert: Travellers going to a malaria zone should see their health care provider to find out the right type of prophylactic treatment that will need to take. Many anti-malarial will need to be taken prior to departure and after return from a destination with endemic malaria.

Methods include chemical prophylaxsis, appropriately selected on an individual basis by your healthcare practitioner:

• Atovaquone plus proguanil (also known as Malarone or Malanil)
• Doxycycline (also known as Vibramycin-D)
• Mefloquine (also known as Lariam or Mefliam)

HCA:  Any update regarding malaria vaccines?  

Dr. Guibert: The complexity of the malaria parasite makes development of a malaria vaccine a very difficult task. According to the WHO, there is currently no commercially available malaria vaccine, despite many decades of intense research and development effort. Some candidate vaccines have been proven to give some level of protection but only temporarily.

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