Malaria Prevention for Non-Immune

Level 2
Introduction

 This presentation is for Schlumberger international employees working in medium and high malaria
risk countries.
 In particular for those working in the company designated high malaria risk countries below:
– Africa – In Sub Sahara Africa including but not limited to Angola,
Chad, Cameroon, Equatorial Guinea, Gabon, Ghana, Nigeria,
Ivory Coast, Sudan, Congo, Uganda, Mozambique and
Tanzania.
– Asia – Including but not limited to Cambodia, Indonesia,
Myanmar, Thailand, and Vietnam
– South America – Amazon Basin including but not limited to the
jungles of Brazil, Colombia, Ecuador and Peru.
Malaria Kills

Looking back:  July 2006

 June 2001 – An expat employee working offshore on a rig,
started feeling ill.
– An expat employee working in Equatorial Guinea,
went on days off and a few days later, he died of – No test for malaria was ever made and he died of
deadly malaria (falciparum). deadly falciparum malaria 4 hours after returning to
land.
– He left a wife and 3 kids behind.
– He left behind a wife and 2 young children.
 Sept 2002
– An expat employee working in Chad, went for days
off and 12 days later, he died of deadly malaria
(falciparum)
– He left behind a large family.
Malaria Kills

Attending this training and following these recommendations

could save your life.
Common Threads

 There were 7 SLB-involved malaria deaths from 2000 – 2012:

– Most happened outside of high malaria risk areas (on days off or at work in a
non-malaria country)
– Visitors / rotators / staff in transit / long term resident expats
– Time was lost due to late diagnosis and lack of medication
– Curative medicine was not available (Note that The Curative Malaria Kit was
introduced in 2003)
– Most cases were from Sub-Saharan Africa
We have had MANY close calls.
Pattern is Due to…

 “Days-off mentality”
 Awareness levels fall when away from high risk location
 Incubation period of malaria delays symptoms
 Symptoms easily-confused (looks like the flu)
 Doctors ignorance of malaria in much of world
 Complacency: “it won’t happen to me”
Who is fit to go?
 In order to work in high malaria
risk countries you must:
– Be declared medically fit on your
last company health
assessment
– Have the required company-
designated vaccinations
– Be aware of the dangers of malaria
 Special attention should be paid to:
– Children under 3 years of age
– Mosquito nets should be used whenever possible and a
doctor’s advice should be sought prior to administering
any preventive or curative medicine
 Company designated high malaria risk countries are not
recommended for:
– Non-immune pregnant women
The Key Facts
 Malaria is a disease transmitted by
mosquitoes.
 The disease is passed by the female
Anopheles mosquitoes that bite at night.
 The disease is passed by the female
Anopheles mosquitoes that bite at night.
 Once in the liver parasites multiply until
ready to enter the blood stream where
they attack red blood cells.
 One bite is enough to provoke malaria.
 Malaria in 2015 infected 215 million
people and killed more than
440,000 (>80% in Africa).
 From the time one gets bitten to the
time the symptoms start to appear
can take between 7 and 60 days.
 There is no vaccination.
 Treatment is urgent.
 This is an emergency.
 The Key Facts

 Only falciparum malaria kills!

 Once correctly treated with the recommended curative medication, falciparum
malaria can only reoccur if the person is once again bitten by an infected
mosquito.
 There are 3 other forms of malaria – vivax, ovale and malariae. These are very
rarely fatal.
 Even if treated with the recommended curative medication effective against
falciparum, P. vivax malaria can reoccur for many years without any new
mosquito bite. An additional treatment is therefore necessary to prevent the
reoccurrence of P. Vivax.
 The Schlumberger Curative Malaria Kit tests for ALL 4 types of malaria.
 1. Infected mosquito

Life Cycle of Malaria bites a human.

 In nature, malaria parasites spread by infecting successively two types of

hosts: humans and female Anopheles mosquitoes.
 In humans, the parasites grow and multiply first in the liver cells and then in
the red cells of the blood. 2. Parasite
rapidly goes to
liver within 30
 In the blood, successive broods of parasites grow inside the red cells and minutes. 3. Parasite gets into
destroy them, releasing daughter parasites that continue the cycle by blood stream and
enters red blood
invading other red cells. cells. The infected
red blood cells burst
 The blood stage parasites are those that cause the symptoms of malaria. infecting other blood
cells.

