A Guide to Malaria Management Programmes

A Guide toMalariaManagementProgrammesin the oil and gas industry

A Pocket Guide to

Malaria ManagementProgrammes

This Pocket Guide is a ‘quick-reference’

supplement to the OGP/IPIECA publication

entitled A Guide to Malaria Management

Programmes which is available from

OGP/IPIECA, both in print and on CD-ROM.

It provides a brief overview of activities and

responses to frequently asked questions related to

malaria for the oil and gas industry.

IPIECAInternational Petroleum Industry Environmental Conservation Association

5th Floor, 209–215 Blackfriars Road, London SE1 8NL, United Kingdom

Telephone: +44 (0)20 7633 2388 Facsimile: +44 (0)20 7633 2389

E-mail: [email protected] Internet: www.ipieca.org

OGPInternational Association of Oil & Gas Producers

London office

5th Floor, 209–215 Blackfriars Road, London SE1 8NL, United Kingdom


E-mail: [email protected] Internet: www.ogp.org.uk

Brussels office

Boulevard du Souverain 165, 4th Floor, B-1160 Brussels, Belgium


E-mail: [email protected] Internet: www.ogp.org.uk

This document was prepared by the Managing Malaria Issue Group on behalf of the OGP-IPIECA Health

committee.The Issue Group comprised: Alex Barbey (Schlumberger) (Chairman); Gary Krieger and Marci

Balge (Newfields); Alison Martin (BP); Gabriel Saada and Frano Mika (Eni Saipem); Jean-Pierre Gardair

(Total); Irene Alfaro (ARPEL); Laurent Arnulf (International SOS); David Johnson (Hess); Michele Alphonse

(ConocoPhillips); Philip Wiggs (IMCA); Brian Doll (ExxonMobil); Hans Berg and Geert de Jong (Shell).

© IPIECA/OGP 2006. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, ortransmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the priorconsent of IPIECA/OGP.

Disclaimer: Information provided herein is offered in good faith as accurate, but without guarantees or warranties ofcompleteness or accuracy. Readers are hereby put on notice that they must rely on their own diligence when determining howor whether to respond to the information herein. Further, this guide is not intended to replace necessary and appropriate medicalor other professional advice or attention.

This publication is printed on paper manufactured from fibre obtained from sustainably grown softwood forests and bleached without any damageto the environment.

A Guide toMalaria ManagementProgrammesin the oil and gas industry

mailto:[email protected]

http://www.ipieca.org



http://www.ogp.org.uk

http://www.ogp.org.uk

A G U I D E TO M A L A R I A M A N AG E M E N T P RO G R A M M E S I N T H E O I L A N D G A S I N D U S T RY

ii

1 Purpose of this guide

2 The overall situation: global burden of malaria

3 Key factors to promote success: role of senior management

3 What are Malaria Management Programmes (MMPs)?

4 Malaria Management Programmes (MMPs)—levels of prevention4 Primary prevention of transmissible vector-borne diseases

4 Life cycle of malaria

5 Pathophysiology

5 Vector epidemiology

6 Urban malaria epidemiology

7 Primary prevention: vector control7 Indoor residual spraying (IRS)

7 Insecticide treated nets (ITNs)

7 Space spraying

8 Secondary and tertiary prevention of transmissible vector-borne diseases8 Secondary prevention

8 ‘A’ for awareness and education

8 ‘B’ for bites—personal protection measures

9 ‘C’ for compliance with chemoprophylaxis

10 ‘D’ for prompt diagnosis and early treatment

11 Tertiary prevention

12 Benefits of an MMP

12 When to develop and implement an MMP

13 Integrating an MMP with other impact assessment and outreach programmes

13 National and international stakeholder consultation

15 Putting it all together: the MMP process16 Screening

16 Scoping

17 Planning including resourcing, cost and time management

17 Stakeholder consultation

17 Risk assessment

18 Decision making

19 Mitigation

19 Implementation and monitoring

20 Evaluation

21 Glossary

22 List of Appendices (The Appendices can be found on the CD-ROM which accompanies this document)

Contents

Purpose of this Guide


1

This Guide outlines and describes the scientificconcepts, rationale and value of MalariaManagement Programmes (MMPs) for the oiland gas industry. The Guide provides a broadoverview of MMPs, and templates such as imple-mentation checklists and audit protocols thatmight typically form part of key activities whenimplementing MMPs in the oil and gas industry.

Experience within the oil and gas industrysuggests that health is one of the key issues forboth the project workforce and the hostcountry. Health impacts can potentially occurwithin defined project geographical bound-aries and across surrounding communities.Thepossibility of impacts is particularly true for anissue like malaria that involves a complexinteraction between biological and environ-mental variables and social and behaviouralpractices. The oil and gas industry operatesacross a myriad of countries and cultures thatform part of this interaction. Typically, thefocus on malaria impacts is centred on Sub-Saharan Africa (SSA), however, malariatransmission occurs globally. Regardless ofgeographical location, the industry operates inan atmosphere of heightened expectations,particularly related to health, social andenvironmental practices.When present, malariacan be more than a health managementproblem; it is increasingly recognized as an

issue that can transcend company medicalsupport systems and significantly affectenvironment, safety and human resourcesactivities. The management of malaria istherefore a potential concern throughout thesupply chain of global exploration, production,refining, distribution and marketing.

This Guide attempts to build on successfulindustry practices. However, experience atboth the international health level, and from aprivate sector perspective, indicates thatmalaria management is both complex anddifficult.There is no unique set of strategies orset of programmes that will work in all situa-tions or geographical locations. The onlyconstant feature of both the biology andhuman medical science of malaria is changeand evolution. However, there are reasonablywell-understood principles that can be utilizedin virtually all situations that the oil and gasindustry is likely to encounter. This Guidepresents and analyses these principles and illus-trates how they can be applied systematicallywithin the context of worldwide oil and gasoperations. A series of linked technical appen-dices is provided on the attached CD-ROM sothat readers who want greater scientific expla-nation and technical back-up will have areadily available source of information. Forcompleteness, a glossary is provided.


2

The overall situation:global burden of malaria

Malaria is not a newly emerging disease.Thereis an extremely long history of human andmalaria parasite interaction spanning over10,000 years. Malaria parasite populationsexperienced rapid growth in Africa and spreadworldwide following human populationgrowth, migration and agricultural devel-opment. Similarly, malaria morbidity, mortalityand disability have changed and evolved overtime and geography.

