Medical Care |

Medical Care



Chaque forme pharmaceutique présente ses propres avantages et inconvénients antibiotiques en ligne.

mais n'ont pas d'effets néfastes pour l'organisme dans son ensemble.

Ogp/ipieca 'guide to malaria management programmes' (2006)

A Guide to
in the oil and gas industry

A Guide to
in the oil and gas industry

International 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 International Association of Oil & Gas Producers
London office
5th Floor, 209–215 Blackfriars Road, London SE1 8NL, United Kingdom Telephone: +44 (0)20 7633 0272 Facsimile: +44 (0)20 7633 2350 Boulevard du Souverain 165, 4th Floor, B-1160 Brussels, Belgium Telephone: +32 (0)2 566 9150 Facsimile: +32 (0)2 566 9159 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 of
completeness or accuracy. Readers are hereby put on notice that they must rely on their own diligence when determining how
or whether to respond to the information herein. Further, this guide is not intended to replace necessary and appropriate medical
or 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. (The Appendices can be found on the CD-ROM which accompanies this document) Purpose of this Guide This Guide outlines and describes the scientific issue that can transcend company medical concepts, rationale and value of Malaria support systems and significantly affect Management Programmes (MMPs) for the oil environment, safety and human resources and gas industry. The Guide provides a broad activities. The management of malaria is overview of MMPs, and templates such as imple- therefore a potential concern throughout the mentation checklists and audit protocols that supply chain of global exploration, production, might typically form part of key activities when refining, distribution and marketing.
implementing MMPs in the oil and gas industry.
This Guide attempts to build on successful Experience within the oil and gas industry industry practices. However, experience at suggests that health is one of the key issues for both the international health level, and from a both the project workforce and the host private sector perspective, indicates that country. Health impacts can potentially occur malaria management is both complex and within defined project geographical bound- difficult.There is no unique set of strategies or aries and across surrounding communities.The set of programmes that will work in all situa- possibility of impacts is particularly true for an tions or geographical locations. The only issue like malaria that involves a complex constant feature of both the biology and interaction between biological and environ- human medical science of malaria is change mental variables and social and behavioural and evolution. However, there are reasonably practices. The oil and gas industry operates well-understood principles that can be utilized across a myriad of countries and cultures that in virtually all situations that the oil and gas form part of this interaction. Typically, the industry is likely to encounter. This Guide focus on malaria impacts is centred on Sub- presents and analyses these principles and illus- Saharan Africa (SSA), however, malaria trates how they can be applied systematically transmission occurs globally. Regardless of within the context of worldwide oil and gas geographical location, the industry operates in operations. A series of linked technical appen- an atmosphere of heightened expectations, dices is provided on the attached CD-ROM so particularly related to health, social and that readers who want greater scientific expla- environmental practices.When present, malaria nation and technical back-up will have a can be more than a health management readily available source of information. For problem; it is increasingly recognized as an completeness, a glossary is provided.
The overall situation:global burden of malaria Malaria is not a newly emerging disease.There contrast, there were minimal effects in those is an extremely long history of human and geographical areas that are characterized by malaria parasite interaction spanning over high levels of malaria endemicity.These obser- 10,000 years. Malaria parasite populations vations are consistent with the documented experienced rapid growth in Africa and spread evidence that controlling malaria across large worldwide following human population geographical areas becomes progressively more growth, migration and agricultural devel- difficult as a function of increasing intensity of opment. Similarly, malaria morbidity, mortality and disability have changed and evolved over In many geographical areas, particularly in time and geography.
sub-Saharan Africa, there is intense but stable Human malaria risk has fallen from year-round transmission. Therefore, MMP 53 per cent to 27 per cent of the Earth's land strategies that are highly successful in a surface. Sub-Saharan Africa (SSA) accounts for geographical setting of low transmission may 59 per cent of the global clinical malaria cases, fail in areas characterized by entrenched, high- Southeast Asia accounts for 38 per cent and level transmission. Further complicating the Latin America accounts for 3 per cent. The situation is a significant movement of popula- Western Pacific region (which includes China) tions from rural to urban settings. For example, has less than a 1 per cent burden, despite a in sub-Saharan Africa, urban cities are growing large population, because of marked reduction by approximately 10 per cent per year. Urban in transmission across China since 1975. The malaria has different transmission character- World Health Organization (WHO) estimates istics due to the unique ecosystem of the city that on a worldwide basis, there are 300–500 million clinical episodes per year.
For many companies, operations exist While there has been a contraction in the simultaneously across virtually all geographical geographical limits of all-cause malaria trans- settings; therefore it should be anticipated that mission, the gains have been in areas that had a variety of malaria management strategies relatively low underlying levels of malaria would be required. for a endemicity. Endemicity is defined as the brief history of the evolution of malaria distri- probable presence of malaria transmission. In 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).
Key factors to promote success:role of senior management For industry, one of the most important Box 1: The role of senior management
insights in malaria management is simply recognizing that malaria is a key business issue Senior management is in a key position to: that cuts across multiple staff and line functions. Because malaria management articulate corporate objectives; potentially requires a large effort, a prominent translate these objectives into performance leadership role by senior management becomes an essential initial activity (see require development of a system for Box 1). While the development of an effective performance monitoring; MMP is a highly technical undertaking, the articulation of a ‘vision' involving the impor- hold all levels of management accountable for tance of malaria related issues becomes one of the most important first steps.
provide the necessary resources, both financial MMPs are multi-dimensional issues and technical.
affecting numerous stakeholders both inside and outside the company. Malaria impacts, either positive or negative, are potentially visible at the in-country staff level and even at national and international levels. Corporate company and the host country: an effective Social Responsibility (CSR) efforts, along programme can significantly enhance with company reputation, can be impacted by operating efficiency and safety while providing malaria. MMPs offer a significant oppor- a clear positive benefit for the host country at tunity for a ‘win-win' scenario for both the multiple levels.