 When certain forms of blood stage parasites are picked up by a female

Anopheles mosquito during a blood meal, they start another, different cycle
of growth and multiplication in the mosquito.
4. This cycle depletes the body of
oxygen and causes fever. The cycle
coincides with malaria’s fever and
chills.
 1. Infected mosquito

Life Cycle of Malaria bites a human.

 After 10-18 days, the parasites are found in the mosquito's

salivary glands.
 When the Anopheles mosquito takes a blood meal on another
2. Parasite
human, the parasites are injected with the mosquito's saliva and rapidly goes to
liver within 30
start another human infection when they parasitize the liver cells. minutes. 3. Parasite gets into
blood stream and
 Thus the mosquito carries the disease from one human to enters red blood
cells. The infected
another (acting as a "vector"). red blood cells burst
infecting other blood
cells.
 The mosquito vector does not suffer from the presence of the
parasites.

4. This cycle depletes the body of

oxygen and causes fever. The cycle
coincides with malaria’s fever and
chills.
Malaria Symptoms

 There are no specific symptoms for malaria. Until you have proven otherwise, assume any of
The main symptoms of malaria are often these symptoms are symptoms of malaria.
mistaken with those of the flu (the common If you have any of these symptoms and you live
cold). in a malaria country or have visited a malaria
 They can include any of the following: country within the last 8 weeks:
– Fever – Aches and pains  See a doctor
– Chills – Abdominal pain
 Get a blood test for malaria
– Headache – Diarrhea
– Fatigue – Vomiting  Do not lose time
– Weakness
Malaria Prevention is Based On…

If you are a visitor to or an employee in a high

malaria risk country, your safety is based on two
lines of defense.
1. Insect Bite Prevention
2. Preventive Anti-Malarial Medication
Mosquito Control: 6 Building Blocks
Personal Protection Source Reduction Larvicides
Deny the blood meal Deny breeding grounds Chemical/Biological

STAGE 1 STAGE 2 STAGE 3

Female mosquitoes develop eggs, fed by human Eggs laid on standing water Eggs hatch and develop into larvae and pupae
blood in a week
Actions
Actions Prevent water logging, destroy unwanted water Actions
Close windows and doors to prevent entry; Protect humans collections, keep water containers closed. Kill the larvae with parricidal agents.
against mosquito bites by using bed nets (insecticide treated)
and repellents.

Bite Prevention Prevent Entry Insecticides

Adult female mosquitoes bite
human beings at night, STAGE 5 STAGE 4
Adult mosquitoes enter human Adult mosquitoes can live up to 4-10 weeks or
maximum between 10pm - 4am dwellings between 5-10 pm and the more
early morning, hide in dark corners
STAGE 6 Actions
Mosquitoes bite humans‘ Actions Kill the adults with space sprays (for instant kill) and
Close the doors and windows and place screens on them; residual sprays (for lasting effect).
Actions clear hiding places if possible.
Personal protection by covering the body with clothes; use of
mosquito nets and repellents.
Insect Bite Prevention: 6 Top Tips
Bed Nets
 Ensure chemically treated nets are fitted
above each bed and that the nets are
used and retreated every 6 - 12 months.
Chemical Diffusers
 Use electro-chemical diffusers in your
house/rooms. Tabs give 10 hours of bite
protection, while liquid insecticide bottles
give 21 days.
Insect Repellent
 Spray on exposed skin before going out
at night. Carry in your pocket when going
out for the night.
Air Conditioners
 Mosquitoes avoid cold places. The P.
falciparum parasite cannot develop
inside mosquitoes if the temperature is
below 20°C.
Mosquito Coils
 Use if socialising outside, burn coils
where people are gathering.
Insect Spray
 Make sure you spray your
house/accommodation regularly.
Insect Bite Prevention: Checklists

Indoors checklist: Outdoors checklist:

 Windows and doors are kept closed.  Long sleeve shirts are worn.
 Doors and windows are fitted with screens and regularly checked for holes.  Long trousers are worn at all
 Where available air conditioning is working and on cold (preferably ≤ 20ºC). times.

