The burden of imported malaria in Cape Town, South Africa

摘要

BACKGROUND: The Western Cape Province of South Africa (SA) is not malaria endemic; however, a considerable number of patients present with malaria to our healthcare services. OBJECTIVES: To establish the frequency of patients presenting with malaria at Groote Schuur Hospital (GSH), Cape Town, SA, and to describe their demographics, clinical outcomes and laboratory findings. METHODS: An observational, retrospective, descriptive study was conducted, which included all patients presenting with smear-positive malaria to GSH over a 4-year period between 1 April 2008 and 31 March 2012. RESULTS: During the study period, 134 malaria patients presented to GSH for management; 85% (n=114) were male, median age was 27 years. Of the total smear-positive tests, 96% (n=128) were Plasmodium falciparum, 3% (n=4) P. ovale, and in 1% (n=2) the species was not identified. The number of malaria patients increased markedly, from 6 cases in 2008 to 50 cases in 2012. Of the patients, 48.3% (n=57) were from Somalia, 8.5% (n=10) from SA and 29% (n=30) from other African countries. One SA patient acquired transfusion-transmitted malaria from a pooled platelet product, and the other SA patients had travelled to malaria-endemic areas. The remaining cases were from countries outside of Africa, including 13% (n=15) from Bangladesh. Almost two-thirds (62%; n=72) were admitted to hospital with a median length of stay of 3 days (range 1 - 32). Clinical outcomes were good with only one death and the remaining patients being discharged. CONCLUSION: Imported malaria is imposing a significant burden on health resources. The costs of medical care for the emergency treatment of foreign nationals needs to be recognised, and adequately budgeted for. Only a small area within South Africa (SA) is malaria endemic and this is in the north-eastern part of KwaZulu-Natal, and in Mpumalanga and Limpopo provinces.[1] All cases of malaria in other areas of SA are imported, either from malaria-endemic parts of SA or from further afield. A large number of migrants travel to SA for economic, political and social reasons. According to the United Nations Refugee Agency, SA was the leading worldwide destination country of new asylum seekers between 2006 and 2011. Between 2008 and 2012, the SA Department of Home Affairs registered 778 600 new asylum applications, with Zimbabweans accounting for more than half of these.[2] However, as only a proportion of migrants to SA are registered as asylum seekers, the true number of migrants is unknown. Many foreign migrants come from malaria-endemic areas and present to SA healthcare services after arrival. Groote Schuur Hospital (GSH) in Cape Town is a tertiary hospital serving the Western Cape Province, with 975 beds and a busy medical casualty department that handles ~40 000 patients/year. The aim of this study was to establish the number of malaria patients presenting to GSH over the 4-year period between 1 April 2008 and 31 March 2012, and to describe their demographics, clinical outcomes and laboratory findings.