What are Malaria Management Programmes (MMPs)? Malaria is a disease that involves the interaction manage malaria illustrates that this disease of a parasite, a vector and a host. A vector is demonstrates remarkable resilience in human defined as an organism that carries and transfers a populations despite enormous efforts to eradicate microorganism from one host to another. For it. In order to realistically develop and implement malaria, the host includes both humans and other MMPs, it is necessary to construct a basic scien- MMPs are multi-disciplinary, tific framework that captures the underlying integrated efforts that combine expertise and biology, pathophysiology (how humans respond strategies in human and vector biology, environ- to malaria infection) and epidemiology of mental management, clinical medicine and malaria infection.This fundamental framework is community level interactions to protect people generally built around the principles of primary, from malaria. The long history of efforts to secondary and tertiary prevention.
Malaria Management Programmes—levels of prevention For MMPs, the levels of prevention can be specifically defined (see Figure 2) so that an in tropical and subtropical areas and is the integrated programme can be developed predominant species causing severe and potentially fatal disease; Primary prevention is considered to be Plasmodium vivax—found in Asia, Latin
eradication and is focused on vector
America, and a few areas of Africa. Because control strategies.
of Asian population densities, this is the Secondary prevention is controlling and
most prevalent form of malaria worldwide; reducing risks. Secondary prevention
Plasmodium ovale—found primarily in West
strategies cover the full range of personal Africa and islands of the western Pacific.
protection (including chemoprophylaxis This form of malaria is similar to vivax; and repellants) and behaviour modification and can produce a long-lasting and chronic Tertiary prevention is treatment of
infection with an extremely long duration.
disease in order to prevent impairment
and subsequent disability or death.
Life cycle of malaria
The female Anopheles mosquito is the key
Primary prevention of transmissible
vector for transmitting malaria parasites to vector-borne diseases
humans because they require blood meals as a source of protein for the production of eggs.
Two critical factors are: a source of blood meals; and Malaria is a parasitic disease of microorganisms the feeding and resting behaviour pattern that belong to the genus Plasmodium. While of the mosquito (dusk or dawn versus there are more than 100 species of Plasmodium nocturnal (night time), as well as the that can infect many birds, reptiles and primary location of feeding and post- mammals, there are only four species of feeding resting, i.e. indoors versus Plasmodium that typically infect humans: Figure 2 Defences against malaria
behaviour and attitude personal protection: DEET, treated clothing, insecticide treated bed nets Malaria management programmes—levels of prevention Feeding and resting behaviours have a significant impact on both the overall vector efficiency and the analysis of potential control measures, e.g. insecticide treated bednets (nocturnal, inside biting), indoor residual spraying (indoor resting), or source reduction (outside biting and resting).
The period of time between the infective bite
and clinically experienced symptoms (incubation period) typically ranges from 7–30 days depending on the infective species y between infective bite and symptoms can cause diagnostic problems and place expatriate workers at without continuous immune (infected bite) significant risk since they or their physician stimulation, e.g. when on long-term expatriate might not recognize that a new fever could be assignment to a non-malarial area.
malaria, particularly if they are no longer in a malarial area.
After multiple malaria infections, an For oil and gas operations, the shift from rural individual develops partial protective to urban setting is critical for MMPs. It is quite immunity. This individual does not have full likely that there will be operations in both immunity but rather is described as ‘semi-
urban and rural settings with frequent inter- immune.' Semi-immune individuals can still
action between the two. Major oil and gas be infected by the malaria parasite but are less including offshore platform likely to develop severe disease and generally settings, generally require some level of urban- lack the usual malaria symptoms commonly centred technical and staff support. Therefore, associated with typical clinical disease.
the urban environment is important for the Expatriates, regardless of home country industry since it is probable that large numbers location, are usually considered as ‘non-
of technical staff will transit through locations, immune', since they lack sufficient protective
e.g. airports, that are located in areas impacted by malaria.‘Airport malaria', defined as malaria The development of acquired immunity acquired through the bite of an infected tends to be location specific and usually results mosquito by an individual without exposure from long-term childhood exposure. An adult to the vector in its natural habitat, has been individual from one malaria endemic region frequently reported and is expected to may not be protected in a country that has a increase. A similar transmission problem could different spectrum and intensity of malaria. In even impact offshore platform crews since order to maintain effective levels of acquired ships and helicopters can readily transport the immunity, an adult individual must be mosquito vectors. In addition, continuous constantly exposed to malaria. As an example, work operations also increase the exposure of an employee whose home country is in a individuals to nocturnal vectors. Finally, malarial area and who has been considered human knowledge, attitudes, beliefs and semi-immune will rapidly lose this immunity practices regarding malaria are important.
Malaria management programmes—levels of prevention Urban malaria epidemiology
It is not well known if all of the standard
malaria prevention, management and control strategies can be effectively transferred to urban settings. While there is some evidence that anopheline species are adapting to urban aquatic habitats (e.g. water-filled domestic containers, back yard gardens), there is concern that misdiagnosis and subsequent inappropriate treatment of malaria is occurring.