Human malaria risk has fallen from53 per cent to 27 per cent of the Earth’s landsurface. Sub-Saharan Africa (SSA) accounts for59 per cent of the global clinical malaria cases,Southeast Asia accounts for 38 per cent andLatin America accounts for 3 per cent. TheWestern Pacific region (which includes China)has less than a 1 per cent burden, despite alarge population, because of marked reductionin transmission across China since 1975. TheWorld Health Organization (WHO) estimatesthat on a worldwide basis, there are 300–500million clinical episodes per year.

While there has been a contraction in thegeographical limits of all-cause malaria trans-mission, the gains have been in areas that hadrelatively low underlying levels of malariaendemicity. Endemicity is defined as theprobable presence of malaria transmission. In

contrast, there were minimal effects in thosegeographical areas that are characterized byhigh levels of malaria endemicity.These obser-vations are consistent with the documentedevidence that controlling malaria across largegeographical areas becomes progressively moredifficult as a function of increasing intensity ofmalaria transmission.

In many geographical areas, particularly insub-Saharan Africa, there is intense but stableyear-round transmission. Therefore, MMPstrategies that are highly successful in ageographical setting of low transmission mayfail in areas characterized by entrenched, high-level transmission. Further complicating thesituation is a significant movement of popula-tions from rural to urban settings. For example,in sub-Saharan Africa, urban cities are growingby approximately 10 per cent per year. Urbanmalaria has different transmission character-istics due to the unique ecosystem of the cityenvironment.

For many companies, operations existsimultaneously across virtually all geographicalsettings; therefore it should be anticipated thata variety of malaria management strategieswould be required. Refer to Appendix A for abrief history of the evolution of malaria distri-bution and impacts.

Figure 1: Global malaria risk, as classified by the World Health Organization (WHO) 1

Group 1 = low risk countries(no chloroquine resistance)

Group 2 = high risk countries(moderate chloroquine resistance)

Group 3 = high risk countries(high chloroquine resistance)

1 WHO risk classification is basedon the parasite’s resistance to themost common antimalarialpreventive medication,chloroquine. Countries areclassified as low risk (Group 1countries) and high risk (Group 2and 3 countries).


3

Key factors to promote success:role of senior management

For industry, one of the most importantinsights in malaria management is simplyrecognizing that malaria is a key business issuethat cuts across multiple staff and linefunctions. Because malaria managementpotentially requires a large effort, a prominentleadership role by senior managementbecomes an essential initial activity (seeBox 1).While the development of an effectiveMMP is a highly technical undertaking, thearticulation of a ‘vision’ involving the impor-tance of malaria related issues becomes one ofthe most important first steps.

MMPs are multi-dimensional issuesaffecting numerous stakeholders both insideand outside the company. Malaria impacts,either positive or negative, are potentiallyvisible at the in-country staff level and even atnational and international levels. CorporateSocial Responsibility (CSR) efforts, alongwith company reputation, can be impacted bymalaria. MMPs offer a significant oppor-tunity for a ‘win-win’ scenario for both the

Malaria is a disease that involves the interactionof a parasite, a vector and a host. A vector isdefined as an organism that carries and transfers amicroorganism from one host to another. Formalaria, the host includes both humans and othermammals. MMPs are multi-disciplinary,integrated efforts that combine expertise andstrategies in human and vector biology, environ-mental management, clinical medicine andcommunity level interactions to protect peoplefrom malaria. The long history of efforts to

manage malaria illustrates that this diseasedemonstrates remarkable resilience in humanpopulations despite enormous efforts to eradicateit. In order to realistically develop and implementMMPs, it is necessary to construct a basic scien-tific framework that captures the underlyingbiology, pathophysiology (how humans respondto malaria infection) and epidemiology ofmalaria infection.This fundamental framework isgenerally built around the principles of primary,secondary and tertiary prevention.

company and the host country: an effectiveprogramme can significantly enhanceoperating efficiency and safety while providinga clear positive benefit for the host country atmultiple levels.

Senior management is in a key position to:

● articulate corporate objectives;

● translate these objectives into performance

expectations;

● require development of a system for

performance monitoring;

● hold all levels of management accountable for

performance; and

● provide the necessary resources, both financial

and technical.

Box 1: The role of senior management

What are Malaria Management Programmes (MMPs)?


4

Malaria Management Programmes—levels of prevention

For MMPs, the levels of prevention can bespecifically defined (see Figure 2) so that anintegrated programme can be developedsystematically.● Primary prevention is considered to be

eradication and is focused on vectorcontrol strategies.

● Secondary prevention is controlling andreducing risks. Secondary preventionstrategies cover the full range of personalprotection (including chemoprophylaxisand repellants) and behaviour modificationmeasures.

● Tertiary prevention is treatment ofdisease in order to prevent impairmentand subsequent disability or death.

Primary prevention of transmissiblevector-borne diseases

(See also Appendix B)

Malaria is a parasitic disease of microorganismsthat belong to the genus Plasmodium. Whilethere are more than 100 species of Plasmodiumthat can infect many birds, reptiles andmammals, there are only four species ofPlasmodium that typically infect humans:

● Plasmodium falciparum—found worldwidein tropical and subtropical areas and is thepredominant species causing severe andpotentially fatal disease;

● Plasmodium vivax—found in Asia, LatinAmerica, and a few areas of Africa. Becauseof Asian population densities, this is themost prevalent form of malaria worldwide;

● Plasmodium ovale—found primarily in WestAfrica and islands of the western Pacific.This form of malaria is similar to vivax;

● Plasmodium malariae—found worldwideand can produce a long-lasting and chronicinfection with an extremely long duration.

Life cycle of malariaThe female Anopheles mosquito is the keyvector for transmitting malaria parasites tohumans because they require blood meals as asource of protein for the production of eggs.Two critical factors are:● a source of blood meals; and ● the feeding and resting behaviour pattern

of the mosquito (dusk or dawn versusnocturnal (night time), as well as theprimary location of feeding and post-feeding resting, i.e. indoors versusoutdoors).

Primary Secondary Tertiary

Infectivemosquito

vector control

personal protection:DEET, treated clothing,

insecticide treated bed nets

human knowledge, behaviour and attitude

malariacase

access todiagnosis

and treatment

emergencyresponse

arrangements

stand-byemergencytreatment,

e.g. malaria kit

fatality

chemoprophylaxis

Figure 2 Defences against malaria


5

Malaria management programmes—levels of prevention

Feeding and resting behaviours have asignificant impact on both the overall vectorefficiency and the analysis of potential controlmeasures, e.g. insecticide treated bednets(nocturnal, inside biting), indoor residualspraying (indoor resting), or source reduction(outside biting and resting).

