An Innovative Approach to Malaria Prevention Based on a QHSE Management System: Experience and Case Study from West and Southern Africa

Abstract

Among all known infectious and tropical diseases in sub-Saharan Africa, malaria is certainly one of the highest in the list of health concerns of African governmental institutions (Table 1) and of oilfield-related companies. Although preventive methods and curative treatment exist, malaria still kills about 2 1/2 million people per year in sub-Saharan African countries. Moreover, in the oilfield industry, a considerable number of nonimmune people travel back and forth between malaria-infested and noninfested areas. Most of the malaria-related fatalities in the oilfield industry come from this type of population. A systematic and methodical approach to malaria prevention was developed and successfully implemented in seven countries in west and southern Africa. In this paper, we explore underlying causes and common patterns seen in malaria fatalities in the oilfield industry using in-depth root cause analysis. Complexity factors are analyzed and their relationship to malaria prevention established, to provide a better understanding of the acuity of the problem. The prevention program is derived from a systematic application of a quality, health, safety, and environment (QHSE) management model. The proposed approach is validated in the short and long term using comprehensive analysis of inputs from a data capturing software. A population of more than 400 nonimmune oilfield personnel traveling in and out of sub-Saharan Africa is used as a sample for the study. It appears that malaria prevention is ineffective if not tackled in a rational manner. Distributing curative and preventive treatment to personnel is not sufficient to solve the problem. Instead, a program based on a logical and structured model, whereby tools and processes are available for each element of the model, provides a more effective approach to malaria risk management to achieve malaria fatality-free operations in west and southern Africa. Introduction Malaria is one of the most important threats to the health of the oilfield population traveling in and out of west and southern Africa. In fact, the most common type of malaria in this part of Africa (malaria P. falciparum or also called cerebral malaria) is life-threatening, and causes 300 to 500 million clinical cases in the world (more than one person is infected every 10 seconds) and more than 2 million deaths occur each year. More than 90% of malaria deaths occur in sub-Saharan Africa (approximately 3,000 deaths each day). Over the past five years, many oilfield industry employees have died from malaria. In almost 100% of the cases, those employees died while on days-off or while traveling outside of the malaria-infested area. Between 2000 and 2002, two major oilfield companies reported six malaria fatalities of their non-African employees and contractors working in west and southern Africa, all happening while outside Africa. In 2002, employees of an oilfield service company reported 16 serious malaria cases in west and southern Africa, most leading to hospitalization. An in-depth analysis and investigation of the above cases have highlighted the following common patterns leading to malaria fatalities:Employees had a "days-off mentality," displaying a higher awareness of the disease on location, but relaxing their vigilance while off location.The incubation period of the disease is from 7 to 60 days.Symptoms of the disease are flu-like and easily confused.Doctors are ignorant of malaria in many parts of the world.Employees displayed a complacent "It won't happen to me" attitude.Curative medication is not available in noninfested areas. In addition to the above, some complexity factors can be added:the notion of semi-immunity against malaria is not well understoodmental barriers to preventive medicationpersonal factors that affect employees behavior with regards to malaria prevention.