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Characteristics of patients (expatriates and long-term travellers) with suspected malaria, being evacuated by fixed-wing air ambulances out of Sub-Saharan Africa to Johannesburg, South Africa. a retrospective case review, for the period July 2006 through June 2009

Background Promotion of job opportunities and tourism in African countries has led to an
increase in expatriates in malaria endemic areas. A paucity of data exist on characteristics
and numbers of expatriates and long-term travellers being evacuated from sub-Saharan
Africa for suspected malaria infections diagnosed while still in Africa.
Methods A retrospective flight record review of a South African fixed-wing air-ambulance
provider from June 2006 through July 2009 was performed. Adult expatriates and long-term
travellers with suspected malaria being evacuated from sub-Saharan African countries to
Johannesburg, South Africa were included.
Results Suspected malaria was the single most common diagnosis for dispatching airambulances
with 81 (11.9%) of the 679 flights. Accuracy of the initial diagnosis, based on
confirmation of malaria at the receiving facility was 78.4% for blood smears, 92.3% for rapid
detection tests and 42.8% for clinical signs alone. P. falciparum (alone, or in combination
with other Plasmodium species) was the most frequently isolated species at both the
referring (100%) and receiving (88.2%) facilities in cases where the species was
documented. The suspected malaria patients were predominantly male 69 (84.1%), with a
mean age of 42.1 ±12.8 years, and were in sub-Saharan Africa for occupational reasons 65
(79.3%). Angola, the Democratic Republic of Congo and Mozambique were the countries of
origin in 48 (58.5%) of the suspected malaria flights. Compliance on appropriate malaria
chemoprophylaxis was documented in two (2.4%) suspected malaria patients. Intubation as
a marker of severity was required for 15 (18.3%) patients, and one (1.2%) patient died inflight.
No statistically significant difference (p=0.50) was shown for intubation requirements
when comparing patients who had utilised malaria chemoprophylaxis with the patients who
had not utilised chemoprophylaxis.
Conclusions Patients presented in advanced stages of severe/complicated malaria with
concurrent poor chemoprophylaxis utilisation and compliance. Appropriate
chemoprophylaxis did not decrease the severity of presentation (based on intubation
requirements) and did not guarantee complete malaria protection.

Identiferoai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/11029
Date17 January 2012
CreatorsVan der Walt, Renske
Source SetsSouth African National ETD Portal
LanguageEnglish
Detected LanguageEnglish
TypeThesis
Formatapplication/pdf

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