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.
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 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.
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.