All fevers cannot be presumptively assumed to be malaria in an urban setting. The typical clinical protocols that are employed in the countryside may not be valid in the city.
Malaria ‘fogging' in Kuala Lumpur, Malaysia
Research has shown that 50–70 per cent of the fevers in an urban setting are not laboratory proven malaria despite an initial clinical (non- laboratory) diagnosis to the contrary.Within an urban context, the cost-effectiveness of standard vector control strategies is also unknown.
Primary prevention: vector control Figure 3: Using vector control to reduce malaria transmission
Box 2: Three strategies for vector control
Vector control in malaria
1. Reduction of human-vector contact by:
‘stopping Anopheles—a moving target' the use of bednets; improvements in housing (screening windows, eaves and doors); • identification repellants for skin and/or clothing; • resistance to 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, and • environmental • personal protection: generally remain within 2 km. Larval control is critical and directed
- clothing - breeding sites - repellents • environmental - resting areas source reduction by environmental management, i.e. drainage, flushing, • community protection filling and altering river and lake margins so that they are unsuitable foranopheline breeding; larviciding using both chemical insecticides and those of biological origin, generally administered in cycles, which may vary between 2 and10 weeks; The general goal of vector control is to reduce biological control using predators such as larvivorous fish.; malaria transmission by: space spraying of insecticides for rapid reduction of vector density: i) decreasing the contact between humans there are significant limitations to this method including difficulty of and the relevant vectors; night time application and poor penetration of fogs into the daytimeresting places of the vectors.
ii) reducing the vector population density; Any larvicidal strategy must also consider potential environmental impacts.
iii) changing vector longevity.
3. Decrease adult vector longevity by:
indoor residual spraying (IRS) for indoor resting mosquitoes; and The three basic strategies that are directed community-wide use of insecticide treated nets (ITNs), particularly for towards different links in the overall trans- mission chain are summarized in Box 2.
Indoor residual spraying (IRS)
sum of the individual protection. ITN community outreach programmes sponsored The main purpose of IRS is to reduce the by a project, while complex, are still likely to survival of malaria vectors entering houses. It is be simpler to support and maintain than a of little use for control of malaria vectors that community-wide IRS effort.
rest outdoors, particularly if they also bite outdoors and do not enter the sprayed structure. Similarly, larval control depends upon extremely high coverage since even a Space spraying is the most rapid method in few temporary breeding sites may be sufficient areas of high population density, however it is to maintain high transmission levels.
an emergency control method and unlikely to be the main vector control strategy due to the Insecticide treated nets (ITNs)
known limitations of this technique and the rapid recovery of the vector population.
As ITN coverage increases, there is an overall A night-time fogging campaign (e.g. between reduction on the vector population; hence the 22:00 and 04:00) will have the greatest impact on effect on the community is greater than the nocturnal indoor feeding and resting mosquitoes.
Secondary and tertiary prevention oftransmissible vector-borne diseases other primary prevention vector control efforts. An example of a malaria programme implementation checklist is included in Secondary prevention involves controlling and reducing individual risks by using the full range ‘A' for awareness and education
of personal protection and behaviour modifi- As part of a secondary prevention programme, cation measures. These measures are divided companies often provide workers who are into a four-level pyramid of prevention often going to travel or reside in potentially malarious known as the ‘A-B-C-D strategy' (Box 3): areas with consistent, standardized educational materials and instructions before travel to malaria risk areas.To be effective, this instruction Box 3: Secondary prevention—the A-B-C-D strategy
typically needs regular reinforcement while working in the malaria risk area.
for awareness and education of the risk of malaria. It requires:
a relationship between patient and physician; ‘B' for bites—personal protection
understanding of prevention strategies; and awareness pre-travel, during travel and post travel.
Bite prevention at the individual level is based for bites—use of personal protection measures. It requires:
on creating a physical and/or chemical barrier an understanding of Anopheles behaviour, i.e. feeding and resting; between the person and the vector. The effec- wearing of proper clothing, e.g. long-sleeved shirts, long pants, tiveness of these measures is shown in Table 1.
use of appropriate repellents, especially at twilight and on neck, use of permethrin on clothes and bed nets; and Table 1 Effectiveness of barriers
preparation of the room for sleeping.
Effectiveness (at typical compliance levels)
for compliance with chemoprophylaxis.
Use of impregnated bed nets Reduces transmission by 68–95% for prompt diagnosis of malaria and securing early treatment.
Permethrin treated clothing Reduces likelihood of infection by 24–97% Permethrin impregnated Reduces bites by up to 99% clothes in combination with In preparation for travel overseas some use of N,N,-diethyl-3- companies have established a ‘malaria visa'
methylbenzamide (DEET) programme.The malaria visa approach requires that an individual perform specific educa- Long sleeve shirts and Reduces likelihood of infection by up to 62% tional, behavioural (for example, spraying clothing with insecticide, obtaining repellents, Reduces likelihood of infection by up to 93% spraying bet nets with insecticide), and chemo- Use of DEET on exposed skin Reduces likelihood of infection by up to 45% prophylaxis (use of a specific medication in order to prevent development of malaria) Vector control measures, If 100% use was feasible, this package of activities before permission is given to enter a including all of the above, measures would virtually eliminate malaria risk plus residual insecticide malarious area on company business. This spraying, space spraying, strategy is potentially quite effective for short- elimination of breeding sites, term assignments and for individuals who are larviciding, biological controland the use of air- transiting known malarious areas. The malaria conditioning, where feasible.
visa strategy can be effectively combined with Secondary and tertiary prevention of transmissible vector-borne diseases is compliance with both the medication AND Table 2: Effectiveness of commercially available repellants
personal protection measures.
