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International SOS: ‘Business travellers often unprepared for malaria risk in Africa’

• Large rise in the number of business travellers going to malaria-endemic countries in Africa: 61% increase in the last three years.

• In 2012, malaria was the number 1 cause of hospitalisations and medical evacuations among its travellers and expatriates in Africa.

On World Malaria Day 25 April, International SOS highlights an increase in the number of business travellers going to countries in Africa where malaria is endemic. Oil & gas, mining and non-governmental organisations have long-operated in Africa and are largely aware of the impact of malaria, however globalisation is bringing in new sectors that are often less prepared.

Dr Myles Neri, Group Medical Director, International SOS says: “We have seen an uptick in mobile employees from finance, education, technology, manufacturing and the engineering sectors. Many of their employers are unprepared -- unaware that even a short trip without the appropriate measures and chemoprophylaxis can be fatal.”

International SOS' recent analysis(1) of over 8.7 million travellers to 220 countries within its TravelTracker system show a 61% increase in travel to African countries with malaria in the past three years. International SOS cites its experience with malaria last year:  

• In 2012, it handled over 740 malaria cases(2) -- including calls for advice, hospitalisations and evacuations.
• 82%(3) of its malaria cases occurred in Africa.
• 47%(4) required medical evacuation to obtain a higher level of medical care.

Malaria programmes for travellers and expatriates often inadequate

Employers often struggle with the scope of their malaria programme(5). “At a minimum, businesses may just send employees to a travel doctor for anti-malarial tablets and advice. Often this isn’t enough. When employees do not take their medication as prescribed or take steps to minimise mosquito bites, they can end up contracting the disease,” says Dr Neri. He refers to a recent case handled by International SOS’ London assistance centre:

“A 51-year old man from Belgrade working as engineer was deployed to Lagos, Nigeria for a two-week business trip.  He was uninformed about the risks of malaria as his employer did not have appropriate travel procedures in place.  Whilst abroad, he did not take anti-malarial tablets. Four days after returning to Europe, he got severe headaches, fever and began to pass blood in his urine. In Belgrade, he was hospitalised. However, the facility did not have malaria treatment readily available. He was evacuated to London where he was able to get appropriate treatment and eventually recovered.”

Most malaria cases occur when business travellers return home(6): Medical kits helpful

Studies have suggested that malaria is often not recognised or properly managed in non-endemic countries(7). Fatalities occur with the failure to take anti-malarial tablets, misdiagnosis, inappropriate treatment or delays in treatment(8).Treatment administered early is very important for recovery. In places where malaria is not commonplace, malaria medications may not be readily available. Many organisations are providing their travellers and healthcare professionals with malaria diagnosis and curative kits backed by telemedicine advice. Early on, these kits can help detect the presence of the parasites that cause malaria and contain malaria treatment.

Prevention measures crucial

It is important for companies to define their policy towards malaria if they send employees to or operate in an area which is medium to high risk. They should:

• Reference evidence-based approaches to chemoprophylaxis.
• Provide access to clinical services and medical assistance for malaria case management.
• Provide education and training around personal protection to reduce mosquito bites. 
• Give access to quality-assured medication before and during travel: In Sub-Saharan Africa, as many as a third of anti-malarial tablets are counterfeit9.

Dr Dave Knight, International SOS, Medical Director says: “Malaria is complex and specialist advice is advisable. There needs to be deep understanding and discussion on testing, disciplinary procedures, cost and practicality.”

--Ends--

1] Taken from a dataset of 8.7 million travellers going to international destinations in TravelTracker in 2009-2012. TravelTracker is used by over 700 of International SOS' multinational clients with each client typically having thousands of travelling employees.

2-4] 2012 analysis of over 12,000 medical cases in International SOS’ medical case management system.

5] Page 18, “Duty of Care of Employers for Protecting International Assignees, their Dependents, and International Business Travelers, International SOS and Dr.Lisbeth Claus, 2009.

6-8] Kain, Keystone, Malaria in Travellers Epidemiology, Disease and Prevention, Infectious Disease Clinics of North America, 12(2):267-84,1998

9] Nayyar GM, Breman JG, Newton PN, Herrington, Lancet Infectious Disease, Jul;12(7):506,2012.

About International SOS

(http://www.internationalsos.com/) is the world's leading medical & security services company operating from over 700 sites in 70 countries with 10,000 employees, led by 1,200 physicians and 200 security specialists. Our global services include medical and risk planning, preventative programs, in-country expertise and emergency response for travellers, expatriates and their dependents of over 70 percent of the Fortune 500 companies.

International SOS provides a wide array of services, from educating and supporting a small number of travelling employees, to delivering a full community health program designed to control malaria in local communities. With over 20 years of experience in supporting malaria programs for clients, including operations in over 500 remote sites around the world, International SOS can help to design a tailored malaria control program specific to a business's corporate policies and