CORPORATE MALARIA CONTROL PROGRAM.pdf

8/10/2019 CORPORATE MALARIA CONTROL PROGRAM.pdf

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Doc. n. STD-COR-HSE-012-E

Rev. 02 Date 19/03/2004CORPORATE STANDARD

MALARIA CONTROL PROGRAM

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CORPORATE STANDARD


STD-COR-HSE-012-E

19/03/2004 02 Issued for updateMED

C. ChessaORGA

F. MikaMED

S. De SanctisQHSE

Date

Revision

Description of Revision

Prepared

Checked

Approved

This document is property of Saipem, who will safeguard its rights according to the civil and penal provisions of the Law.


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Summary of Revisions

Code Date Revision Description of Revision Prepared Checked Approved

HSE-012-E 27/08/2003 01 Issued for approvalMED

C. ChessaORGA

F. MikaMED

S. De SanctisQHSE

HSE-012-E 19/03/2004 02 Issued for updateMED

C. ChessaORGA

F. MikaMED

S. De SanctisQHSE


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INDEX

1

SCOPE AND PURPOSE 4

2 REFERENCE DOCUMENTS 4

3

DEFINITIONS 4

4 RESPONSIBILITIES 5

4.1

CORPORATE RESPONSIBILITIES 5

4.2 OPERATING COMPANIESRESPONSIBILITIES 5

5. STANDARD 6

5.1 MALARIA INFORMATION AND AWARENESS COURSE 65.2 PRIMARY PROPHYLAXIS 65.2.1

Mans Role in Malaria Control 6

5.2.2

Vector Control 7

5.2.3

CHEMO PROPHYLAXIS 7

5.2.3.1

Compulsory Chemo Prophylaxis 8

5.3

EARLY DIAGNOSIS AND PROMPT TREATMENT 9

5.3.1 Site Medical Facilities 95.3.2 Referrals 95.3.3 Severe / Complicated Cases of Malaria 95.3.3.1 Central Nervous System Involvement in P. Falciparum Malaria 95.3.3.2

Neurological Signs in Cerebral Malaria 9

5.3.3.3

Management of Cerebral Malaria 9

5.3.3.4 Treatment of Severe P. Falciparum Malaria 95.4

MALARIA CASE REPORTING 9

6

ATTACHMENTS 9


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1 SCOPE AND PURPOSE

The scope of this Standard is to provide Corporate guidelines and information to Management of Operating

Companies for developing site-specific Malaria control program in order to:

minimize the risk of Malaria contamination to the lowest reasonably possible level for all employeesworking or accommodated on site;

achieve a zero fatality rate among employees.

2 REFERENCE DOCUMENTS

Corporate Policy "Health Safety and Environment (Doc. no. POL-COR-HSE-001-E)

Corporate Standard Health Plan (Doc. no. STD-COR-HSE 005-E)

Management of the Health of Foreign and Expatriate Personnel" (Doc. no. WI-SPA-HSE-004-E)

WHO Expert Committee on Malaria (Twentieth Report)

WHO International Travel and Health Recommendations

3 DEFINITIONS

Chemo Prophilaxis Regular intake of a specific drug regimen aimed to prevent the onset of illnesseven after exposure to the causative factor.

Malaria Disease, distributed mainly in tropical areas of Africa, Asia, and Latin Americacaused by a parasite of the genus Plasmodium and is transmitted through abite of an obligatory vector, a mosquito (Anopheles).

Non-immune Individual Employees who do not live in Malaria endemic arias and witch did notdeveloped partial immunity against the disease.

Primary Prophylaxis Rules to follow and measures to be taken, collectively or by individuals, todefend against infectious diseases.

Semi-immune Individual Person who has acquired partial immunity against a disease (Malaria) due totheir longevity of exposure to the disease.

Vector Control Specific measures in order to reduce or eliminate the presence of vectors(mosquitoes), and consequently prevent bites.