Duration of coverage
Drug-based prevention strategies are based on two key concepts: prevention of infection—also known as Picaridin (KBR-3023) 9.3% causal prophylaxis; and Soybean-oil based prevention of illness—known as Citronella based products, Less than 20 minutes These strategies work by killing the parasites as they differentiate and develop in either the liver and/or the red blood cell.
discusses the malaria life cycle The overwhelming medical consensus on and presents the underlying theory for these bite prevention is to strongly recommend: drug-based strategies. As with all drug (1) insecticide (permethrin or deltamethrin) treatment regimes, malaria chemoprophylaxis impregnated mosquito nets; (2) permethrin is a balance between risk and benefit.
treatment of clothing; (3) wearing of long- Medications all have potential adverse effects, sleeved shirts and trousers; and (4) use of individual tolerability issues and cost consider- repellants for exposed skin (e.g. DEET or ations. Many individuals purchase ‘black market medications' that may be cheaper but A variety of skin repellants are commercially are often ‘fakes' containing no active ingredient available. These products vary significantly in or lacking appropriate pharmacological their effectiveness (see Table 2). There are potency. Even if using established brand name marked differences in the duration of activity drugs from reputable suppliers it is critical to for each product. Every product requires understand that no chemoprophylaxis regime reapplication; however, some products are far is 100 per cent efficacious because of: more long-lasting than others. In general, the unpredictable drug absorption; various DEET products are the most effective.
variable therapeutic plasma levels being reached due to individual genetic ‘C' for compliance with
differences in metabolism; and the presence of drug resistant parasites.
Chemoprophylaxis involves taking a specific medication in order to prevent development of malaria. Each medication has its own spectrum of 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 country basis, since resistance profiles are constantly changing for the medications.The most current guidelines for the target country should always be consulted. In addition, appropriate local medical experts can also be consulted.
Regardless of the medication, the key concept PhotoLink/Getty Images Secondary and tertiary prevention of transmissible vector-borne diseases noted above, in some cases this is due to a small percentage of non-compliant individuals who do not take, or do not consistently take, the Compliance drug testing regimes, using urine testing for medication metabolites, have been implemented by some companies in the oil and gas industry as part of an overall Malaria Management Programme. These tests form part of contractual arrangements between employer and employee and where required for non-immune expatriate staff will likely also be required for contract staff; individuals testing negative for metabolites The full range of secondary prevention are first counselled and transferred to a strategies should be considered for all non- ‘frequent test pool'. Should the problem immune individuals.
persist, the individual will be investigated individuals, the situation is more complex.
further to determine the cause of the Chemoprophylaxis is often considered for: problem and if necessary may be transferred infants under three years of age; to a non-malarial area.
semi-immune pregnant women; semi-immune people who have left their ‘D' for prompt diagnosis and early
endemic malaria area for more than 6–12 months, becoming non-immune, and Malaria is a true medical emergency that returning to an endemic malaria area; and requires rapid diagnosis and treatment, as other vulnerable groups (e.g. people with infected individuals can rapidly deteriorate over a 24-hour period. Ninety per cent of cases of all malaria are associated with: It cannot be assumed that someone from a inappropriate chemoprophylaxis, e.g. the malaria endemic country is semi-immune since wrong drug and/or dosage; or partial immunity can only be acquired by signif- icant and continuous exposure to the same malaria species from childhood onwards.
Therefore, individuals transferring between different malarious areas may need additional medical consideration. Chemoprophylaxis alone does not provide absolute protection; therefore, providing the full range of secondary prevention strategies is an important consideration.
Finally, with regard to compliance, it is important to note that the provision of antimalarials to employees in the field does not obviate the risk of contracting malaria. While in some cases this is due to poor absorption and/or variable therapeutic plasma levels, as Secondary and tertiary prevention of transmissible vector-borne diseases do not indicate malaria, travellers are encouraged to take Coartem® as a precaution.
Coartem® is now included in the World Health Organization (WHO) Model List of Essential Medicines, and is being distributed through the WHO as part of the worldwide Roll Back Malaria initiative.
Some oil and gas companies have developed RDT and SBT kits as part of their MMP efforts. These kits represent tertiary prevention and are not a substitute for developing a In two-thirds of tropical travellers who die comprehensive MMP that includes appro- of malaria, either treatment is delayed or the priate primary and secondary prevention. The diagnosis is simply missed. In most cases the essential features of comprehensive MMPs individuals concerned never took chemopro- involve systematic evaluation and institution of phylaxis in the first place, so a common primary and secondary prevention strategies so recommendation is to assume that every that an adequate and defensible wall of traveller with fever or unexplained flu-like prevention is constructed and maintained.
illness has life threatening malaria. This recommendation will obviously produce ‘false-positives' and subsequent over-diagnosis of malaria; however, the medical rationale is that ‘false-negatives' are potentially at substantial risk for a fatal outcome due to missed diagnosis. This overriding concern related to delay in diagnosis has led to the rapid diagnostic tests (RDTs); and stand-by emergency treatment (SBT) kits.