PathophysiologyThe period of time between the infective biteand clinically experienced symptoms(incubation period) typically ranges from7–30 days depending on the infective species(see Appendix B).The delay between infectivebite and symptoms can cause diagnosticproblems and place expatriate workers atsignificant risk since they or their physicianmight not recognize that a new fever could bemalaria, particularly if they are no longer in amalarial area.

After multiple malaria infections, anindividual develops partial protectiveimmunity. This individual does not have fullimmunity but rather is described as ‘semi-immune.’ Semi-immune individuals can stillbe infected by the malaria parasite but are lesslikely to develop severe disease and generallylack the usual malaria symptoms commonlyassociated with typical clinical disease.Expatriates, regardless of home countrylocation, are usually considered as ‘non-immune’, since they lack sufficient protectiveimmunity.

The development of acquired immunitytends to be location specific and usually resultsfrom long-term childhood exposure. An adultindividual from one malaria endemic regionmay not be protected in a country that has adifferent spectrum and intensity of malaria. Inorder to maintain effective levels of acquiredimmunity, an adult individual must beconstantly exposed to malaria. As an example,an employee whose home country is in amalarial area and who has been consideredsemi-immune will rapidly lose this immunity

without continuous immune (infected bite)stimulation, e.g. when on long-term expatriateassignment to a non-malarial area.

Vector epidemiologyFor oil and gas operations, the shift from ruralto urban setting is critical for MMPs. It is quitelikely that there will be operations in bothurban and rural settings with frequent inter-action between the two. Major oil and gasoperations, including offshore platformsettings, generally require some level of urban-centred technical and staff support. Therefore,the urban environment is important for theindustry since it is probable that large numbersof technical staff will transit through locations,e.g. airports, that are located in areas impactedby malaria.‘Airport malaria’, defined as malariaacquired through the bite of an infectedmosquito by an individual without exposureto the vector in its natural habitat, has beenfrequently reported and is expected toincrease. A similar transmission problem couldeven impact offshore platform crews sinceships and helicopters can readily transport themosquito vectors. In addition, continuouswork operations also increase the exposure ofindividuals to nocturnal vectors. Finally,human knowledge, attitudes, beliefs andpractices regarding malaria are important.


6

Urban malaria epidemiologyIt is not well known if all of the standardmalaria prevention, management and controlstrategies can be effectively transferred tourban settings. While there is some evidencethat anopheline species are adapting to urbanaquatic habitats (e.g. water-filled domesticcontainers, back yard gardens), there is concernthat misdiagnosis and subsequent inappropriatetreatment of malaria is occurring.

All fevers cannot be presumptively assumedto be malaria in an urban setting. The typicalclinical protocols that are employed in thecountryside may not be valid in the city.Research has shown that 50–70 per cent of thefevers in an urban setting are not laboratoryproven malaria despite an initial clinical (non-laboratory) diagnosis to the contrary.Within anurban context, the cost-effectiveness of standardvector control strategies is also unknown.

Malaria management programmes—levels of prevention

Malaria ‘fogging’ in Kuala Lumpur, Malaysia

Primary prevention: vector control


7

The general goal of vector control is to reducemalaria transmission by:i) decreasing the contact between humans

and the relevant vectors;ii) reducing the vector population density;

andiii) changing vector longevity.

The three basic strategies that are directedtowards different links in the overall trans-mission chain are summarized in Box 2.

Indoor residual spraying (IRS)

The main purpose of IRS is to reduce thesurvival of malaria vectors entering houses. It isof little use for control of malaria vectors thatrest outdoors, particularly if they also biteoutdoors and do not enter the sprayedstructure. Similarly, larval control dependsupon extremely high coverage since even afew temporary breeding sites may be sufficientto maintain high transmission levels.

Insecticide treated nets (ITNs)

As ITN coverage increases, there is an overallreduction on the vector population; hence theeffect on the community is greater than the

1. Reduction of human-vector contact by:

● the use of bednets;

● improvements in housing (screening windows, eaves and doors);

● repellants for skin and/or clothing;

● insecticide dispensers (mosquito coils, plug-ins); and

● room preparation (spraying curtains, under bed, etc.).

2. Vector density reduction (treatment of vector breeding places). Most anophelines cannot fly more than 4 km from their breeding sites, andgenerally remain within 2 km. Larval control is critical and directedtowards:

● source reduction by environmental management, i.e. drainage, flushing,filling and altering river and lake margins so that they are unsuitable foranopheline breeding;

● larviciding using both chemical insecticides and those of biologicalorigin, generally administered in cycles, which may vary between 2 and10 weeks;

● biological control using predators such as larvivorous fish.;

● space spraying of insecticides for rapid reduction of vector density:there are significant limitations to this method including difficulty ofnight time application and poor penetration of fogs into the daytimeresting places of the vectors.

Any larvicidal strategy must also consider potential environmental impacts.

3. Decrease adult vector longevity by:

● indoor residual spraying (IRS) for indoor resting mosquitoes; and

● community-wide use of insecticide treated nets (ITNs), particularly forages 0 to 5.

Box 2: Three strategies for vector control

Vector control in malariastudy theAnopheles ‘stopping Anopheles—a moving target’

Anophelesresponse

vectordensity

vectorlongevity

vector-mancontact

• changes inbehaviour

• resistance toinsecticides

• environmentalmodification

• environmentalmanipulation

• biologicalsolutions

• chemicalspraying of:- breeding sites- resting areas

• bednetimpregnation

• personal protection:- clothing- repellents- screens- bednets

• community protection

• identification• behaviour• density

Figure 3: Using vector control to reduce malaria transmission

sum of the individual protection. ITNcommunity outreach programmes sponsoredby a project, while complex, are still likely tobe simpler to support and maintain than acommunity-wide IRS effort.

Space spraying

Space spraying is the most rapid method inareas of high population density, however it isan emergency control method and unlikely tobe the main vector control strategy due to theknown limitations of this technique and therapid recovery of the vector population.

A night-time fogging campaign (e.g. between22:00 and 04:00) will have the greatest impact onnocturnal indoor feeding and resting mosquitoes.


8

Secondary and tertiary prevention oftransmissible vector-borne diseases

(See also Appendix C)

Secondary prevention

Secondary prevention involves controlling andreducing individual risks by using the full rangeof personal protection and behaviour modifi-cation measures. These measures are dividedinto a four-level pyramid of prevention oftenknown as the ‘A-B-C-D strategy’ (Box 3):

other primary prevention vector controlefforts. An example of a malaria programmeimplementation checklist is included inAppendix D.

