Outpatient treatment of malaria in recently arrived African migrants

Abstract

Objective: To describe the clinical features and management of African migrants recently arrived in Western Australia and subsequently diagnosed with malaria. Design, participants and setting: Retrospective case record analysis of African migrants aged ≥ 16 years with malaria referred to Royal Perth Hospital (RPH) from the WA Migrant Health Unit (MHU) between 1 March 2003 and 30 September 2005. Main outcome measures: Demographic variables; clinical and laboratory variables; Plasmodium species; antimalarial medications used and their efficacy. Results: 57 (3.5%) of 1609 adult African migrants screened at the MHU were diagnosed with malaria and referred for treatment. 52 were infected with P. falciparum, two with P. ovale, one with P. malariae, and one with both P. falciparum and P. malariae; the malaria parasite could not be identified in one individual. No patients had severe malaria by World Health Organization criteria. Most patients (53/57) were treated as outpatients with oral antimalarial therapy; four patients without severe malaria were admitted to hospital for treatment and observation. Atovaquone–proguanil was the antimalarial medication most commonly used (in 52/57), and treatment was well tolerated in most patients. Post‐treatment follow‐up was possible in 50 patients; all 27 of those who were followed for 4 weeks or longer were cured. Cure could not be concluded in patients with shorter follow‐up periods. All follow‐up blood films were negative for malarial parasites. Conclusions: Outpatient treatment of malaria in recently arrived adult African migrants appeared to be safe and efficacious in our cohort.

Representations and coverage of non-English-speaking immigrants and multicultural issues in three major Australian health care publications

“…Five articles provided descriptive information on African or refugee medical and physical health derived from on-arrival screening or related services [30-34]; three discussed Vitamin D deficiency in veiled and dark-skinned women and their babies [35-37]; five were concerned with the mental health of refugees [15,38-41]; one with iron depletion in Arabic-speaking toddlers [42]; one examined the hospital utilisation of refugees based on their source country [43]; one examined the differential access rights of Temporary Permit Visa holders, as compared with refugees [44]; one studied the primary care utilisation patterns of 341 asylum seekers in Melbourne [45]; one studied the effectiveness of outpatient malarial treatment with African refugees [46]; one looked at the barriers to healthcare access for newly arrived African refugees [47]; one studied shared antenatal care by women of non-English speaking backgrounds [16]; and one studied the positive relationship between intravenous drug use and Human Immunodeficiency Virus in Indochinese communities [48]. …”

Factors Associated with the Performance of a Blood-Based Interferon-γ Release Assay in Diagnosing Tuberculosis

“…In the resettled refugee population, many malarial infections are chronic, with low level parasitaemia and minimal symptoms. [34], [35] Both acute and chronic asymptomatic malaria infection are broadly immunosuppressive, increasing susceptibility to infection with other pathogens such as salmonella and reducing responses to polysaccharide vaccines. [36] Similar mechanisms may contribute to reduced mitogen responses in IGRA.…”

Malaria in Sydney, Australia: Lessons learned from case management

“…However, very little is known about the frequency with which children in Sydney are diagnosed with malaria, their clinical profile and local management practices. [13][14][15][16]…”

“…Given the mobility of the Australian population and the influx of foreign nationals, imported malaria remains a concern. However, very little is known about the frequency with which children in Sydney are diagnosed with malaria, their clinical profile and local management practices …”