When the test kit is well maintained, some RDT products can achieve a sensitivity (the ability to detect a ‘positive') for P. falciparum similar to that obtained by microscopy. RDTs can be damaged by exposure to high temper- ature extremes (heat or cold). If transport and storage within conditions specified by the manufacturer are not met, the sensitivity of the RDTs may be impaired and shelf life reduced.
Coartem® (artemether/lumefantrine), is a new, life-saving malaria treatment that is included in most SBT kits. Even where RDTs Benefits of an MMP A well-executed MMP can prevent morbidity workforce (including semi-immune nationals), and mortality in the workforce. MMPs send an surrounding communities and other national important and positive message to the entire and international stakeholders.
Box 4: Benefits of a Malaria Management Programme
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 When to develop and implement an MMP If a company is considering business opportu- secondary and tertiary prevention practices nities in malarious settings then, it is critical to and procedures for any work in malarious consider development of an appropriate MMP areas, e.g. malaria visa process. In addition to for all phases of the business activity.
their own workforces, these standard practices Programme development and complexity and procedures may cover a variety of should reflect an accurate understanding of contractors and suppliers.
malaria risks for company personnel and even integrated approach, using primary, secondary surrounding communities. Many companies and tertiary prevention, is likely to have the may wish to develop a standardized set of greatest chance of success.
Integrating an MMP with other impactassessment and outreach programmes Malaria is a multi-dimensional disease; vector-related diseases like malaria as part of therefore, a complex skill set is essential for the impact assessment process. Integration with programme development and management.
company HSE management and health risk Construction of each level of the wall of assessment processes is also important. Malaria- prevention requires a diverse team of related issues could be a significant area of specialized professionals. If a proposed business activity for both social and environmental activity is in a malarious area, then the accurate assessments. Because of both the importance and detailed assessment of malaria risk is and complexity of MMP issues, many indicated. Experience indicates that environ- companies in the oil and gas industry have mental scientists, developed stand-alone multi-disciplinary professionals, vector biologists, education integrated teams of specialists for programme trainers and community development development and implementation. Often the specialists may be necessary. Malaria risks and ‘lessons learned' from MMPs in large projects, impacts should also be considered in carrying e.g. oil field development and pipelines, are out health, social and environmental impact directly transferable to both other key business assessments.The OGP/IPIECA Guide to Health partners and internally to other locations of a Impact Assessments in the oil and gas industry companies' worldwide business activity.
specifically discusses the need to consider National and international stakeholder consultation Malaria-related issues have a large and well- carefully consider the multi-level social and organized set of international stakeholders.
community ramifications of any compre- These stakeholders include, NGOs, academic hensive malaria management programme.
institutions, multi-lateral development and finding agencies and institutions purely created for malaria prevention, management and control. In addition, some level of local, provincial and national malaria control efforts will be encountered at the host country level.
In many situations, co-ordination and commu- nication with all of these international and national stakeholders is a daunting task.
Nevertheless, because of the potential for significant benefit or inadvertent adverse impacts, e.g. duplication of efforts, unmet and unanticipated community level expectations that could be produced, it is important to National and international stakeholder consultation It has become apparent that significant is increasingly asked to address problems that advances in the medical and environmental traditionally are ‘outside the fence line' and control areas have not necessarily translated historically considered responsibilities of the into success at the individual, community and host government. In a given project setting, health systems levels. There is a significant gap comprehensive secondary and tertiary between intervention efficacy and effectiveness prevention strategies may be adequate for the at the community level in a developing project; however, it is quite likely that other country setting. Increasingly, the oil and gas international and national stakeholders will industry faces the need to understand request a more active outreach role in all levels community level health, social and environ- of prevention management and control, partic- mental concerns in order to receive and ularly in vector control efforts. In order to maintain a ‘license to operate.' MMP is a realistically understand these expectations, particularly difficult set of issues because the careful, close and early consultation during biology of the disease is not easily confined project formation and development stages within the boundaries of a proposed project with key national and international stake- and invariably, in a large project, overlaps into holders is advisable.
adjacent communities.The oil and gas industry Putting it all together: the MMP process There is no single MMP process that will neces- process and is illustrated in Figure 4. The sarily be appropriate in all the diverse situations process is modelled after the general framework confronting the oil and gas industry. However, used in the suite of environmental, social and there are a series of systematic steps that can be health impact assessments (see Box 5).
used in order to determine what type of MMP is appropriate in a particular situation. Many companies in the oil and gas industry already Box 5: Framework for social and health impact assessments
have a general approach for developing MMPs.
Similarly, many international agencies and Screening—determine if a proposed business activity is going to take
place within a potentially malarious environment
national governments have published detailed Scoping—outline the range and types of malaria problems that could be
guidelines covering malaria diagnosis and treatment at both an individual and community Planning including resourcing, cost and time management—consider
level. Because both diagnostic testing and the types of resources, activities costs and level of effort that may be available medications and treatment protocols are constantly evolving, the most currently Stakeholder consultation—co-ordinate, communicate and exchange
information at the local, provincial, national and international level
available guidelines should always be consulted.