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4 RESPONSIBILITIES

Malaria is a parasitic disease, caused by one among four Plasmodium genus parasites to which the humans

are susceptible. It is transmitted by a bite of infected mosquito (Genus Anopheles). It is a main cause ofdeath among the population is Sub-Saharan Africa. Within the Oil and Gas industry it is the second cause ofdeath among the work force related to the diseases, coming immediately after cardio-vascular incidents, andthird or fourth as overall cause of death where the road traffic accidents lead.

4.1 CORPORATE RESPONSIBILITIES

Saipem Corporate Medical Department is responsible for:

assuring that a Non-immune Individual going to visit or work in a Malaria endemic area is dully informedabout the potential risks and methods of prevention prior to his departure;

supplying of medicines, diagnostic equipment and devices not available locally;

assuring a24/7/365 on-the-phone counselling regarding Malaria prophylaxis and treatment.

It is the responsibility of Saipem Management to ensure that all the proper means are implemented toprevent the disease among the work force, both non- and Semi-immune Individuals, by assuring that:

all the employees are properly informed about the risks and possible consequences of the disease, aswell as about the preventive measures to be applied;

all the means of prevention are available and applied as reasonable as possible;

adequate diagnosis facilities are available on sites;

adequate and immediate treatment is available to each individual on site;

counselling is made available for Saipems employees at all times even during the individuals leaveperiod;

Subcontractors are informed about the Malaria prophylaxis requirements.

4.2 OPERATING COMPANIESRESPONSIBILITIES

Saipem Medical Department in Operating Companies is responsible for:

the development and implementation of the Malaria Prevention Program;

the organisation and carrying out of information and training courses regarding Malaria;

the hygiene surveillance, outdoor and indoor disinfections;

the adequate quantities of Malaria prevention and treatment drugs are readily available on site;

the immediate application of adequate treatment on site;

the implementation and availability of quick diagnosis procedures on sites;

the availability of written information to the employees family doctor and the hand-over of suchinformation to all non-immune employees.

Saipem Site Managers responsibility is to assure that all necessary resource, human, material, financial, etc,are available to in order to implement and make efficient the prevention program. They also have to assure

that the personnel is available for training and information courses.

Saipems employees are responsible for:

attending information and training courses regarding Malaria prevention;

observing Saipems recommendations and requirements fro Malaria prophylaxis;

strictly following the prescribed medical treatment in case of confirmed disease.


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5. STANDARD

Malaria prevention program consists of information course, Primary Prophylaxis and Chemo-Prophylaxis.

5.1 MALARIA INFORMATION AND AWARENESS COURSE

All non-immune employees arriving on any of Saipem Projects will have to undergo Malaria awarenesscourse. This course, developed, organised and carried out by Saipem Medical Personnel is focused on:

information and education regarding prevention and vector transmission;

motivation to change high risk behaviour, i.e. staying outdoors during dusk to dawn;

behavioural skills for performing specific preventive acts.

Malaria prevention course is structured in a way to provide general information about Malaria (parasites,presence in the area, world wide distribution, etc), way of transmission, symptoms (both during incubation andduring the various stages of disease), Primary Prophylaxis, Chemo Prophylaxis (methods, drugs, duration,benefits, risks if not taken, availability on site, possible side effects, etc.), diagnostic procedures and treatment.

Once the presentation is over, and after all the questions from the attendees regarding the matter have beenanswered, a letter shown in the Annex F, is given to each of them. The purpose of this letter is to give moreinformation to the employees family doctor regarding Malaria, its symptoms and available treatment.Furthermore, each attendee will be asked to sign a declaration of participation at the Malaria prevention courseas shown in Annex E.The attendance at the information courses will be registered on the format (Annex G) and monthly submitted aspart of medical reporting to the Saipem Managers and Saipem Corporate Medical Department.

5.2 PRIMARY PROPHYLAXIS

There are three determinants to be considered in an effective Malaria control program. These are:

Man (the host);

Plasmodia (the agent); Anopheles mosquito (the vector).

