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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
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
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
1. Centers for Disease Control and Prevention. Malaria
information for travelers to countries in West Africa. Travelers Health; Regional Malaria Information file//C; My document/Destinations Malaria west Africa CDC Travelers 2. Parveen K, Michael C. Clinical Medicine. Fourth edition;
Mefloquine is an orally administered blood 3. Goldman AB. BCh. Current Views on Malaria prophylaxis
schizontide for prophylaxis against malaria and for 12/11/ 2005. Avilabile from treatment. Studies between 1977 and 1988 demonstrated efficacy of Mefloquine against 4. Filler S, CauserLM, Newman RD, et al. Malaria surveillance
multidrug resistant Plasmodium falciparum. Several USA 2001. MMWR Surveill Summ 2003; 52(5): 1-14. 5. Huges C, Tucker R, Bannister B, Bradley DJ. Malaria
studies suggested high protective efficacy of prophylaxis for long-term travelers. Communicable Disease and Mefloquine more than 91% of travelers to areas with Public Health 2003; 6(3): 201-208. resistant Plasmodium falciparum, it was also 6. Armengaud M. Arguments against Chemoprophylaxis in areas
at low risk for chloroquine-resistant Pl. Falciparum. J Travel effective against Plasmodium vivax.(2,7,8,9)
Centers for Disease Control advice all travelers to 7. Richie TL,Widjaja H, et al. Mefloquine compared with
take Mefloquine for prophylaxis against malaria and Doxacycline for the prophylaxis of malaria in Indonesian Soldiers, Ann Intern Med 1997; 126(12): 963-972. reported that Mefloquine has rarely been reported to 8. Knobloch J. Long-Term Malaria Prophylaxis for Travelers. J
cause serious side effects, such as seizures, depression, and psychosis.(10) These serious side
9. Croft A Garner P. Mefloquine to prevent Malaria: A
effects are more frequent with the higher doses used systematic review of trials, BMJ 1997; 315: 1412-1416. to treat malaria; few side effects occurred with the 10. Centers for Disease Control and Prevention. Information for
the public: Prescription drugs for malaria, Available from weekly prophylactic doses used to prevent malaria. The most common side effects reported by travelers 11. Kitchener ST, Nasveld PE, Gregory RM, Edstein MD.
taking Mefloquine include headache, nausea, Mefloquine and doxycycline malaria prophylaxis in Australian soldiers in East Timor. MJA 2005; 182(4): 168-171. dizziness, and difficulty in sleeping, anxiety, vivid 12. Kwar GI, Maayah JF. Malaria among Jordanian Medical
dreams, and visual disturbances.(11)
Team on prophylactic Mefloquine in Sierra Leone. JRMS 2004; Higher incidence of malaria cases in the Jordanian Hospital in Sierra Leone between January 2002 and 13. Wallace MR, . Malaria among United
July 2002 and United States troops deployed in Somalia between December 1992 and May 1993 JOURNAL OF THE ROYAL MEDICAL SERVICES
Vol. 15 No. 2 August 2008


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