Risk assessment—investigate, appraise and qualitatively or quantitatively
While the science of malaria is constantly rank the impacts positive or negative that could be produced changing, an overall management framework is reasonably well established and can be used in Mitigation strategy—develop a written mitigation action plan
almost all situations confronting the oil and gas industry.This structure consists of a sequence of Implementation and monitoring—define roles and responsibilities
common elements that frames the MMP Figure 4: The MMP process
project conception design and engineering identification of stakeholder communication and consultation Putting it all together: the MMP process nationals, and community residents. If primary prevention vector control The geographical settings where malaria trans- strategies are deemed critical, then a mission exists are reasonably well known.
general series of sequential questions Therefore, if a business activity is likely to should be considered.The overall process either be centred in or transit through a for this effort is shown in Figure 5.
malarious area then, malaria should be considered as a potential health concern. A The output of the scoping exercise can also description of the proposed business activity be used as a basis for formally developing a set covering location, size, workforce, surrounding of terms of reference (TOR). Either internal or communities, and operations is essential. This external consultants, or a combination of both, initial review will help determine the need and can use the TOR.
level of MMP that may be required. Not all business activities require comprehensive MMPs. In many situations, companies have developed a ‘malaria visa' programme that is based on secondary and tertiary prevention Figure 5: Decision-making process (Najera, 2002)
strategies incorporated into the ‘A-B-C-D' programme discussed in earlier sections of this Stratify area according to the disease burden and Guide. Based on the initial screening, implemen- epidemiology of transmission tation of a malaria visa programme may be sufficient for the workforce. However, it is important to understand that this programme is internally workforce focused and not fully trans- Determine whether there is a role for vector control in each epidemiological stratum and in ferable to the large number of semi-immune current local circumstances individuals who may be living in communities adjacent to the proposed business activity.
If there is a role for vector control determine vector(s) in each stratum Scoping is generally a process for outlining the range and types of hazards and potential For each vector implicated determine: beneficial impacts. The overall types and • breeding sites categories of questions that must be addressed • adult resting sites• blood feeding behaviour are defined at this stage. At the scoping stage the overall types of questions include: • history of insecticide resistance defining the type and endemicity level of malaria, e.g. dominant Plasmodium parasite, and whether it is stable or unstable; Determine which method(s) of considering whether different strategies vector control is (are) suitable will be required depending upon the phase of the project, i.e. construction, operation, Where the use of insecticides is essential, defining the at-risk population including select the method and timing of application construction workers, contractors, Putting it all together: the MMP process Planning including resourcing, cost and
time management

After the general scope has been determined, the planning process can begin. It is critical to identify at the outset the types of resources that may be required. Resourcing issues require careful consideration since multi-level, integrated MMPs draw expertise across many disciplines. While many oil and gas companies have large and sophisticated medical, environ- mental and safety departments, it is quite likely ofsky/Getty Images that some level of outside specialty expertise will still need to be considered, particularly related to the implementation of primary vector control strategies. For large projects, even secondary prevention strategies require cally identified and defined since it is quite significant levels of active on-site clinical likely that there will be multiple levels of medical support for accurate diagnosis and groups and organizations that will be both treatment. If the proposed business activity does interested, active and operating within the not require an on-site medical function, it may overall sphere of the business activity. Malaria is still be advisable to identify appropriate local a disease that has attracted worldwide attention resources, including medical practitioners and in virtually all areas where transmission is hospitals with appropriate malaria expertise and found. Therefore, it is highly likely that any proposed project in a known malarious area Implementing an MMP is potentially an will already be subject to some level of NGO, expensive undertaking and may require a national or international intervention control significant level of staffing. The level of staffing effort. Given this reality, the opportunity for is a function of the goals that the programme miscommunication and duplication of effort is wishes to achieve and the underlying level of significant. Therefore, a malaria stakeholder malaria transmission. Many programmes have communication programme is often considered overall global objectives that include achieving as early as possible in the overall business devel- a zero fatality rate while minimizing the risk of opment cycle. This effort should be carefully contracting malaria to the lowest practicable planned and coordinated in a fashion that is level. Potentially, these goals can be achieved consistent with and responsive to overall but an intense, integrated and sustained effort using a variety of primary, secondary and tertiary strategies is likely to be needed.
Risk assessment is the process that investigates, appraises and qualitatively or quantitatively Stakeholder communication and consultation ranks the impacts, positive or negative, that is a process of mutual dialogue and information could be produced by a given activity. Many oil exchange between the project and the key and gas companies have internal risk assessment stakeholders. Stakeholders should be systemati- procedures and protocols covering health, Putting it all together: the MMP process is indicated. As previously discussed, the profile of malaria in urban and peri-urban settings is quite different than the intensity usually seen in a rural environment. If new data is deemed necessary, then a series of carefully defined study questions should be developed. These study questions are likely to cover vector species, habitat, and density in addition to objective burden of disease.
The ranking of potential impacts can be considered from an individual environmental, medical and sociological perspective or as an integrated exercise. Since malaria is a disease that operates at many levels, it may be more environmental, social and safety aspects of a efficient and meaningful to develop an proposed new business project.These processes integrated impacts ranking that considers not can be applied to MMP efforts. In a given only health but also social and environmental geographical location, it is important to under- effects. The degree of detail and sophistication stand the specific biology, pathophysiology, and of the ranking exercise is project specific. The epidemiology of malaria that may be encoun- literature on community level impacts of tered. The level of malaria risk will vary malaria is vast and varies significantly across substantially both by geographical location and different global locations. Impacts and effects complexity of proposed project. An oil field observed in sub-Saharan Africa should not be development and pipeline is likely to require assumed to be fully relevant for Asia or South substantially more investigation and America. For a large project, that is expected to programme development than opening a small last for many years, risk assessments frequently marketing office or retail store. The risk consider both the workforce and the assessment process can capture these differences and provide an appropriate way to rank impacts so that they can be address in a priority fashion.