To achieve a sustainable outcome, Saipem is addressing control of the above three living beings and theirenvironment. Man, the host, is a moving target and can take the disease with him far and wide. Mosquitoesare moving and highly adaptable. It is therefore important to target non-flying eggs and larvae. The parasitealso is highly adaptable, hides in humans and mosquitoes and has also developed resistance to drugs.Therefore, for effective Malaria control, target man first, control mosquitoes next and keep trying to tackle theparasite with development of effective drugs. To promote an effective and long lasting program, it isimperative that all parameters concerned should be given adequate attention and enough support to attainand sustain the program in the long run yielding a positive long lasting effect.

5.2.1 Mans Role in Malaria Control

Man is the most important link in the Malaria control chain. He can be made to understand the problem andhe can help in breaking the chain at multiple points. For example, by taking personal protective measures,three things can be achieved prevention of Malaria in the given individual, thus reduced parasite load andreduction in spread, and by denying blood meal to the mosquito the egg laying is also hampered. In therecent years, more emphasis is being laid on early diagnosis and treatment and on personal protectivemeasures. By these means, it is intended to minimize the use of potentially harmful chemical insecticides.

Person concerned should avoid exposure of any part of the body to mosquito bites. Positive behaviouralpatterns would include:

not staying out between dusk to dawn;


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proper choice of clothing materials, preferably thick clothes with long sleeves;

avoiding areas notorious for mosquito infestation;

interactive communication with the Medical Department and workers on matters pertaining to Malaria;

simple but effective ways in controlling potential breeding areas like proper disposal of water retaining

litters; i.e. bottles, cans, used tires, etc.

At each working site in a high-Malaria risk aria sufficient quantities of recognized quality repellents, creams orsprays, will be available in the clinic in order to be distributed to the workforce whenever needed/ asked.

5.2.2 Vector Control

It is impossible to control Malaria without controlling the anopheles mosquitoes, the vector for Malaria. Butcontrolling these highly adapted, flying and hiding vectors is indeed a formidable task.Development of resistance to insecticides has compounded to the problem.

The following are the steps in mosquito control:

egg laying should be discouraged;

development of laid eggs into larvae and adults should be prevented;

grown adults should be killed;

un-killed adults should not be let into places of human dwelling;

mosquitoes that have already entered should not be allowed to bite human beings.

In order to control the vectors effectively, Saipem has taken the following steps:

External and internal fumigation are regularly done on all areas of the camp. Fumigation is scheduledand a written notice is posted on the particular area a day before the procedure is carried out. Swing fogsusing insecticides are used for external fumigation. It is performed by a trained safety personnel withprior approval from the Safety Coordinator, Medical Coordinator, and Camp Boss. Each area isfumigated at least once a month. Internal fumigation is occupant-based. Insecticide sprays are suppliedto each room monthly and regular spraying is left at the prerogative of the room occupant.

Mosquito magnets using propane gas attract mosquitoes and trap them inside a one-way net is provided.These are strategically placed around the camp in order to promote maximum coverage for mosquitoattraction. This equipment effectively diverts mosquito movement by luring them to the nets preventinginfestation of the camp.

Accommodation rooms in the camp are designed to be mosquito proof. Rubber seals on doors andwindows are placed to prevent entry of mosquitoes as well as other insects inside the rooms. All roomsare air conditioned and comfortably designed to discourage occupants from leaving their rooms open. Inthe sites, ergonomically designed caravans are used. They are tightly sealed, air conditioned for singleoccupancy provided with a toilet and bath. This offers both privacy and convenience to the occupantwhich results to less insect exposure when conveying from one caravan to the other (as in camps usingcommon bath and latrine).

Regular maintenance of the camp premises is a major activity. Tending and pruning of ornamentalplants, maintenance of grass/weed height, and landscaping prevents insect proliferation and is visuallygratifying. Daily cleaning and inspection of drainage is strictly implemented to assure continuous flow of

both sewage and runoff water. A hygiene control program is being implemented to define and maintain standard of cleanliness within

the camp. It is extensively discussed in a separate work instruction document.