‘A’ for awareness and educationAs part of a secondary prevention programme,companies often provide workers who aregoing to travel or reside in potentially malariousareas with consistent, standardized educationalmaterials and instructions before travel tomalaria risk areas.To be effective, this instructiontypically needs regular reinforcement whileworking in the malaria risk area.

‘B’ for bites—personal protectionmeasuresBite prevention at the individual level is basedon creating a physical and/or chemical barrierbetween the person and the vector.The effec-tiveness of these measures is shown in Table 1.

A for awareness and education of the risk of malaria. It requires:

● a relationship between patient and physician;

● understanding of prevention strategies; and

● awareness pre-travel, during travel and post travel.

B for bites—use of personal protection measures. It requires:

● an understanding of Anopheles behaviour, i.e. feeding and resting;

● wearing of proper clothing, e.g. long-sleeved shirts, long pants,socks and shoes;

● use of appropriate repellents, especially at twilight and on neck,face and ankles;

● use of permethrin on clothes and bed nets; and

● preparation of the room for sleeping.

C for compliance with chemoprophylaxis.

D for prompt diagnosis of malaria and securing early treatment.

Box 3: Secondary prevention—the A-B-C-D strategy

In preparation for travel overseas somecompanies have established a ‘malaria visa’programme.The malaria visa approach requiresthat an individual perform specific educa-tional, behavioural (for example, sprayingclothing with insecticide, obtaining repellents,spraying bet nets with insecticide), and chemo-prophylaxis (use of a specific medication inorder to prevent development of malaria)activities before permission is given to enter amalarious area on company business. Thisstrategy is potentially quite effective for short-term assignments and for individuals who aretransiting known malarious areas. The malariavisa strategy can be effectively combined with

Prevention measures

Use of impregnated bed nets

Permethrin treated clothing

Permethrin impregnatedclothes in combination withuse of N,N,-diethyl-3-methylbenzamide (DEET)insect repellent

Long sleeve shirts andtrousers

Chemoprophylaxis

Use of DEET on exposed skin

Vector control measures,including all of the above,plus residual insecticidespraying, space spraying,elimination of breeding sites,larviciding, biological controland the use of air-conditioning, where feasible.

Effectiveness (at typical compliance levels)

Reduces transmission by 68–95%

Reduces likelihood of infection by 24–97%

Reduces bites by up to 99%

Reduces likelihood of infection by up to 62%



If 100% use was feasible, this package ofmeasures would virtually eliminate malaria risk

Table 1 Effectiveness of barriers


9

Secondary and tertiary prevention of transmissible vector-borne diseases

is compliance with both the medication ANDpersonal protection measures.

Drug-based prevention strategies are basedon two key concepts:● prevention of infection—also known as

causal prophylaxis; and● prevention of illness—known as

suppressive prophylaxis.

These strategies work by killing theparasites as they differentiate and develop ineither the liver and/or the red blood cell.Appendix C discusses the malaria life cycleand presents the underlying theory for thesedrug-based strategies. As with all drugtreatment regimes, malaria chemoprophylaxisis a balance between risk and benefit.Medications all have potential adverse effects,individual tolerability issues and cost consider-ations. Many individuals purchase ‘blackmarket medications’ that may be cheaper butare often ‘fakes’ containing no active ingredientor lacking appropriate pharmacologicalpotency. Even if using established brand namedrugs from reputable suppliers it is critical tounderstand that no chemoprophylaxis regimeis 100 per cent efficacious because of:● unpredictable drug absorption;● variable therapeutic plasma levels being

reached due to individual geneticdifferences in metabolism; and

● the presence of drug resistant parasites.

The overwhelming medical consensus onbite prevention is to strongly recommend:(1) insecticide (permethrin or deltamethrin)impregnated mosquito nets; (2) permethrintreatment of clothing; (3) wearing of long-sleeved shirts and trousers; and (4) use ofrepellants for exposed skin (e.g. DEET orPicaridin).

A variety of skin repellants are commerciallyavailable. These products vary significantly intheir effectiveness (see Table 2). There aremarked differences in the duration of activityfor each product. Every product requiresreapplication; however, some products are farmore long-lasting than others. In general, thevarious DEET products are the most effective.

‘C’ for compliance withchemoprophylaxisChemoprophylaxis involves taking a specificmedication in order to prevent development ofmalaria. Each medication has its own spectrumof side-effects, dosage schedule of adminis-tration and indications and contra-indications.Drug branding, marketing and advisory guide-lines are typically produced on a target countrybasis, since resistance profiles are constantlychanging for the medications.The most currentguidelines for the target country should alwaysbe consulted. In addition, appropriate localmedical experts can also be consulted.Regardless of the medication, the key concept

Insect repellent

23.8% DEET

Picaridin (KBR-3023) 9.3%

Soybean-oil based

IR3535

Citronella based products, ‘skin-so-soft’

Duration of coverage

301.5 minutes

120 minutes

94.6 minutes

22.9 minutes

Less than 20 minutes

Table 2: Effectiveness of commercially available repellants

Phot

oLin

k/G

etty

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ages


10

The full range of secondary preventionstrategies should be considered for all non-immune individuals. For semi-immuneindividuals, the situation is more complex.Chemoprophylaxis is often considered for:● infants under three years of age;● semi-immune pregnant women;● semi-immune people who have left their

endemic malaria area for more than 6–12months, becoming non-immune, andreturning to an endemic malaria area; and

● other vulnerable groups (e.g. people withimmunosuppression).

It cannot be assumed that someone from amalaria endemic country is semi-immune sincepartial immunity can only be acquired by signif-icant and continuous exposure to the samemalaria species from childhood onwards.Therefore, individuals transferring betweendifferent malarious areas may need additionalmedical consideration. Chemoprophylaxis alonedoes not provide absolute protection; therefore,providing the full range of secondary preventionstrategies is an important consideration.

Finally, with regard to compliance, it isimportant to note that the provision ofantimalarials to employees in the field does notobviate the risk of contracting malaria. Whilein some cases this is due to poor absorptionand/or variable therapeutic plasma levels, as

noted above, in some cases this is due to a smallpercentage of non-compliant individuals whodo not take, or do not consistently take, theprescribed medication.

Compliance drug testing regimes, usingurine testing for medication metabolites, havebeen implemented by some companies in theoil and gas industry as part of an overallMalaria Management Programme.These testsform part of contractual arrangementsbetween employer and employee and whererequired for non-immune expatriate staff willlikely also be required for contract staff;individuals testing negative for metabolitesare first counselled and transferred to a‘frequent test pool’. Should the problempersist, the individual will be investigatedfurther to determine the cause of theproblem and if necessary may be transferredto a non-malarial area.