 At night electric diffusers are plugged in and working, particularly in bedrooms.  Socks are worn outside at night.
 Before going outdoors repellent
 In verandas coils are burned.
is applied to uncovered parts of
 Accommodation is regularly sprayed with insecticide. the body.
 Chemically treated bed net is provided and regularly checked for holes and  Stay indoors at night whenever
used correctly (tucked under the mattress all around the bed). possible.
Preventive Medication

In company-designated high malaria risk countries, use of preventive malaria medication is highly recommended.
For staff assigned to ExxonMobil projects the use of preventive medication is mandatory. Preventive medicine works by
preventing the malaria parasite from reproducing in the liver.
 Take as preventive medication one of the following medicines:
– 1 tablet/day of Malarone®
– 1 tablet/WEEK of Lariam ® (Mefloquine) 250 mg
– 1 tablet/day of Doxycycline 100mg
 All medication needs to be taken REGULARLY during the entire stay in a malaria country and for 4 weeks after leaving
a malaria country except for Malarone which needs to be taken for only 7 days after leaving a malaria country.
 The risk of side effects exists with all medications but is small and reversible when medication is stopped.
 The risk of side effects is always smaller than the risk of malaria which is DEATH.
Preventive Medication
Treatment Preventive Medication

Lariam®
Medicine Malarone® Doxycycline
(Mefloquine)

Recommended
1 tablet per day 1 tablet per week 1 tablet per day
dosage
Treatment must 1 day before 1 week before 1 day before
start departure departure departure
7 days after 4 weeks after 4 weeks after
Treatment must leaving the leaving the leaving the
not stop until malaria-risk malaria-risk malaria-risk
region region region

Potential side Digestive, Digestive, skin

Neurological
effects* headaches photosensitivity

Protection level 95% 90% 90%

Caution required Avoid prolonged

if operating and excessive
Comments
machinery or exposer to
driving sunlight
Malaria: ‘Skip-taking’ Preventive Medication

Blood Parasite Count

 It is vital that when you start taking DAY: 3

chemoprophylaxis you follow the Person stops taking

preventive medicine
again. This time

medicine’s dosage as prescribed. DAY: 2

Person feels ill and
there is a massive
increase in
parasites in the
takes preventive
blood and the
Failure to take the medicine could
medicine again and
 DAY: 1
Person does not
condition appears to
stabilize. Malaria
person becomes
critically ill.

give a false sense of security

Parasite Count
take preventive parasites are already in
medicine and the blood and are not
parasites begin to being killed off by the

leading to death. break out from the

liver into the blood.
Malaria symptoms
preventive medicine.

DAY: 0 begin.
Person takes
preventive
medicine.

Time
Warning!

 Although a preventive treatment taken regularly

greatly reduces the risk of contracting the
disease it does not protect 100%.
 Therefore, even if you are taking a preventive
treatment and come down with any of the
symptoms of malaria.
See a doctor URGENTLY!
Malaria: Once You Leave the Malaria Country

 Once you leave a malaria country your malaria risk increases dramatically because
you may not ‘think malaria first.' Once away from the location:
– You are in a ‘days off’ mentality.
– Those around you may not suspect malaria.
– Your doctor will very likely not suspect malaria. He/she may not have experience in diagnosing
malaria and the curative medication may not be available.
– The incubation period of malaria can cause the onset of symptoms to occur weeks after having
left the high malaria risk country (up to 8 weeks).
– You must be aware that this is where the risk of your developing malaria is by far the
highest! Nearly all our malaria deaths have occurred after leaving a high malaria risk
country!!!
When Travelling to a Remote Location

 When you travel to a remote location/rig your malaria risk also increases significantly
because medical support and treatment could be many hours way:
– The location is remote and may be hard to reach in an emergency
– You may not have access to good quality medical care
– You may not have reliable communications with the outside world
– Medevac takes time to arrange
– You must always take a Curative Malaria Kit with you when you visit a remote location or
oil rig. If you fail to do this you are putting your life at risk.
A Little Help From Friends