5.2.3 CHEMO PROPHYLAXIS

To permit the employer to protect employees health, the employer reminds each employee that he shall takecare of his own health and security assuring that the best practice is followed. Therefore, the medical team ofthe employer will provide to the employee a specific medical prescription for prophylactic therapy and theemployee shall inform the employer, when such therapy is considered by the employer to be compulsory, ifhe decidesnot to take such therapy and the reason of such refusal.


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Throughout the years, a lot of research have proven chemoprophylaxis to be beneficial in preventing Malariainfection for people visiting known endemic areas, especially for expatriates who would be staying there on ashort-term basis. Up to now there are no evidences as to the physiologic effectiveness and safety in long-term use. Prevention of Malaria through drug intake (chemoprophylaxis) is highly recommended but it is

considered a voluntary act of the individual employee.

Recent guidelines give emphasis to the importance of balancing the risk of adverse reactions against anti-Malaria drugs. The main determinants of Malaria-risk are the geography, duration of stay, conditions ofaccommodation, work and social patterns of the site (particularly dusk to dawn activities).Saipems Medical personnel in charge of the worksites will provide pertinent information on diseaseprevention, and administer prophylactic drug regimens.The purpose of chemoprophylaxis is to prevent the onset of the illness in case of exposure. No matter beingthe best protection measure, it does not guarantee total protection from acquiring the disease, however, itcan limit the illness to its less severe, uncomplicated form.

Before starting the drug regimen, the following prerequisites are required:

Thorough anamnesis should be taken form the individual. Special attention should be given to the

cardiac and circulatory history, familial predisposition and personal history. History of allergic reactions,Cardiac arrhythmias, hypertension, past ECG abnormalities, present medications (if any).

Complete physical examination with special attention to cardio-circulatory system.

Laboratory examinations should include routine CBC, liver function tests (Transaminases), renal functiontests, FBS.

These ancillary procedures are aimed to provide a baseline for future references. ECG recordings should bedone prior to selecting the most appropriate prophylaxis among the ones pre-approved by Corporate MedicalDepartment (Annex C). These drugs shall be available in all working sites.Prophylactic therapy should be started prior to exposure or travel to endemic areas. Strict coordination andcompliance among the clinics from the country of origin and site clinic should be empowered. Theprescription issued prior to departure shall be presented to the site medical doctor which will enable that theprescribed prophylactic therapy is continued by the site physician.The most common and anticipated problem which poses a threat to a successful prophylactic therapy is

Compliance. A centralized way of administering the drug is the most effective in monitoring and ensuring thatthe schedule is strictly complied with.The use of Chemo Prophylaxis will be monitored by the site physician.

5.2.3.1 Compulsory Chemo Prophylaxis

In certain cases and in base of the Health Risk Assessment carried out by its Medical Department, local lawsand regulations, best international practice and/or Clients contractual requirements, Saipem could ask bothits own and Subcontractors non-immune employees to take the Chemo Prophylaxis compulsory during theassignment to a specific Project. In such case, each employee prior to his/her mobilisation shall be asked bythe Personnel Department to sign an employee statement of understanding and compliance with the Malariachemoprophylaxis requirements.This statement will include the employees agreement to be subject to unannounced, random and periodictesting to determine his/her compliance with the requirement that he/she is taking approved Malaria Chemo

Prophylaxis. For this testing he/she will be asked to provide the urine sample for laboratory verification.This sample will be sent for analysis to an approved laboratory. The laboratory will provide the tests results,positive and negative, to the Saipems designated Medical Officer. Should the result show an individualsnon-compliance with the prescribed regimen, he/she will be invited, in a written manner, to fulfil therequirement.Should an individual result negative on two consecutive tests, his/her name shall be forwarded to theProjects Management in order for them to eventually undertake any appropriate action.


