Abstract:
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.