Two important considerations in the risk assessment process are the evaluation of existing Decision making establishes priorities and data and determination of the need for new begins the process of developing and dedicating baseline information. Existing sources of infor- appropriate resources. For episodic or small- mation must be carefully reviewed for accuracy, scale business activities the implementation of relevance and completeness. All fevers are existing standard practices may be entirely actually not malaria even though in rural sufficient, e.g. a malaria visa programme. For malarious areas fever is ‘presumptively assumed' large, long-term projects, many companies have to be malaria and treated accordingly. Many established dedicated multi-disciplinary malaria studies have documented that malaria is management teams in order to simultaneously frequently misdiagnosed. If there is a concern manage both internal and external malaria that the project will impact the existing trans- issues. Senior management support, both at the mission pattern and burden of malaria, then project and corporate level, is essential since careful consideration should be given to sustainable MMP programmes are neither determine whether a new data collection effort simple nor inexpensive.
Putting it all together: the MMP process management capacity is critical. Building the environmental, medical and social capacity and The written MMP is the mitigation plan. This sustainability required for an integrated plan specifies how high and how thick the ‘wall approach to malaria are neither simple nor of prevention' is constructed. The MMP is not cheap. Many malaria programmes initially a static exercise but a ‘living document' that will succeed only to fail at a later date, as primary evolve and change over time. The programme prevention vector control strategies are not is likely to be a combination of both internal properly maintained. Long-term planning and workforce and external community needs.
commitment is essential since sustainable Many of the most important concerns and capacity development is a long and slow controversies surround the key vector control process. The role of contractors becomes quite strategies of insecticide application, IRS, space important since much of the day–to-day spraying, ITNs, and larviciding. Finally, activity is performed by rotating contractors, emergency response and planning should also particularly during the construction phase of a be performed since there is no 100 per cent project. Contractor roles and responsibilities effective MMP programme and, in some situa- can be assigned and specified during the initial tions, immediate treatment and or evacuation scope of work contract process.
may be indicated.
Ongoing staffing levels will also require attention and consideration since MMP is not a Implementation and monitoring
static process. It should be reasonably antici- pated that unexpected swings in weather and For comprehensive MMPs, one of the most human migration patterns and activities will critical aspects of the implementation plan is occur. Both of these events can have profound the division of responsibilities and timescales impacts on malaria transmission within the between the project and the host government workforce and external communities.
at local, regional and national levels. Roles and Development of a monitoring system for responsibilities should be defined and clearly the overall MMP effort is a critical component.
understood, particularly if the MMP efforts are A monitoring system is designed to document going to extend outside the project bound- how the programme is affecting malaria trans- aries. Therefore, an analysis of local, regional mission. A variety of indicators can be and national malaria infrastructure and developed for this purpose. Similarly, standard medical outcome indicators can de developed covering diagnosis and treatment, suspected, probable, confirmed and fatal malaria cases.These medical data are important because it provides an early detection system for changes, negative or positive, in malaria trans- mission. A sample malaria case investigation tesy of ExxonMobil Left: satellite imagery can be used to predict the distribution
of the main vectors of malaria—landscape epidemiology is
a critical feature that can be used for the development of

Putting it all together: the MMP process Finally, early detection is not the same thing Audits should be considered at regular as early warning. Malaria Early Warning intervals because large projects are constantly Systems (MEWS) require a different level of changing, for example: monitoring, planning and development and are new company activities (e.g. work near usually considered to be a national government swamps, jungles, etc.); project. However, because of the high levels of new projects in potentially exposed technological expertise, particularly regarding geographic locations; RS/GIS techniques, that are resident in many modifications in work schedule (e.g.
oil and gas companies, collaboration or technology transfer may be entirely appropriate changing contractual requirements; new scientific discoveries (e.g. medications, international and government advisory recommendations concerning malaria Evaluation and verification of performance resistance to medication.
and effectiveness is one of the most important steps in an MMP programme. A system for An example of an audit form is included in determining that implementation has been accomplished and is achieving the desired results should be considered. Within the implementation and monitoring plan a system of outcome indicators is typically specified.
Auditing against these indicators can be readily performed. Contractor performance should also be verified and assessed for effec- tiveness and compliance. If the MMP is actively cooperating with host country programmes, these efforts should also be independently assessed against previously established outcome indicators.