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5.3 EARLY DIAGNOSIS AND PROMPT TREATMENT

In case of a suspected illness, early diagnosis and prompt treatment of Malaria is the dictum on all the sites

located in endemic areas to achieve zero fatality rate among employees. To attain this goal, the followingrequisites are put in place.

5.3.1 Site Medical Facilities

All Company sites located in Malarial areas (and barges when operating in such areas) must have thefacilities to rapidly confirm or exclude the diagnosis of Malaria in a suspected case.These can include:

standard laboratory equipment with adequate staining techniques, and/or

advanced microscopic diagnosis facilities (QBC Rapid Malaria Identification Test), and/or

ICT rapid diagnostic tests.

Medical personnel assigned to these locations have to be competent and trained, fully able to perform and

interpret Malaria tests.

Adequate anti Malarial drugs for treatment of severe Malaria must also be available on all sites. Corporateapproved Malaria treatment protocols for uncomplicated and complicated cases as tabulated below isestablished and closely adhered to by site doctors (Annex B).

5.3.2 Referrals

All confirmed Malaria cases among non-immune employees have to be reported to the Saipems Medical sitestaff or directly to the Head Office .In case that the local medical support is not sufficient for the treatment of Malaria or its suspected relatedcomplications, the evacuation of the affected person should be done to the closest medical facility equippedfor this purpose.

5.3.3 Severe / Complicated Cases of Malaria

The implementation of adequate prevention measures, the diagnosis and treatment of Malaria patients ontime shall limit the occurrence of severe and complicated cases to practically zero. Nevertheless, suchcases can not be completely ruled out and it is extremely important to recognise them on time and treat themcorrectly. Due to the specificity of Plasmodium species and drug resistance the general rule is to treatMalaria in the area where it has been acquired. In case local structures cannot meet the needs for a modernand adequate life support, necessary for the treatment of complicated cases, a non.-immune individual shallbe evacuated using the resources and equipment of specialised MEDEVAC providers that Company hascontracted for.

5.3.3.1 Central Nervous System Involvement in P. Falciparum Malaria

This is the most common cause of death in severe P. falciparum Malaria. C.N.S manifestations in Malaria

could be due not only to severe P. falciparum Malaria, but also high grade fever, anti Malarial drugs,hypoglycaemia, hyponatremia and severe anaemia. Therefore, it is extremely important to differentiatebetween these so as to avoid unnecessary anxiety and improper treatment. Focal neurological deficits, neckrigidity, photophobia, papilloedema, and neurological sequelae are very rare in P. falciparum Malaria andsuch a picture would therefore suggest other possibilities.

Manifestations of cerebral dysfunction include any degree of impaired consciousness, delirium, abnormalneurological signs, and focal and generalized convulsions. In severe P. falciparum Malaria, the neurologicaldysfunction can manifest suddenly following a generalized seizure or gradually over a period of hours.A strict definition of cerebral Malaria has been recommended for sake of clarity and this requires thepresence of unarousable coma, exclusion of other encephalopathies and confirmation of P. falciparuminfection. However, all patients with P. falciparum Malaria with neurological manifestations of any degree


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should be treated as cases of cerebral Malaria.

5.3.3.2 Neurological Signs in Cerebral Malaria

As per the definition, patient should have unarousable coma, not responding to noxious stimuli with aGlasgow coma scale of


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In areas where resistance to quinine is known or suspected, add single dose of

pyrimethamine/sulphadoxine OR Tetracycline or Doxycycline for 7 days.

ARTEMISININ DERIVATIVES

Preparation Dose and administration

Artemether (Availability: 80mg/ml inj. and

40mg cap)

I.M: 3.2mg/kg as loading dose, followed by

1.6mg/kg daily, until the patient is able to

swallow or for 5 days.

Oral: 160mg in two doses on the first day, then

80mg/day for total 5 days.

