MALARIA INCIDENCE AMONG A GROUP OF JORDANIAN MILITARY TROOPS IN SIERRA LEONE IN 2000
Sami Abu Rumman MD*, Yosef Wardat MD*, Mohamed Abu Rumman RN**, Munir Arabiat MD*, Mohamed Aljar MD^
Objective: To evaluate the efficacy of Mefloquine as a prophylactic treatment against malaria among Jordanian soldiers in Sierra Leone. Methods: This is a retrospective study of 756 Jordanian soldiers among United Nations troops of Peace keeping forces in Sierra Leone, during a period of eight months extending from April until December 2000. All soldiers were given Mefloquine as a chemoprophylaxis upon United Nations recommendations in conjunction with Word Health Organization and Centers of Disease Control recommendations. Other preventive measures such as insect repellents and education were also instituted. Results: Out of the 756 soldiers of the battalion, only 39 (5.1%) had laboratory confirmed malaria during this period, the patients who were diagnosed were admitted to the hospital with rapid improvement of their symptoms within two days of treatment, and by the seventh day all patients were free of any residual complaint. Conclusion: Chemoprophylaxis with Mefloquine plus adequate preventive control measures against mosquito bites is not 100% effective to prevent falciparum malaria, but they reduce the incidence of the disease. Key words: United Nation, Malaria, Mefloquine, Peace Keeping Forces JRMS August 2008; 15(2): 38-40
illness and death from malaria are largely
Malaria in humans is caused by one of four
preventable.(4,5)
protozoan species of the genus Plasmodium: P.
Worldwide Malaria affects 270 million people
falciparum, P. vivax, P. ovale, or P. malariae. All
each year, and has a mortality rate of 1%. About
species are transmitted through the bite of an
90% of Malaria cases and deaths are believed to
infected female Anopheles mosquito. Occasionally,
occur in West Africa where the incidence rate
transmission occurs by blood transfusion, organ
without prophylaxis is estimated to be 1.4% per
transplantation, needle sharing, or congenitally from
month.(6) Travelers to this area have 1-4% chance to
mother to fetus. Although malaria can be a fatal
catch the disease.(7) Malaria is found in all countries
disease as in West Africa mainly in Sierra Leone,(1-3)
between the latitudes 30°S and 40°N and is
From the Departments of: *Family Medicine, King Hussein Medical Center, (KHMC), Amman-Jordan ** Nursing, (KHMC) ^ Ophthalmology, (KHMC) Correspondence should be addressed to Dr. S. Abu Rumman, P. O. Box 1878 Swelah-Jordan, E-mail:Manuscript received January 19, 2006. Accepted September 30, 2006
JOURNAL OF THE ROYAL MEDICAL SERVICES Vol. 15 No. 2 August 2008
considered a primary disease of hot humid countries
- The officers checked their soldiers daily that
at altitudes less than 2200 meters above mean sea
level where conditions are ideal for prolific breeding
- The soldiers were ordered to keep sleeves rolled
of the mosquito Anopheles.(4)
Travelers from temperate climates where infection
- Fumigation was done daily mainly in the
with Plasmodium falciparum is endemic are at
particular risk of morbidity and mortality,
chemoprophylaxis with an antimalarial drug is
- The sources, which attracted insects, were
Organization and Centers for Disease Control.
All suspected malaria cases were laboratory tested
United Nations recommendations obliges all
by thick smear and / or rapid test. All laboratories
military personal to take chemoprophylaxis in
confirmed malaria cases were admitted to hospital
malarious areas to reduce the non-battle casualties,
and started proper anti malarial treatment.
and to take Mefloquine as a chemoprophylactic
- The dosage is 250 mg (one tablet) once a week
Out of the 756 soldiers of the battalion, only 39
- The first dose should be taken one week before
(5.1%) had clinically manifested malaria during this
period. The species was Plasmodium falciparum
- Dose should be taken once a week, at the same
(the evolution of symptoms in treated patients is
day of the week, while in the risk area.
- Dose should be taken once a week for four
Table I. Number of malaria cases with various
- The drug to be taken on a full stomach with a
disappearance of symptoms in the post-treatment
Symptoms
This is a retrospective study of 752 Jordanian
military personal. The data was collected from the
hospital medical records, the age range was 19-42
All participants were among United Nations peace
keeping forces in Sierra Leone, who where given
Mefloquine during a period of eight months
extending from April until December 2000, all
Both fever and bone aches were the most frequent
personnel were enrolled in the study. Soldiers took
presenting symptoms of the disease (n=38) followed
the drug once weekly on Friday after lunch. All the
in order of frequency by chills (n=35) and sweating
soldiers were young and healthy according to
(n=28). The majority of patients felt well within 24
medical examination done prior to the mission.
hours of starting treatment with dramatic
The protective measures against the vector of
improvement within the first two days and by the
malaria and insects were applied through the
seventh day all patients were free of any residual
- Using the insect repellent on exposed parts of
Pallor, mild soft splenomegaly along with tinge of
jaundice was seen in a considerable number of
- Weekly lecture by the medical staff about
patients (n=38, n=38 and n=31 respectively). While
malaria and benefit of personal protective
the tinge of jaundice disappeared after initiating
measures and Mefloquine against disease.
treatment, splenomegaly and hepatomegaly
- Medical staff was taking the drug in front of
persisted for the next two to four weeks with slow
JOURNAL OF THE ROYAL MEDICAL SERVICES Vol. 15 No. 2 August 2008 Table II. Number of malaria cases with various
and others was low compliance with personal
presenting signs and the progressive disappearance
protective measures and chemoprophylaxis.(7,12,13)
Mefloquine is eliminated slowly by the body and
Initial signs
thus may stay in the body for a while even after the
drug is discontinued. Therefore, side effects caused
by Mefloquine may persist weeks to months after
the drug has been stopped. The side effects of
Mefloquine which occurre with the weekly
prophylactic dose (250mg) rarely necessitate
discontinuation and replacement of Mefloquine with
Anemia was corrected in 37 patients within five
other prophylactic treatment. Most travelers taking
days after treatment; mild hyperbilirubinemia
Mefloquine do not have serious side effects
disappeared within 48 hours of treatment (Table III).
No side effects of anti malarial medications were
Chemoprophylaxis with Mefloquine plus adequate
Table III. Frequency of relevant laboratory results
preventive control measures against mosquito bites
and their evolution during and after treatment
is not 100% effective to prevent falciparum malaria,
but they reduce the incidence of the disease.
Laboratory
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JOURNAL OF THE ROYAL MEDICAL SERVICES Vol. 15 No. 2 August 2008
Are you concerned that you or a family member might be sick with H1N1 flu? Follow this set of questions and find out what to do. Question #1: Does the patient have a new cough, or new shortness of breath (not related to feeling anxious)? No… be reassured, they do not have H1N1. Stop right here. Yes… Continue with questionnaire. Note: sore throat or runny nose, without c
April 2, 2008 NCAA Committee on Competitive Safeguards and Medical Aspects of Sports -- Medical Exceptions and Banned Drug Classes. The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports in conjunction with the NCAA Health and Safety staff has issued the following educational article on medical exceptions and banned drug classes. Please contact Mary Wilfert, associate di