 When you have malaria you might not be able to think correctly. Having severe fever
may impair your judgment. Make sure your family, friends and co-workers:
– Know what the symptoms of malaria are so they know what to look out for
– Understand that plasmodium falciparum malaria can appear rapidly and that, if not treated
urgently, you may lose the ability to help yourself
– Know that an extra pair of eyes watching you may see symptoms you yourself don’t recognize
– Know that they should inform Schlumberger if you become ill with flu-like symptoms
– Know about the malaria hotline and how to use it
– Know how to use the curative malaria kit
Malaria – What Should I Do if I Suspect Malaria?
Every member of staff has the responsibility to
locate the nearest doctor/hospital to their place of
residence that has experience in treating tropical
disease. Ensure that you:
 See a doctor rapidly and take your Curative
Malaria Kit.
 If you develop malaria you may rapidly lose the
ability to think straight.
Do not lose time! This is an emergency
 If you do not have immediate access to a doctor use
the Curative Malaria Kit which is made up of:
– Three malaria diagnostic tests to check for the 4 types of
malaria.
– Curative Treatment - Coartem® also known as Riamet ® .
Schlumberger Malaria Hotline telephone card.
– Health Alert Card to be given to the consulting physician
in order to remind him of the dangers of malaria.
Your Curative Malaria Kit

3 compartments – Instructions, Fever, Malaria

 Your Curative Malaria Kit – Content

1 - INSTRUCTIONS
3 - MALARIA
Alert cards and stickers
3 Rapid Diagnostic
Quick User Guide – 8 steps to Test packets you will use
diagnose & treat malaria to diagnose malaria

Curative Coartem
2 - FEVER Medication – A 3 day
treatment is provided to
Forehead thermometer cure malaria
to measure fever

Paracetamol to reduce
fever
Your Curative Malaria Kit – Content of a Rapid Diagnostic Test packet

Alcohol wipe
Opened diagnostic
test packet Lancet for finger prick

Plastic inverted cup

1 Rapid Malaria
Diagnostic Test

Buffer bottle
Disposable gloves
1
Malaria Curative Kit – Do the test

1. Remove the rapid diagnostic test from the packet.

2. Place the rapid diagnostic test on a clean, flat surface.
2 3. With one hand pick up a plastic lancet twist off the purple sterility cap.
The penetration depth is set to the medium position. The lancet is
ready to use. If another person than yourself is performing the test,
they should wear gloves to prevent infections.

3
4
Malaria Curative Kit – Do the test

4. Disinfect the side of any finger using an alcohol wipe contained in

the kit.
5. Prick the finger to obtain a drop of blood. Firmly hold the lancet
5 against the side of the fingertip chosen and press the purple button
to activate. Excess pressure on the finger should be avoided. The
finger prick is almost painless. (The lancet can only be used once as
the needle automatically retracts after use).
6. Use the inverted cup to transfer a drop of blood from the finger prick
to the round (S for Specimen) Blood port in the Rapid Diagnostic
6
Test and add 4 drops of buffer fluid in the square Buffer area.

Wait 15 minutes before

reading the result.
Malaria Curative Kit – Read the test

Test validity
One red line in the “Control” area
indicates that the test is working correctly.
Invalid test
The absence of a red line in the “Control” area
indicates that the test is not working correctly and is invalid.

If the diagnostic test is invalid, it must be discarded and a new test performed using
another drop of blood, another rapid diagnostic test and another bottle of buffer liquid.
Malaria Curative Kit – Read the test

Negative for Malaria

Only one red line appears within the
control zone = Valid test and no malaria is
detected on the rapid diagnostic test.
Note: A negative test means you have a negative test. It does NOT mean that you do not
have malaria.
 If symptoms persist, repeat the test 12 hours later.
 Repeat the test again 12 hours later (24 hours after the initial test) if the second test
remains negative.
20
Malaria Curative Kit – Read the test

Positive for Malaria

Two or three red lines appear in the
Control Area = YOU HAVE MALARIA!
 Start curative treatment now and see
a doctor urgently
Note: Do not throw the rapid diagnostic test
away after use. It may be requested by the
consulting physician or by the Schlumberger
Medical Department in order to confirm with the
laboratory findings.
21
Malaria – Ignorance Kills

“I’m working offshore on a rig and have a

fever and headache. The air conditioner was
on really low last night and there are other
crew members with flu on the rig so it must be
flu. I visited the medic and got some medicine Maybe
for my headache and fever. The medicine has  If symptoms persist you must repeat the test
worked and my headache has gone but I after 12 hours.
decided to perform a malaria test. The result Think malaria first, your life is on the line!
is negative so I think I don’t have malaria?”