Artesunate (Availability: 60mg powder with

1ml of 5% sodium bicarbonate ampoule forinjection and 50mg tablet)

Injection: The powder should be reconstituted in

1 ml of 5% sodium bicarbonate and then furtherdiluted with isotonic saline or 5% dextrose (to a

total of 3ml for i.m and 6ml for i.v use). DOSE:

2.4mg/kg on the first day (additional 1.2mg/kg

after 4 hours in case of severe falciparum

Malaria), followed by 1.2mg/kg daily until patient

is able to swallow or for a maximum of 7 days.

Oral: 100mg on the first day, followed by

50mg/day for 7 days.

OTHER DRUGS

Drug Dose

Mefloquine 15-25mg/kg (max. of 1500mg), given as two

doses, 6-8 hrs apart

Tetracycline 250mg 4 times a day for 7 days

Doxycycline 100mg twice a day for 7 days

NOTE:

Most blood schizonticidal drugs prevent the development of the forthcoming erythrocytic cycle ofparasitic development and hence have no or little effect on the ongoing cycle that is already causingfever. Therefore, it would take at least 48 hours for the treatment to be effective.

Artemisinin derivatives can be used in cases of hyperparasitaemia or life threatening complications onaccount of their ability to clear the parasitaemia earlier compared to other anti-malarial drugs.

Most anti Malarial drugs have a long plasma half-life. Therefore, adding similar drugs half way throughthe treatment will only add to the adverse effects and not to the therapeutic benefit. The followingcombinations should therefore be avoided, concurrently or within a short interval:

Cloroquine + Quinine

Chloroquine + Mefloquine


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6 ATTACHMENTS

The following documents are integral part of this Corporate Standard:

Annex A: Global Malaria Status

Annex B: Reported Falciparium Drug Resistance

Annex C: List of Recommended Drugs for Chemoprophylaxis

Annex D: List of Recommended Drugs for Chemotherapy

Annex E: Declaration of Attendance and Comprehension (Form: COR-HSE-064-E)

Annex F: Letter to Family / Attending Physician (Form: COR-HSE-065-E)

Annex G: Attendance Sheet for Information Courses (Form: COR-HSE-066-E)

Annex F: Malaria Control Program Log (Form: COR-HSE-067-E, Pages 1-2)

Annex H: Malaria Cases Stewardship Report (Form: COR-HSE-068-E)


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ANNEX A: GLOBAL MALARIA STATUS


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ANNEX B: REPORTED FALCIPARIUM DRUG RESISTANCE


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ANNEX C: LIST OF RECOMMENDED DRUGS FOR CHEMOPROPHYLAXIS

Drug Preparation Dose Route

Mefloquine(Lariam) *

250mg tablet 1 tablet once aweek

Oral

Proguanil+Atovaquone(Malarone) **

Proguanil 100mg +Atovaquone 250mgtablet

1 tablet once daily Oral

Doxycycline ** Doxycycline 100mgcap

1 capsule oncedaily

Oral

Duration of prophylaxis.

Mefloquine: start two and a half weeks before travel, throughout the stay and continue four weeks afterreturn.Doxycycline: start two days before travel, throughout the stay in the endemic area and continue for fourweeks after return.Malarone: start two days before travel, throughout the stay in an endemic area and continue for one weekafter return.


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ANNEX D: LIST OF RECOMMENDED DRUGS FOR CHEMOTHERAPY

DRUG DOSEChloroquine tablet and ampoule 600mg base initially, 300mg base in 6 hrs, then

300mg base at 24 and 48 hrs.

Sulfadoxine 500mg, Pyrimethamine 25mg tablet(Fancidar)

3 tablets in a single dose.

Sulphamethoxypyrazine + Pyrimethamine tablet(Metakelfin)

2 tablets in a single dose to adults with a body weightof 50-70kg; 3 tablets over 70kg.