‘D’ for prompt diagnosis and earlytreatmentMalaria is a true medical emergency thatrequires rapid diagnosis and treatment, asinfected individuals can rapidly deteriorateover a 24-hour period. Ninety per cent ofcases of all malaria are associated with:● inappropriate chemoprophylaxis, e.g. the

wrong drug and/or dosage; or● no chemoprophylaxis.


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In two-thirds of tropical travellers who dieof malaria, either treatment is delayed or thediagnosis is simply missed. In most cases theindividuals concerned never took chemopro-phylaxis in the first place, so a commonrecommendation is to assume that everytraveller with fever or unexplained flu-likeillness has life threatening malaria. Thisrecommendation will obviously produce‘false-positives’ and subsequent over-diagnosisof malaria; however, the medical rationale isthat ‘false-negatives’ are potentially atsubstantial risk for a fatal outcome due tomissed diagnosis. This overriding concernrelated to delay in diagnosis has led to thedevelopment of:● rapid diagnostic tests (RDTs); and● stand-by emergency treatment (SBT) kits.

When the test kit is well maintained, someRDT products can achieve a sensitivity (theability to detect a ‘positive’) for P. falciparumsimilar to that obtained by microscopy. RDTscan be damaged by exposure to high temper-ature extremes (heat or cold). If transport andstorage within conditions specified by themanufacturer are not met, the sensitivity of theRDTs may be impaired and shelf life reduced.

Coartem® (artemether/lumefantrine), is anew, life-saving malaria treatment that isincluded in most SBT kits. Even where RDTs

do not indicate malaria, travellers areencouraged to take Coartem® as a precaution.Coartem® is now included in the WorldHealth Organization (WHO) Model List ofEssential Medicines, and is being distributedthrough the WHO as part of the worldwideRoll Back Malaria initiative.

Tertiary prevention

Some oil and gas companies have developedRDT and SBT kits as part of their MMPefforts.These kits represent tertiary preventionand are not a substitute for developing acomprehensive MMP that includes appro-priate primary and secondary prevention.Theessential features of comprehensive MMPsinvolve systematic evaluation and institution ofprimary and secondary prevention strategies sothat an adequate and defensible wall ofprevention is constructed and maintained.

When to develop and implement an MMP


12

Benefits of an MMP

A well-executed MMP can prevent morbidityand mortality in the workforce. MMPs send animportant and positive message to the entire

If a company is considering business opportu-nities in malarious settings then, it is critical toconsider development of an appropriate MMPfor all phases of the business activity.Programme development and complexityshould reflect an accurate understanding ofmalaria risks for company personnel and evensurrounding communities. Many companiesmay wish to develop a standardized set of

secondary and tertiary prevention practicesand procedures for any work in malariousareas, e.g. malaria visa process. In addition totheir own workforces, these standard practicesand procedures may cover a variety ofcontractors and suppliers. Overall, anintegrated approach, using primary, secondaryand tertiary prevention, is likely to have thegreatest chance of success.

workforce (including semi-immune nationals),surrounding communities and other nationaland international stakeholders.

● Protecting the health of the workforce

● Demonstrating commitment of senior management to a key health issue

● Defining roles and responsibilities between companies, contractors and host governments

● Establishing an accurate and appropriate baseline of a key disease for future comparison during the development,operation and eventual closure of a project

● Demonstrating the potential improvement in the malaria burden in surrounding communities

● Identifying and documenting key environmental features that relate to vector habitat and subsequent control

● Documenting baseline environmental conditions relevant to vector control

● Developing and enhancing local, provincial and national capacity for malaria control

● Providing a positive framework/opportunity for stakeholder input, involvement and trust building

● Enhancing the companies profile amongst NGOs, international institutions, including multi-lateral development andfinancial institutions

● Potentially contributing to host community’s health systems capacity, infrastructure, and development

Box 4: Benefits of a Malaria Management Programme

Integrating an MMP with other impactassessment and outreach programmes


13

Malaria is a multi-dimensional disease;therefore, a complex skill set is essential forprogramme development and management.Construction of each level of the wall ofprevention requires a diverse team ofspecialized professionals. If a proposed businessactivity is in a malarious area, then the accurateand detailed assessment of malaria risk isindicated. Experience indicates that environ-mental scientists, sociologists, medicalprofessionals, vector biologists, educationtrainers and community developmentspecialists may be necessary. Malaria risks andimpacts should also be considered in carryingout health, social and environmental impactassessments.The OGP/IPIECA Guide to HealthImpact Assessments in the oil and gas industryspecifically discusses the need to consider

vector-related diseases like malaria as part ofthe impact assessment process. Integration withcompany HSE management and health riskassessment processes is also important. Malaria-related issues could be a significant area ofactivity for both social and environmentalassessments. Because of both the importanceand complexity of MMP issues, manycompanies in the oil and gas industry havedeveloped stand-alone multi-disciplinaryintegrated teams of specialists for programmedevelopment and implementation. Often the‘lessons learned’ from MMPs in large projects,e.g. oil field development and pipelines, aredirectly transferable to both other key businesspartners and internally to other locations of acompanies’ worldwide business activity.

National and international stakeholder consultation

Malaria-related issues have a large and well-organized set of international stakeholders.These stakeholders include, NGOs, academicinstitutions, multi-lateral development andfinding agencies and institutions purely createdfor malaria prevention, management andcontrol. In addition, some level of local,provincial and national malaria control effortswill be encountered at the host country level.In many situations, co-ordination and commu-nication with all of these international andnational stakeholders is a daunting task.Nevertheless, because of the potential forsignificant benefit or inadvertent adverseimpacts, e.g. duplication of efforts, unmet andunanticipated community level expectationsthat could be produced, it is important to

carefully consider the multi-level social andcommunity ramifications of any compre-hensive malaria management programme.