22
Malaria Curative Kit – If Your First Test is Negative
Blood Parasite Count
TIME: 24 hours
 The first malaria test may be negative. TIME: 12 hours
If symptoms persist you
should perform a 3rd

 There may not be enough parasites in If symptoms persist you

should perform a 2nd
malaria test.

the blood to register a positive test. malaria test after 12

hours. By this time the
3

number of malaria
 It is critical you repeat the test again TIME: 0 parasites will have
increased. But is it
in 12 hours and if necessary again

Parasite Count
The 1st malaria test may sufficient to register a
be negative as there may positive test?
24 hours after the 1st test. not be enough parasites
in your blood to register a 2
positive test.
If the first test is negative, and symptoms
persist, always repeat the test after 12
1

hours.
23
Time
Treat malaria
Company designated curative anti-malarial
treatment is based on Coartem.
 Riamet is the same medication but the name
may vary from one country to another.
 1 tablet morning and evening for 3 days. Total
of 6 tablets (take with a little food or a glass of
milk).
 Once started, Coartem/ Riamet should be
continued for the full 3 days, even if the 3
tests remain negative.
 Curative medicine kills the blood stage of the
parasite.
 P. vivax, which rapidly goes to the liver, will
require an additional medication to treat the
liver stage and prevent reoccurrence.
Schlumberger Malaria Hotline

The Malaria Hotline provides:
 A phone service providing advice and emergency help
on malaria 24/7.
 Access to a team of doctors specialized in tropical
medicine.
 Staff with up-to-date knowledge on preventive and
curative malaria medication.
 Direct access to the Schlumberger organization.
 A multi-lingual service.
 Assistance with hospitalisation or evacuation when
necessary.
 A call back facility – if you call the Hotline you must
provide your name, GIN number and cell phone
number so that the doctor can call you back to check
on your health.
Toll-free number:
00-800-MALARIA-0 (00-800-6252-7420)
USA = 011-800-6252-7420
In countries where the toll free number does not
directly connect, place a collect call (free) to the
following number:
00-33-1-55-63-37-80
USA = 011-33-1-55-63-37-80

DO NOT HESITATE TO CALL!

Before Departing a High Risk Country
 An employee is responsible for ensuring that:
– The date of the Curative Malaria Kit is valid and the
expiry date has been logged in QUEST.
– The contents of the kit is complete with no missing
items.
– The kit is carried in hand luggage on departure for a
remote location/rig or when departing from the high
risk country on business or vacation.
– They know how to use all items in the Curative
Malaria Kit.
– They have located the nearest medical facility to
their residence that can diagnose and treat malaria.
– Next of kin as well as relevant family members have
been informed about the risk and symptoms of
malaria (they could save your life).
– They see a doctor very rapidly if they become ill
within 8 weeks after having left a high malaria risk
country.
– In the event of a positive malaria test the employee
should contact the Malaria Hotline and their
manager as soon as possible. Schlumberger
provides support.
– If they need any advice or have any questions
about malaria they should call the Malaria Hotline.
Conclusion
 The risk is highest after leaving a high risk
country or when working in a remote location/rig.
 Malaria is fatal if not treated rapidly.
This is an emergency!
 Take preventive medication regularly.
 If you suspect malaria: take Coartem ®or
Riamet® for 3 days and use your Curative Kit to
perform a malaria test for confirmation of the
diagnosis.
 Even if the 3 tests remains negative continue the
Coartem or Riamet treatment for 3 days (1 tablet
morning and evening).
 Do not hesitate to call the
Schlumberger Malaria Hotline for
advice.
 Malaria can be prevented and
treated
 For more info read the
Schlumberger Guide to Malaria on
the Schlumberger Health Hub at:
http://hub.slb.com/functions/HSE/Topic
Hubs/HealthHub/Health_Topics/malaria
.aspx