Artemether 80mg amp(Paluther)

3 Day Treatment: one ampoule containing 80mgtwice a day by intra muscular injection (i.e. 160mg/day) for 3 days5 Day Treatment: 1 ampoule containing 80mg twicea day by intra muscular injection the first day (i.e.160mg). Then one ampoule containing 80mg for thenext 4 days.

Halofantrine hydrochloride 250mg tablet(Halfan)

2 tablets (i.e. 500 mg) every 6 hours for 3 doses, notwith meals. Repeat dose in 7 days.

Quinine sulphate 300mg tablet and 600mg/2mlampoule

2 tablets (600mg) 3 times a day for 7 days.I/V Infusion: 20mg of salt/kg diluted in 10ml/kgisotonic fluid, infused over 4 hrs; then 10mg ofsalt/kg over 4 hrs, every 8-12 hrs until patient canswallow.

Mefloquine 250mg tablet(Lariam)

3 tablets (i.e. 750 mg) followed in 12 hrs by 2 tablets(i.e 500mg).

Proguanil 100mg +Atovaquone 250mg tablet(Malarone)

4 tablets (i.e 1000mg Atovaquone and 400 mgProguanil) once daily for 3 days.


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ANNEX E: DECLARATION OF ATTENDANCE AND COMPREHENSION

Company name / logo :Form: COR-HSE-064-E

DECLARATION OF ATTENDANCE ANDCOMPREHENSIONPage 1 of 1

DECLARATION

I, the undersigned hereby declare that on (date) I attended the MalarialPreventive course as per Saipem program. During this course the following topics had beendiscussed.

1. Details regarding Malaria, signs and symptoms

2. Ways of transmission

3. Health risks related to Malaria

4. Presence of Malaria in specific area

5. Primary Prophilaxis

6. Chemo Prophilaxis benefits and risk

I state that I was fully informed regarding the subject. I confirmed that benefits of Chemo Prophilaxis were

clearly explained and I dont have further questions regarding this tropical disease.

Furthermore, I was given a letter and to be given to the Doctor from my country of origin during the time ofmy vacation if something unusual symptoms related to such disease will occur.

Signed by:

____________________________


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ANNEX F: LETTER TO FAMILY / ATTENDING PHISICIAN


LETTER TO FAMILY / ATTENDINGPHYSICIANPage 1 of 1

MEDICAL DEPARTMENT

TO THE FAMILY / ATTENDING PHYSICIAN

Dear Colleague:

I would like to inform you that the bearer, our employee, just arrived from a Malaria-endemic country

in one of our worksites. In lieu of this, we send this letter to forewarn you on any untoward events that mayoccur during his vacation period.The most common problem we have encountered with our expatriate personnel is Malaria. Other

tropical diseases like Typhoid, etc do occur seldom. P. falciparum has an incubation period of 48 hrs. Signsand symptoms usually involve a general sense of not being well, malaise, arthromyalgia, spiking fever,tremors, nausea, vomiting. No particular focus is present to attribute the symptoms. With our experience inthe field, an early recognition of the illness can be contained with simple treatment regimens and does notrequire long-term hospitalisation.

The drugs commonly used are: Chloroquine phosphate 250 mg tablet; 4 tablets as initial dose, 2tablets after 6 hrs from initial dose, then 1 tablet every 12 hrs thereafter for 4 doses. However, forCloroquineresistant cases, Artemeter 80 mg ampule; 1 ampule deep IM every 12 hours for 6 doses can begiven. If Artemeter is not available, Quinine 300 mg tablet; 2 tablets every 8 hours for 7 days, with regularmonitoring of blood pressure and cardiac rate. Usual complications with Quinine therapy is hypotension andarrythmias. Anti-malaria regimen is usually coupled with antipyretics and antiemetics if indicated.

For confirmation and monitoring, a peripheral smear is very helpful in determining the Malaria variantand efficacy of the treatment, but sometimes it can give false negative results. That is why, in suspectedcases, it has to be repeated even several times.

We would be glad to accommodate any query from you regarding this matter. You can get in touchwith us thru Pronto Dottore telephone number +390252034777. We hope that this simple note wouldprove useful in the management of your patient.

