Malaria Control in the Nigeria Oil and Gas industry: A comparison of two MCP models

1. Malaria Control in the Nigeria Oil and Gas industry: A comparison of two MCP models 2018 SOEHPON Annual Scientific Conference 8th – 10th November, 2018 Civic Centre, Lagos. by: ‘Lanre Ajayi

2. Aim of the paper • Describe and compare risk perception and uptake of two malaria risk minimisation programs available within Nigeria’s oil industry for the non-immune work population

3. Outline: • Introduction • Brief description of Risk categorization • Elements of a typical MCP • Two models of MCP • Pros and Cons • Study Findings • Recommendations • Conclusion

4. Introduction 3.3 billion exposed to malaria worldwide (half of world population living in 106 countries) 350-500 million infected worldwide (90% esp. in sub-Saharan Africa) 1 million deaths in Africa alone (91% of all malaria deaths!) >20,000 return with Malaria to the EU alone after leaving high malarious areas

5. Risk Categorization - Nigeria Prevalence (notified cases) in Nigeria (WHO, 2014) > 51 million (>97% of population at risk for malarial transmission (high + low) - Hyperendemicity) Reported confirmed cases (healthcare facility + community) ~ 12 million Av. 207,000 deaths in Nigeria annually (WHO, 2014) Approx. 1% of all P. falciparum malaria in the non-immune is fatal Fatality is common after return to home country or in host country when Rx is delayed Employers in the petroleum industry seek to reduce the risk to tolerable levels by implementing a MCP as part of a wider OHSMS

6. Risk Categorization - Nigeria Risk of contracting malaria depends on: length of stay in malaria-endemic areas, seasonality of transmission, vector type, use of chemoprophylaxis, host behaviour, host itinerary, offshore/onshore, etc Non-immune: anyone not born or raised at least till age of 5 in a region of similar plasmodia type and intensity of malarial transmission as the region in which he now lives or works No single malaria control method reduces the malarial risk to tolerable levels.

7. Elements of a Typical MCP IPIECA/OGP Guidelines Diagnosis & Treatment Awareness A D C Chemoprophylaxis B Bite prevention

8. Two models of MCP

9. Pros and Cons of each model

10. Pros and Cons of each model Some Facts to bear in mind.... • Any MCP model that does not emphasize Malaria Awareness and Bite prevention is weakened already! • No single method of control has been found adequate • Awareness is critical since malaria in the non-immune is still enshrouded in many misconceptions • Bite prevention can probably offer an excellent potential for control (cf: ITNs)

11. Study Methodology Qualitative Research 1-mo study period in July Identified clinic in Lagos accessible to expatriate community Av. Sample size anticipated = 55 Ethical approval sought and granted Use of anonymised paper questionnaires Convenience sampling 21-item single construct questions (after adjusting to suggestion from a piloted study targeting 25% of sample size) 8mins 35 secs av. completion time Confidentiality guaranteed Sample size: 218 clinic visits within study period 58 candidates eligible for study enrolment (26.6%) 35 actual respondents (Response rate = 60%) Result Analysis

12. Study Findings - Respondent Demographics

13. Study Findings – Risk Perception

14. Study Findings – Malaria Control

15. Study Findings – Malaria Risk Aversion (Results) Hypothesis 2 Hypothesis 1 p = 0.01. Association statistically significant p = 0.5. Association not statistically significant

16. RecommendationsBased on 2 principles: • It is always difficult and perhaps rarely justified to prescribe a blanket brand of MCP for every employer within same industry sector, and for every employee within same organisation. • However, the risk that malaria (especially falciparum malaria) poses to non-immune oil industry employees in malaria endemic regions CANNOT be ignored! This risk must be controlled to ALARP.

17. Recommendations • At policy level, the employer is to define, implement and continually review a proven evidence-based MCP • ALL MCPs should be kept auditable against certain KPIs, with a view to detecting any non-conformance at the earliest opportunity • For the non-immune, risk-benefit ratio of taking chemoprophylaxis must always be determined, and decision to take drugs based on this determination • The semi-immune should also be enrolled in the MCP as their risk is still also intolerable. Awareness and Bite prevention (esp. ITNs) present the best critical control points for this category of staff. • The employer should identify and retain a competent local medical facilities through a rigorous accreditation and selection process • The company should endeavour to demand stewardship in malaria control throughout its supply chain

18. Recommendations • The semi-immune should also be enrolled in the MCP as their risk is still also intolerable. Awareness and Bite prevention (esp. ITNs) present the best critical control points for this category of staff. • CPY to identify and retain competent local medical facilities through a rigorous accreditation and selection process • CPY to demand stewardship in malaria control throughout its supply chain

19. Study Limitation Small Study Sample Gender bias Exclusion criteria Prescribed Study duration Single source of data

20. Conclusion • In deciding to take any medications, risk-benefit ratio must always justify the decision making • Categories of non-immune workers for whom malarial advice is difficult: • Rotational Offshore employees (esp. deep offshore) • Long-term employees • Pregnant employees • Employees with unpredictable biz itineraries in malarious areas • Much remains to be done to understand and control the risk from malaria to workers within the Oil industry, especially the non-immune working in endemic areas. Furthermore, we should be willing to continually review existing MCPs so as to improve the system and be assured of its effectiveness.

21. Thank you all for your attention