Assessment of a Targeted Approach to Preventing Malaria in the Oil and Gas Industry: Responses to a Web-Based Questionnaire

Abstract

Following the death from malaria of four of its expatriate employees while they were in nonmalarious countries, an oilfield service company developed a targeted, multi¬component malaria prevention program. The program consists of two levels of malaria training, malaria arrival and departure quizzes, a Malaria Hot Line, and a curative malaria kit (CMK). The cornerstone of the program is the CMK, which contains a diagnostic test that employees can use to diagnose malaria in minutes and standby (emergency) curative medication. Completing training in malaria prevention and using the CMK are mandatory for all employees and dependents living or working in or transiting through any malarious area, even if for only a few hours. The complementary 24/7 Malaria Hot Line was set up by the company to assist employees with questions or problems. This paper presents the preliminary analysis of employees' responses to a Web-based questionnaire to review the effectiveness of the company-mandated training, CMK, and Malaria Hot Line in preventing illnesses and deaths from falciparum malaria. Introduction Every year, malaria caused by the parasite Plasmodium falciparum infects 300 to 500 million people and kills between one and two million, particularly in sub-Saharan Africa and parts of South America and Southeast Asia. Among the expatriate population working or living in these malarious areas of the world, malaria is a major occupational illness, responsible for numerous lost days and several deaths within the oil and gas industry every year. In nonimmune individuals falciparum malaria can kill within a few days if not immediately treated. Because the symptoms of malaria are not unique---fever, shivering, joint pain, and headache---and they do not occur until 7 to 60 days after infection, malaria is easily misdiagnosed or not properly treated. Most of the expatriate deaths occur not in the malarious country where the disease was transmitted by the bite of an infected mosquito but in nonmalarious countries where the infected expatriates have traveled to for work or days off. In the past, the oilfield service company had at least one death from malaria and numerous near fatalities almost every year. Four employees died of malaria between 2000 and 2002. All deaths took place outside of the malarious locations where the disease was contracted and in countries where the fatal form of malaria is not endemic. Following these deaths a task force was created within the company with the aim of obtaining and maintaining the goal of zero malaria deaths. The result was development of a malaria prevention program based on the company's comprehensive QHSE Management System. The program provides processes and tools to fulfill the requirements of each of the system's eight elements. Components of the program are two levels of malaria training, malaria arrival and departure quizzes, a set of auditable malaria prevention program guidelines, and two innovative tools not previously used in oilfield malaria prevention: a Malaria Hot Line and a curative malaria kit (CMK). The malaria prevention program was distributed by the oilfield service company to its international employees and their dependents and to its contractors working in high-malaria-risk areas. Since the prevention program began in early 2003, the service company has not reported a single malaria death within its employee and contractor population.

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

“…The cornerstones of this preventive programme were a malaria awareness training programme and provision of a curative malaria kit, which contained dipstick-based strips for self-diagnosis and emergency standby medication for self-treatment of falciparum malaria. In an initial survey, this programme was rated very good to excellent by more than 60% of the respondents [ 4 ].…”