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


CONCLUSIONS
This survey demonstrated that a comprehensive programme targeting malaria prevention in expatriates can be effectively implemented and that it significantly increased malaria awareness.
Roukens
Anna H
AH
Infectious Diseases, Leiden University Medical Center (LUMC), 2300 RC, Leiden, The Netherlands. a.h.e.roukens@lumc.nl
Berg
Johannes
J
Barbey
Alex
A
Visser
Leo G
LG
D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D018890:Chemoprevention; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D020407:Internet; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012646:Self Administration; D016353:Self-Examination; D011795:Surveys and Questionnaires
D000962:Antimalarials