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Column: What do health professionals in Europe know about malaria? ‘Part I: European statistics’

April 10, 2014 - 20:00 -- Ingeborg van Schayk

Four years ago, after working for six years as a hospital and pre-hospital emergency doctor in Spain, I accepted a position as a remote site doctor in Sierra Leone. Until then malaria was an obscure, almost phantasmagorical, condition to me.

The first time a patient came into my clinic and complained of having malaria I was really shocked. Although I had learned by heart the epidemiology, diagnosis and treatment of malaria, never before did I face a malaria patient. I did the quick test and after diagnosing fever and general weakness I realized that I was dealing with my first malaria patient. A bit overwhelmed, I gave him the medication and explained his condition to him. And… He survived. Later I treated many more malaria patients. Some even with complicated malaria to whom I had to prescribe intravenous therapy indicated.

Looking back, I can now see how unaware I was of the reality of malaria: the A-B-C-D approach; the different treatments; and that fact that malaria, if diagnosed well and on time and treated properly does not have to be a mortal condition.

For those involved in malaria -prevention, -clinical management (diagnosis and treatment) or –research, malaria is a common and known disease. Indeed, malaria is still one of the main causes and mobility and mortality in the world. But, unlike HIV/AIDS or tuberculosis that still have high prevalence and incidence in high-income countries, malaria is an extremely rare condition to most Western doctors.

In this series of columns, I would like to reflect on the perception of malaria among western health professionals with a particular focus on those who are not concerned with malaria in their daily practice or research. I will discuss several issues that can help us to understand the lack of malaria knowledge of these professionals.

Here I will provide data on malaria between 2003 and 2013 in Europe.

Autochthonous cases
In the period form 2003–2013 only 11 European countries (Armenia, Azerbaijan, France, Georgia, Greece, Kyrgyzstan, the Republic of Moldova, the Russian Federation, Spain, Tajikistan and Turkey) reported autochthonous cases of malaria. More than 90% of the cases were detected in five European countries: Azerbaijan, Georgia, Kyrgyzstan, Tajikistan and Turkey. It means that malaria is, fortunately, only present in 22% of the European countries. In absolute numbers, 35,680 cases among the 739,165,030 Europeans represent a very low incidence over the past 10 years.  Moreover, in the past two years (2012–2013) there were only 241 cases of autochthonous malaria in Europe.

Imported cases
Imported cases have been reported from almost every European country. A total of 81,352 cases were registered between 2003 and 2013. Most of these cases occurred in France (36,220), the UK (16,123) and Germany (6057). In 2012 and 2013 only 5852 of imported cases were detected in Europe.

Deaths
There have been 413 registered malaria deaths in 34 European countries over the past ten years. Most of these cases occurred in France (94), UK (74) and Germany (29) and were mainly cases of imported malaria. In the last two years there were only 26 malaria related deaths in Europe.

As we can thankfully see, there are relative few malaria cases (imported and autochthonous) and very few malaria deaths in Europe. Great efforts to eradicate vectors and to improve surveillance, diagnosis and treatments have been undertaken on this continent. This situation has turned malaria into a rather unknown condition to European health professionals. This resulted in a general lack of medical knowledge of its clinical features and, especially, awareness of its effects in those areas where malaria is still present.

In my next columns I will focus on the social aspects of malaria; its historical evolution in different countries; and what health professionals in Europe have learned about malaria.

* The Statistical data have been obtained from the WHO Europe Centralized Information System for Infectious Diseases (CISID) webpage (http://data.euro.who.int/cisid/)
 


Alvaro Pemartin (Spain) Prehospital Emergency and Remote Site Doctor. My daily tasks are providing emergency and primary care in Remote Sites (Sierra Leone, Guinea-Conakry, Mauritania) Volunteer in my local Civil Protection Agency, Interested in Emergency and Disaster Management and in scientific ways of improving this management (Lessons Learned, Operational Research, Simulation, Modelling)…  Member of International Association of Emergency Managers and Member of the Editorial Board of Crisis Response Journal.

Comments

Submitted by Ricardo Ataide on

Hi Alvaro,

Nice job on bringing this topic to the table. It is really interesting how little is know about this disease among the medical doctors and health professionals, not just in Europe, but even within countries where malaria is endemic! While I was working in Brazil, conducting research on Malaria in Pregnancy, I had my base in São Paulo and travelled often to the Amazon region. The fact that the knowledge about malaria is poor in São Paulo was not at all surprising to me. Although São Paulo state has small pockets where malaria transmission is thought to still occur, malaria is hardly a concern in the state's mega-capital. The same is not true for the State of Acre and the city of Cruzeiro do Sul in the Amazon region, where malaria is an everyday concern with hundreds of cases a month, every month of the year and with both vivax and falciparum making appearances. One would expect that the medical doctors there would be much more 'on top of their game'. Unfortunately, that was not the case... not at all. The problem was that the majority of the medical doctors are not from that region. The amount of times I have witnessed doctors not knowing what to do with a malarial patient... So you see, it is not just a problem of western health professionals. Even those from an endemic country can be as naive.

Just as a curiosity, my first encounter with a malaria patient (bear in mind that I am not a medical doctor) happened in the Cajueiros Hospital in Angola when a semi-naked man wearing one of those hospital gowns that only cover the front came running up to me and almost whispered in my ear: 'Do you know john of god?' (in portuguese was: você conhece João de Deus?). Faced with what must have been a very weird look on my face he proceeded to shout out loud ' Do you know John of God?' 'Do you know John of God?' Before I had time to answer that I had no idea of what he was talking about a couple of nurses rushed in and very apologetically said that he was a malaria patient under observation and they were sorry he had bothered me! While they took him he shouted that he was John of God and started laughing. That whole episode is still clear to me as if it had happened 10 hours ago and not 10 years ago... I have to admit that the bewilderment and fear of a decade ago as been replaced by a sense of comedy!

Ricardo Ataíde