Experience with Malaria and the Use of Antimalarials in an Oil and Gas Producing area of Nigeria

摘要

With an estimated worldwide 300-500 million clinical casesrnand 1.5 to 2.7 million deaths per year, malaria continues to berna major health problem especially in the tropics. Thisrnprospective two-phased study was carried out in ChevronrnNigeria’s operational areas to determine effectiveness ofrnconventional antimalarials, degree of drug resistance andrnthereby update our treatment policy. The first phase wasrncarried out between March and December 1998 in Escravos,rnwhich is the operational headquarters with a well equippedrnbase clinic. Employees with malaria (Parasitaemia confirmedrnusing the QBC technique) were randomized to takernchloroquine or Fansidar, which are our first line drugs in thernimmune/semi-immune. Malaria parasitaemia was checked atrn24, 48 and 72 hours. A second line drug was administered ifrnparasitaemia persisted or increased and patient’s symptomsrnpersisted. A total of 85 employees, all males (84 nationals andrn1 expatriate) were included in the study.rnThe second phase was carried out between March andrnAugust 1999 in Warri, which is 15 minutes flight fromrnEscravos. Here, the company has a 26-bedded hospital, whichrnserves as a back up to the Escravos clinic, and also caters forrnthe employees when they are on time off, and theirrndependants. A protocol similar to the phase 1 study was used,rnwith modifications to accommodate the different categories ofrnpatients seen and the different specialists managing them. Arntotal of 150 patients were studied. From both studies, a total ofrn235 employees were studied. 195 completed the treatmentrnprotocol and the drugs used were Chloroquine (85), Fansidarrn(34), Halfan (68), Quinine (5), Mefloquine (1) and artemetherrnin 2. There was no mortality. We found chloroquine andrnFansidar still very useful as first line drugs but there wasrnsignificant multidrug resistance. This paper discusses ourrnfindings, an overview of our experience with malaria, thernprevalence of antimalarial drug resistance, and ourrnprescription pattern. It also highlights our experience withrnchemoprophylaxis among our expatriate staff.