Thank you and best regards.

Cordially,

Medical Coordinator


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ANNEX G: ATTENDANCE SHEET FOR INFORMATION COURSES


ATTENDANCE SHEET FORINFORMATION COURSESPage 1 of 1

COUNTRY SITE/VESSEL

COURSE TITLE CARRIED OUT IN LANGUAGE

FROM _______________________ TO _____________ OCLOCK TOTAL HOURS

CARRIED OUT FROM ______________ TILL ______________ LECTURER

NR. NAME AND SURNAME BADGE N. POSITION NATIONALITY WORK AREA SIGNATURE

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15


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ANNEX H: MALARIA CONTROL PROGRAM LOG


MALARIA CONTROL PROGRAM LOG

Page 1 of 2


Project / Site / Vessel:_____________________ Date:_________________________

Country and Client: _______________________________Prepared by:__________________

No Surname & NameAttendedthe course

(Yes/No)

SignedDeclaration of

attendance(Yes/No)

SignedAttestation form

(Yes/No)For

ExxonMobileProjects ONLY

Chemoprophylaxistaken (Name of

medicines)

Position Nationality Company

1

2

3

4

5

6

7

8

9

10


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ANNEX H: MALARIA CONTROL PROGRAM LOG


MALARIA CONTROL PROGRAM LOG

Page 2 of 2


Project / Site / Vessel: _____________________ Date: ________________________

Country and Client: _________________________________ Prepared by: _________________

Signed Attestation form ( for Exxon Mobile

projects ONLY)

NationalityNo. of Personnel who

attended the course

No. of Personnel who did not

attend the course YES NO

Nationality

Nationality

Nationalities

..

ASIANS

0 0 0 0

Nationalities

..

..

.

.

..

..

.

EUROPEANS

0 0 0 0

Nationalities

..

..

OTHERS

0 0 0 0

GRANDTOTAL 0 0 0 0


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ANNEX I: MALARIA STEWARDSHIP REPORT


MALARIA STEWARDSHIP REPORT

Page 1 of 1

Project/Site/Vessel: Date:

Country and Client: Prepared by:

Enter the data in light blue cells. All yellow cells are formulas for this sheet.

Duble click tab and rename as in-country organization name (The header will be corrected automatically)

Jan

Feb

March

April

May

June

July

Aug

Sept

Oct

Nov

Dec

1q

2q

3q

4q

Mid-year

Year-end

YTD

Saipems Non-immune (Expat)

FatalMalariaCases

No

TotalStewardable MalariaCases

No

ExposureHours

No

MalariaCasesRate

Saipems Semi-immune (Nationals)

FatalMalariaCases

No


No

ExposureHours No

MalariaCasesRate

Subcontractors Personnel

FatalMalariaCases

No


No

ExposureHours

No

MalariaCasesRate

Notes:1.Stewardable Malaria Case

All Malaria fatalities.

All confirmed Malaria cases in non-immunes.

Confirmed cases in semi-immunes with any one of the following (consult physician): Hospitalization(4) for treatment, 5%parasitemia, Patient meets criteria for severe Malaria according to World Health Organization standards.2.Man-Hours Worked. Wherever possible, use actual man-hours worked for indicated groups. Where a breakdown of man-hours is notavailable for the indicated groups (e.g., Non-Immunve and Semi-Immune), utilize the percentage composition of the workforce tocalculate.(e.g., Total contractor man-hours multiplied by the percentage of Non-Immune and Semi-Immune personnel).3.Malaria Case Rate (automatically calculated on this sheet). MCR = (Total number of Stewardable Malaria Cases x 200,000) divided byman-hours worked for particular workforce. The number of confirmed Malaria cases and the corresponding Malaria case rates are notto be combined with SHE stewardship data. Malaria case information is stewarded separately.


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CORPORATE MALARIA CONTROL PROGRAM.pdf

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