14

It has become apparent that significantadvances in the medical and environmentalcontrol areas have not necessarily translatedinto success at the individual, community andhealth systems levels.There is a significant gapbetween intervention efficacy and effectivenessat the community level in a developingcountry setting. Increasingly, the oil and gasindustry faces the need to understandcommunity level health, social and environ-mental concerns in order to receive andmaintain a ‘license to operate.’ MMP is aparticularly difficult set of issues because thebiology of the disease is not easily confinedwithin the boundaries of a proposed projectand invariably, in a large project, overlaps intoadjacent communities.The oil and gas industry

is increasingly asked to address problems thattraditionally are ‘outside the fence line’ andhistorically considered responsibilities of thehost government. In a given project setting,comprehensive secondary and tertiaryprevention strategies may be adequate for theproject; however, it is quite likely that otherinternational and national stakeholders willrequest a more active outreach role in all levelsof prevention management and control, partic-ularly in vector control efforts. In order torealistically understand these expectations,careful, close and early consultation duringproject formation and development stageswith key national and international stake-holders is advisable.

National and international stakeholder consultation

Putting it all together: the MMP process


15

There is no single MMP process that will neces-sarily be appropriate in all the diverse situationsconfronting the oil and gas industry. However,there are a series of systematic steps that can beused in order to determine what type of MMPis appropriate in a particular situation. Manycompanies in the oil and gas industry alreadyhave a general approach for developing MMPs.Similarly, many international agencies andnational governments have published detailedguidelines covering malaria diagnosis andtreatment at both an individual and communitylevel. Because both diagnostic testing andavailable medications and treatment protocolsare constantly evolving, the most currentlyavailable guidelines should always be consulted.

While the science of malaria is constantlychanging, an overall management framework isreasonably well established and can be used inalmost all situations confronting the oil and gasindustry.This structure consists of a sequence ofcommon elements that frames the MMP

process and is illustrated in Figure 4. Theprocess is modelled after the general frameworkused in the suite of environmental, social andhealth impact assessments (see Box 5).

R E V I E W

legislationand projectinformation

modellingand ranking

significancecriteria effectiveness

screening scopingrisk assessment;

impactassessment

decision making;establishing

priorities;reporting

implementationand

monitoringevaluation

health context define TOR baseline data

mitigationstrategies;

health actionplan (HAP)

surveillancesystem audit

stakeholder communication and consultation

project conception design and engineering construction; operations;decommissioning

definingroles and

responsibilities

hazard types;identification ofhealth hazards

Figure 4: The MMP process

● Screening—determine if a proposed business activity is going to takeplace within a potentially malarious environment

● Scoping—outline the range and types of malaria problems that could beencountered

● Planning including resourcing, cost and time management—considerthe types of resources, activities costs and level of effort that may berequired

● Stakeholder consultation—co-ordinate, communicate and exchangeinformation at the local, provincial, national and international level

● Risk assessment—investigate, appraise and qualitatively or quantitativelyrank the impacts positive or negative that could be produced

● Decision making—establish priorities

● Mitigation strategy—develop a written mitigation action plan(MMP programme)

● Implementation and monitoring—define roles and responsibilities

Box 5: Framework for social and health impact assessments


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Screening

The geographical settings where malaria trans-mission exists are reasonably well known.Therefore, if a business activity is likely toeither be centred in or transit through amalarious area then, malaria should beconsidered as a potential health concern. Adescription of the proposed business activitycovering location, size, workforce, surroundingcommunities, and operations is essential. Thisinitial review will help determine the need andlevel of MMP that may be required. Not allbusiness activities require comprehensiveMMPs. In many situations, companies havedeveloped a ‘malaria visa’ programme that isbased on secondary and tertiary preventionstrategies incorporated into the ‘A-B-C-D’programme discussed in earlier sections of thisGuide. Based on the initial screening, implemen-tation of a malaria visa programme may besufficient for the workforce. However, it isimportant to understand that this programme isinternally workforce focused and not fully trans-ferable to the large number of semi-immuneindividuals who may be living in communitiesadjacent to the proposed business activity.

Scoping

Scoping is generally a process for outlining therange and types of hazards and potentialbeneficial impacts. The overall types andcategories of questions that must be addressedare defined at this stage. At the scoping stagethe overall types of questions include:● defining the type and endemicity level of

malaria, e.g. dominant Plasmodium parasite,and whether it is stable or unstable;

● considering whether different strategieswill be required depending upon the phaseof the project, i.e. construction, operation,decommissioning;

● defining the at-risk population includingconstruction workers, contractors,

nationals, and community residents. Ifprimary prevention vector controlstrategies are deemed critical, then ageneral series of sequential questionsshould be considered.The overall processfor this effort is shown in Figure 5.

The output of the scoping exercise can alsobe used as a basis for formally developing a setof terms of reference (TOR). Either internal orexternal consultants, or a combination of both,can use the TOR.


Figure 5: Decision-making process (Najera, 2002)

Stratify area according to the disease burden andepidemiology of transmission

Determine whether there is a role for vector controlin each epidemiological stratum and in

current local circumstances

If there is a role for vector controldetermine vector(s) in each stratum

For each vector implicated determine:• breeding sites• adult resting sites• blood feeding behaviour• ecology• history of insecticide resistance

Determine which method(s) ofvector control is (are) suitable

Where the use of insecticides is essential,select the method and timing of application


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Planning including resourcing, cost andtime management

After the general scope has been determined,the planning process can begin. It is critical toidentify at the outset the types of resourcesthat may be required. Resourcing issuesrequire careful consideration since multi-level,integrated MMPs draw expertise across manydisciplines.While many oil and gas companieshave large and sophisticated medical, environ-mental and safety departments, it is quite likelythat some level of outside specialty expertisewill still need to be considered, particularlyrelated to the implementation of primaryvector control strategies. For large projects,even secondary prevention strategies requiresignificant levels of active on-site clinicalmedical support for accurate diagnosis andtreatment. If the proposed business activity doesnot require an on-site medical function, it maystill be advisable to identify appropriate localresources, including medical practitioners andhospitals with appropriate malaria expertise anddiagnostic equipment.

Implementing an MMP is potentially anexpensive undertaking and may require asignificant level of staffing.The level of staffingis a function of the goals that the programmewishes to achieve and the underlying level ofmalaria transmission. Many programmes haveoverall global objectives that include achievinga zero fatality rate while minimizing the risk ofcontracting malaria to the lowest practicablelevel. Potentially, these goals can be achievedbut an intense, integrated and sustained effortusing a variety of primary, secondary andtertiary strategies is likely to be needed.

Stakeholder consultation

Stakeholder communication and consultationis a process of mutual dialogue and informationexchange between the project and the keystakeholders. Stakeholders should be systemati-

cally identified and defined since it is quitelikely that there will be multiple levels ofgroups and organizations that will be bothinterested, active and operating within theoverall sphere of the business activity. Malaria isa disease that has attracted worldwide attentionin virtually all areas where transmission isfound. Therefore, it is highly likely that anyproposed project in a known malarious areawill already be subject to some level of NGO,national or international intervention controleffort. Given this reality, the opportunity formiscommunication and duplication of effort issignificant. Therefore, a malaria stakeholdercommunication programme is often consideredas early as possible in the overall business devel-opment cycle. This effort should be carefullyplanned and coordinated in a fashion that isconsistent with and responsive to overallbusiness objectives.

