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

[摘要] Background Promotion of job opportunities and tourism in African countries has led to anincrease in expatriates in malaria endemic areas. A paucity of data exist on characteristicsand numbers of expatriates and long-term travellers being evacuated from sub-SaharanAfrica for suspected malaria infections diagnosed while still in Africa.Methods A retrospective flight record review of a South African fixed-wing air-ambulanceprovider from June 2006 through July 2009 was performed. Adult expatriates and long-termtravellers with suspected malaria being evacuated from sub-Saharan African countries toJohannesburg, South Africa were included.Results Suspected malaria was the single most common diagnosis for dispatching airambulanceswith 81 (11.9%) of the 679 flights. Accuracy of the initial diagnosis, based onconfirmation of malaria at the receiving facility was 78.4% for blood smears, 92.3% for rapiddetection tests and 42.8% for clinical signs alone. P. falciparum (alone, or in combinationwith other Plasmodium species) was the most frequently isolated species at both thereferring (100%) and receiving (88.2%) facilities in cases where the species wasdocumented. The suspected malaria patients were predominantly male 69 (84.1%), with amean 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 oforigin in 48 (58.5%) of the suspected malaria flights. Compliance on appropriate malariachemoprophylaxis was documented in two (2.4%) suspected malaria patients. Intubation asa 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 requirementswhen comparing patients who had utilised malaria chemoprophylaxis with the patients whohad not utilised chemoprophylaxis.Conclusions Patients presented in advanced stages of severe/complicated malaria withconcurrent poor chemoprophylaxis utilisation and compliance. Appropriatechemoprophylaxis did not decrease the severity of presentation (based on intubationrequirements) and did not guarantee complete malaria protection.

[发布机构] University of the Witwatersrand