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Question: How can I use the ETool to see when a patient is at risk of malaria when travelling?


Answer: Watch the following video

This video covers how to identify the number of days patient requires protection against malaria

 

4. Concluding the consultation for malaria.
Having confirmed all details on the patient’s vaccine record you will now come to the section of the consultation concentrating on malaria prophylaxis. 

We are going to look at three scenarios, designed to illustrate how you should use the tool to assist you when offering advice on malaria prophylaxis, during a consultation.

Scenario 1: Travelling in and out of at-risk malaria areas

In the first example, a 25 year old male patient is about to embark on a holiday to South America; to Bolivia, Chile and Peru.

All travel dates and destinations are visible on the ‘Travel itinerary’ page of the consultation. 

Given the varying risk of exposure to malaria, depending on the area of the country a traveller visits, you need to check the exact itinerary, be sure of all precise destinations and the proposed length of stay in each area.  In this example:

  • The patient is flying to the capital city of Bolivia, La Paz, and spending a few days there (this will last a total of 3 days). 
  • From there he plans to travel up to the Amazon basin, to for a river cruise (and this will total a further 5 days). 
  • The patient will then travel back to La Paz and fly on to the capital city in Chile, Santiago; from there down to the south of the country to explore some of the lake districts before returning to Santiago.  (this will total a further 18 days)
  • The patient will fly from Santiago to Cuzco, in Peru, from where he will complete the Inca trail through the Andes, finishing at Machu Picchu (this will last a further 7 days). 
  • The patient’s final destination is Iquitos; again, in the Amazon basin (this will last 9 days in total). 

We will now refer to the box titled: ‘Malaria risk may be present -….’

You will find useful information relevant to malaria prophylaxis by clicking on the buttons ‘1. General information’ and ‘2. Risk advice’.  Using your own knowledge you should be able to supplement the advice provided by the system.

You can see a geographical illustration of at-risk malaria areas in the destination countries listed in the patient’s travel itinerary, by clicking on ‘3. Malaria map’.
The map will only display for countries where malaria is present.

You will first see an image giving instructions on how to use this useful tool:

  1. Check the malaria maps for each country to review where there is a malaria risk.
  2. Check the number of days the patient will be at risk in a malarial area.
  3. Check the protection information for each country.

And

  1. Review the entire travel itinerary moving from one country to the next.

When you click on the button to the right of the page, a map of the first destination country where malaria is present appears (in this case, it’s a map of Bolivia). 
By matching the patient’s exact destinations to the map and by referring to the key at the bottom, you can establish whether the patient will be at risk of exposure to malaria. 
Based on the travel itinerary described earlier, including all planned activities, you can deduce that the patient will first need anti-malarials when on the river cruise in the north of Bolivia (this will be for a total of 5 days).
The notes beneath the map give further information on the risk areas, precautions to take and the usual recommended malaria prophylaxis.  To move onto the next map you click on the arrow to the right of the page.  As the next stop in the patient’s itinerary is Chile, where malaria is not normally present, the second map which displays, is of Peru.
After temporarily leaving an at risk malaria area, the patient plans to return to one; Iquitos, in northern Peru (for a total of 9 days), at the end of the trip. This will be 25 days after they will have left the previous malarious area, in Bolivia.

Having finished with the maps click on ‘4. Conclude’.  You can tick the box confirming the patient wants malaria prophylaxis and then a button will appear asking you to confirm the patient is not taking any medicine.

The system now needs information to determine which, if any anti-malarial, is suitable and how many tablets are required to ensure protection.
You first need to calculate the total number of days the patient will be in a malarious area (5 days in Bolivia and 9 in Peru, making 14 days in total). Type this information into the appropriate box. 
As this patient is travelling into and out of malarious areas you can indicate that the patient may want two separate courses of anti-malarials, if at all possible, so as to save them having to take tablets unnecessarily.
You can double check and type in the number of days between the patient leaving one malarious zone and entering the other, in this case 25.
And then once you have provided all information, click on the confirmation button and the tool will show which malaria prophylaxis options are available.

In this example, if the patient wants to complete two separate courses of malaria prophylaxis the only option of the three listed is atovaquone/proguanil and the total number of pills has been calculated as 32. 
By hovering over the text related to ‘regime' you and the patient can see how the tool has arrived at that number. 
Similarly, by matching the ‘Total days between courses’ and the text in ‘Regime’ for both  mefloquine and doxycycline it becomes clear that the gap between leaving one malarious area and entering another is too short for two courses of these two antimalarials. 

Given that two separate courses of malaria prophylaxis are not available for all three listed options, the tool gives instructions to re-calculate the number of days for which protection is required, as well as the number of courses, and amend the details accordingly so as to check if one course of antimalarials would be possible for all three options. 
Following the instructions, in this example, the total number of days for which protection is required becomes 39 and by clicking on the ‘Confirm to proceed’ button the tool will display the number of pills required for a single course. 
The patient already knows that two separate courses of atovaquone/proguanil are possible, so the single course would only be relevant if they wanted to be protected for all 39 days of the trip.
The patient can now decide which antimalarial they want and in this case, they decide to get the two courses of atovaquone/proguanil so you need to enter the details for two courses again and then click on the appropriate button.

Article published on the 13-10-2016



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