Risk assessment

Risk assessment is the process that investigates,appraises and qualitatively or quantitativelyranks the impacts, positive or negative, thatcould be produced by a given activity. Many oiland gas companies have internal risk assessmentprocedures and protocols covering health,

Kei

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18

environmental, social and safety aspects of aproposed new business project.These processescan be applied to MMP efforts. In a givengeographical location, it is important to under-stand the specific biology, pathophysiology, andepidemiology of malaria that may be encoun-tered. The level of malaria risk will varysubstantially both by geographical location andcomplexity of proposed project. An oil fielddevelopment and pipeline is likely to requiresubstantially more investigation andprogramme development than opening a smallmarketing office or retail store. The riskassessment process can capture these differencesand provide an appropriate way to rank impactsso that they can be address in a priority fashion.

Two important considerations in the riskassessment process are the evaluation of existingdata and determination of the need for newbaseline information. Existing sources of infor-mation must be carefully reviewed for accuracy,relevance and completeness. All fevers areactually not malaria even though in ruralmalarious areas fever is ‘presumptively assumed’to be malaria and treated accordingly. Manystudies have documented that malaria isfrequently misdiagnosed. If there is a concernthat the project will impact the existing trans-mission pattern and burden of malaria, thencareful consideration should be given todetermine whether a new data collection effort

is indicated.As previously discussed, the profileof malaria in urban and peri-urban settings isquite different than the intensity usually seen ina rural environment. If new data is deemednecessary, then a series of carefully definedstudy questions should be developed. Thesestudy questions are likely to cover vectorspecies, habitat, and density in addition toobjective burden of disease.

The ranking of potential impacts can beconsidered from an individual environmental,medical and sociological perspective or as anintegrated exercise. Since malaria is a diseasethat operates at many levels, it may be moreefficient and meaningful to develop anintegrated impacts ranking that considers notonly health but also social and environmentaleffects.The degree of detail and sophisticationof the ranking exercise is project specific. Theliterature on community level impacts ofmalaria is vast and varies significantly acrossdifferent global locations. Impacts and effectsobserved in sub-Saharan Africa should not beassumed to be fully relevant for Asia or SouthAmerica. For a large project, that is expected tolast for many years, risk assessments frequentlyconsider both the workforce and thesurrounding community.

Decision making

Decision making establishes priorities andbegins the process of developing and dedicatingappropriate resources. For episodic or small-scale business activities the implementation ofexisting standard practices may be entirelysufficient, e.g. a malaria visa programme. Forlarge, long-term projects, many companies haveestablished dedicated multi-disciplinary malariamanagement teams in order to simultaneouslymanage both internal and external malariaissues. Senior management support, both at theproject and corporate level, is essential sincesustainable MMP programmes are neithersimple nor inexpensive.



19


Mitigation

The written MMP is the mitigation plan.Thisplan specifies how high and how thick the ‘wallof prevention’ is constructed.The MMP is nota static exercise but a ‘living document’ that willevolve and change over time. The programmeis likely to be a combination of both internalworkforce and external community needs.Many of the most important concerns andcontroversies surround the key vector controlstrategies of insecticide application, IRS, spacespraying, ITNs, and larviciding. Finally,emergency response and planning should alsobe performed since there is no 100 per centeffective MMP programme and, in some situa-tions, immediate treatment and or evacuationmay be indicated.

Implementation and monitoring

For comprehensive MMPs, one of the mostcritical aspects of the implementation plan isthe division of responsibilities and timescalesbetween the project and the host governmentat local, regional and national levels. Roles andresponsibilities should be defined and clearlyunderstood, particularly if the MMP efforts aregoing to extend outside the project bound-aries. Therefore, an analysis of local, regionaland national malaria infrastructure and

management capacity is critical. Building theenvironmental, medical and social capacity andsustainability required for an integratedapproach to malaria are neither simple norcheap. Many malaria programmes initiallysucceed only to fail at a later date, as primaryprevention vector control strategies are notproperly maintained. Long-term planning andcommitment is essential since sustainablecapacity development is a long and slowprocess.The role of contractors becomes quiteimportant since much of the day–to-dayactivity is performed by rotating contractors,particularly during the construction phase of aproject. Contractor roles and responsibilitiescan be assigned and specified during the initialscope of work contract process.

Ongoing staffing levels will also requireattention and consideration since MMP is not astatic process. It should be reasonably antici-pated that unexpected swings in weather andhuman migration patterns and activities willoccur. Both of these events can have profoundimpacts on malaria transmission within theworkforce and external communities.

Development of a monitoring system forthe overall MMP effort is a critical component.A monitoring system is designed to documenthow the programme is affecting malaria trans-mission. A variety of indicators can bedeveloped for this purpose. Similarly, standardmedical outcome indicators can de developedcovering diagnosis and treatment, e.g.suspected, probable, confirmed and fatal malariacases.These medical data are important becauseit provides an early detection system forchanges, negative or positive, in malaria trans-mission. A sample malaria case investigationform is included as Appendix E to this Guide.

Left: satellite imagery can be used to predict the distributionof the main vectors of malaria—landscape epidemiology isa critical feature that can be used for the development ofMMP programmes.La

ndsa

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ager

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20

Finally, early detection is not the same thingas early warning. Malaria Early WarningSystems (MEWS) require a different level ofmonitoring, planning and development and areusually considered to be a national governmentproject. However, because of the high levels oftechnological expertise, particularly regardingRS/GIS techniques, that are resident in manyoil and gas companies, collaboration ortechnology transfer may be entirely appropriate(refer to Appendix B for additional details).

Evaluation

Evaluation and verification of performanceand effectiveness is one of the most importantsteps in an MMP programme. A system fordetermining that implementation has beenaccomplished and is achieving the desiredresults should be considered. Within theimplementation and monitoring plan a systemof outcome indicators is typically specified.Auditing against these indicators can bereadily performed. Contractor performanceshould also be verified and assessed for effec-tiveness and compliance. If the MMP isactively cooperating with host countryprogrammes, these efforts should also beindependently assessed against previouslyestablished outcome indicators.

A variety of audit systems for healthprogrammes have been developed. Generalaudits often cover:● medical records and reports;● facility inspections for vector control

evaluation;● knowledge, attitude and practices (KAP)

assessments;● training records—topics, attendances and

feedback;● health care programme reviews and audits;● emergency drills; and● incident investigations.

Audits should be considered at regularintervals because large projects are constantlychanging, for example:● new company activities (e.g. work near

swamps, jungles, etc.);● new projects in potentially exposed

geographic locations;● modifications in work schedule (e.g.

night shifts);● changing contractual requirements;● new scientific discoveries (e.g. medications,

resistance);● international and government advisory

recommendations concerning malariaresistance to medication.

An example of an audit form is included inAppendix F of this Guide.


Glossary


21

A-B-C-D A simple way to remember the key stepsneeded to protect people from malaria:Awareness - Bite prevention -Chemoprophylaxis - Diagnosis

Anopheles Category (i.e. genus) of mosquito—somefemale species of Anopheles are capableof transmitting malaria to humans andanimals

Burden Size of a health problem in an area,measured by cost, mortality, morbidity, orother indicators

Chemoprophylaxis A method of attempting to preventmalaria by taking various drugs prior to,during, and after exposure to malaria

Coartem® A new, life-saving malaria treatment(artemether/lumefantrine)

DEET An insecticide (N,N,-diethyl-3-methylbenzamide) for use on exposedskin to repel mosquitoes

Disability A physical or mental impairment thatsubstantially limits one or more major lifeactivities

E&P Exploration and Production

Endemic Describes a disease that is localized to aparticular geographical region

Endemicity The probable presence of malariatransmission

Entomologist An expert on insects, such as Anophelesmosquitoes

Epidemic A sudden increase in the frequency ofmalaria that significantly exceeds theseasonal variation normally observed in agiven area

Epidemiology The study of the incidence, distribution,and control of disease in a population

Host The human or animal in which themalaria parasite lives outside of themosquito

Immunity Protection generated by the body’simmune system in response to previousmalaria attacks resulting in ability tocontrol or lessen a malaria attack

Incubation period The interval of time between infectionby a malaria parasite and the onset of thefirst symptoms of the illness. Incubationperiods for malaria can range from 7 to40 days depending on the species

Infective bite A mosquito bite that introduces malariaparasites into the bitten host

IPIECA International Petroleum IndustryEnvironmental Conservation Association

IRS Indoor Residual Spraying—treatment ofhouses where people spend night-timehours, by spraying insecticides that have aresidual efficacy, i.e. they continue toaffect mosquitoes for several months

ITNs Insecticide Treated bed Nets

Malaria A parasitic disease that kills two millionpeople per year around the world

Malarone Brand name of atavaquine-proguanil, adrug used to prevent and treat malaria

Mefloquine A drug used to prevent malaria that goesunder the brand name of Lariam

MEWS Malaria Early Warning System—a systemfor predicting malaria epidemics based onsatellite date

MMP Malaria Management Programme

Morbidity Proportion of the population who have aparticular disease

Mortality Proportion of a population who havedied from a particular disease

NGO Non-Governmental Organization

Nocturnal Term describing Anopheles mosquitoesthat are active at night

Non-immune A person with no immunity to malaria

OGP International Association of Oil and GasProducers

Parasite A microorganism, such as Plasmodium,that lives, grows and feeds in a differentorganism while contributing nothing tothe survival of its host

Pathogen Parasites (including those causingmalaria), bacteria, viruses or fungi thatcan cause disease

Pathophysiology The functional changes in humansresulting from infection by malariaparasites

Perennial Situation whereby malaria is spreadtransmission throughout the year

Peri-urban The area immediately surrounding anurban or city area


22

Permethrin An insecticide effective in treating clothesto repel and kill mosquitoes

Plasmodium The category (i.e. genus) of the parasitethat causes malaria.The genus includesfour species that infect humans:Plasmodium falciparum, Plasmodium vivax,Plasmodium ovale and Plasmodium malariae.P. falciparum is the fatal form. P. vivax andP. falciparum are the species mostcommonly encountered by the oil andgas industry.

Prophylactic drugs Medication taken to prevent malaria

RDT Rapid Diagnostic Tests—these tests formalaria are often included in stand-byemergency treatment kits to enablesubjects to self-test for the presence ofmalaria in their own blood.

Risk The product of the chance that a specificundesired event will occur and theseverity of the consequences of the event:Risk = (Probability) x (Consequence)

RS/GIS Remote Sensing/GeographicalInformation System

Appendix A: Brief History of the Evolution of Malaria Distribution and Impacts

Appendix B: Primary Prevention of Transmissible Vector-Borne Diseases

Appendix C: Secondary and Tertiary Prevention of Transmissible Vector-Borne Diseases

Appendix D: Malaria Programme Implementation Checklist

Appendix E: Malaria Case Investigation Form

Appendix F: Audit Form

SBT Stand-By emergency Treatment kits:these kits typically consist of two parts:(1) a Rapid Diagnosis Test; and(2) malaria treatment medication such asCoartem; these kits enable personnel toself-test for malaria and take medicationto cure the disease.

Space spraying The widespread spraying of insecticide(often called fogging) from vehicles oraircraft to kill mosquitoes

SSA Sub-Saharan Africa

TOR Terms of Reference

Vector An organism (e.g. female Anophelesmosquito) that transmits an infectiousagent (e.g. malaria parasites) from onehost to another (e.g. humans)

Vector-borne Diseases (e.g. malaria) that arediseases transmitted from one host to another

(e.g. humans) via an organism known as avector (e.g. female Anopheles mosquito)

Vector control Process of eliminating mosquitoes thatcan transmit malaria

WHO World Health Organization

List of Appendices

Glossary


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A Guide toMalaria Management Programmes

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The OGP/IPIECA Membership

Company membersADNOCAgipKCOHessAnadarko Petroleum CorporationBG GroupBHP BillitonBPCairn EnergyChevronCNOOCConocoPhillipsDolphin Energy DONG Denerco OilENIExxonMobilGNPOCHocolHunt Oil CompanyHydroJapan Oil, Gas & Metals NationalCorporation Kuwait Oil CompanyKuwait Petroleum CorporationMærsk Olie og GasMarathon OilNexenNOC LibyaOXYOMVPetroCanada PetrobrasPDVSAPEMEXPDOPetronasPetrotrin Premier OilPTT EP Qatar PetroleumRasGasRepsol YPFSaudi Aramco ShellSonatrachStatoilTNK-BPTOTALTullow OilWoodside EnergyYemen LNG

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A Guide to Malaria Management Programmes