A variety of audit systems for health programmes have been developed. General audits often cover: medical records and reports; facility inspections for vector control knowledge, attitude and practices (KAP) training records—topics, attendances and health care programme reviews and audits; emergency drills; and A simple way to remember the key steps A mosquito bite that introduces malaria needed to protect people from malaria: parasites into the bitten host Awareness - Bite prevention - International Petroleum Industry Chemoprophylaxis - Diagnosis Environmental Conservation Association Category (i.e. genus) of mosquito—some Indoor Residual Spraying—treatment of female species of Anopheles are capable houses where people spend night-time of transmitting malaria to humans and hours, by spraying insecticides that have a residual efficacy, i.e. they continue to Size of a health problem in an area, affect mosquitoes for several months measured by cost, mortality, morbidity, orother indicators Insecticide Treated bed Nets A method of attempting to prevent A parasitic disease that kills two million malaria by taking various drugs prior to, people per year around the world during, and after exposure to malaria Brand name of atavaquine-proguanil, a A new, life-saving malaria treatment drug used to prevent and treat malaria A drug used to prevent malaria that goes An insecticide (N,N,-diethyl-3- under the brand name of Lariam methylbenzamide) for use on exposed Malaria Early Warning System—a system skin to repel mosquitoes for predicting malaria epidemics based on A physical or mental impairment that substantially limits one or more major life Malaria Management Programme Proportion of the population who have a Exploration and Production particular disease Describes a disease that is localized to a Proportion of a population who have particular geographical region died from a particular disease The probable presence of malaria An expert on insects, such as Anopheles Term describing Anopheles mosquitoes that are active at night A sudden increase in the frequency of A person with no immunity to malaria malaria that significantly exceeds the International Association of Oil and Gas seasonal variation normally observed in a A microorganism, such as Plasmodium, The study of the incidence, distribution, that lives, grows and feeds in a different and control of disease in a population organism while contributing nothing to The human or animal in which the the survival of its host malaria parasite lives outside of the Parasites (including those causing malaria), bacteria, viruses or fungi that Protection generated by the body's can cause disease immune system in response to previous The functional changes in humans malaria attacks resulting in ability to resulting from infection by malaria control or lessen a malaria attack Incubation period The interval of time between infection Situation whereby malaria is spread by a malaria parasite and the onset of the throughout the year first symptoms of the illness. Incubationperiods for malaria can range from 7 to The area immediately surrounding an 40 days depending on the species urban or city area An insecticide effective in treating clothes Stand-By emergency Treatment kits: to repel and kill mosquitoes these kits typically consist of two parts:(1) a Rapid Diagnosis Test; and The category (i.e. genus) of the parasite (2) malaria treatment medication such as that causes malaria.The genus includes Coartem; these kits enable personnel to four species that infect humans: self-test for malaria and take medication Plasmodium falciparum, Plasmodium vivax, to cure the disease.
Plasmodium ovale and Plasmodium malariae.
P. falciparum is the fatal form. P. vivax and The widespread spraying of insecticide P. falciparum are the species most (often called fogging) from vehicles or commonly encountered by the oil and aircraft to kill mosquitoes gas industry.
Sub-Saharan Africa Prophylactic drugs Medication taken to prevent malaria Terms of Reference Rapid Diagnostic Tests—these tests for An organism (e.g. female Anopheles malaria are often included in stand-by mosquito) that transmits an infectious emergency treatment kits to enable agent (e.g. malaria parasites) from one subjects to self-test for the presence of host to another (e.g. humans) malaria in their own blood.
Diseases (e.g. malaria) that are The product of the chance that a specific transmitted from one host to another undesired event will occur and the (e.g. humans) via an organism known as a severity of the consequences of the event: vector (e.g. female Anopheles mosquito) Risk = (Probability) x (Consequence) Process of eliminating mosquitoes thatcan transmit malaria Remote Sensing/GeographicalInformation System World Health Organization List of Appendices A ‘Guide to Malaria Management Programmes'on CD-ROM This document is also included on the attached CD-ROM in PDF format†.The file includes links to the associated Appendices which are also included on the CD-ROM. The links are represented in this printed version by the blue underlined text.
† Requires Acrobat Reader™ — available from the Adobe w * Web browser and Internet connection required A Guide to
Al rights reserved. No unauthorized copies of this CD-ROM may be made without prior agreement with IPIECA/OGP Malaria Management Programmes
in the oil and gas industry
This CD-ROM is designed to runautomatically. If it fails to start,browse to the file called ‘Malaria'and double-click to begin. (RequiresAdobe Acrobat Reader v.4 or later) This CD-ROM contains the joint OGP/IPIECA publication A Guide to Malaria Management Programmes in PDF format.
The PDF version includes links to related information included on this CD-ROM.
The OGP/IPIECA Membership
Company members
Anadarko Petroleum Corporation
BG Group
BHP Billiton
Cairn Energy
Dolphin Energy
Denerco Oil
Hunt Oil Company
Japan Oil, Gas & Metals National
Kuwait Oil Company
Kuwait Petroleum Corporation
International Association of Oil & Gas Producers (OGP)
Mærsk Olie og GasMarathon Oil OGP represents the upstream oil and gas industry before international organizations including the International Maritime Organization, the United Nations Environment Programme (UNEP) Regional Seas Conventions and other groups under the UN umbrella. At the regional level, OGP is the industry representative to the European PetroCanada Petrobras Commission and Parliament and the OSPAR Commission for the North East Atlantic.
Equally important is OGP's role in promulgating best practices, particularly in the areas of health, safety, the environment and social responsibility.
PDOPetronasPetrotrin Premier Oil International Petroleum Industry Environmental Conservation Association (IPIECA)
PTT EP Qatar Petroleum The International Petroleum Industry Environmental Conservation Association (IPIECA) is comprised of oil and gas companies and associations from around the world. Founded Repsol YPFSaudi Aramco in 1974 following the establishment of the United Nations Environment Programme (UNEP), IPIECA provides one of the industry's principal channels of communication with the United Nations. IPIECA is the single global association representing both the upstream and downstream oil and gas industry on key global environmental and social issues including: oil spill preparedness and response; global climate change; health; fuel quality; biodiversity; social responsibility and sustainability reporting.
Association and Associate members
Australian Institute of Petroleum
American Petroleum Institute
Baker Hughes
Canadian Association of Petroleum Producers
Canadian Petroleum Products Institute
Energy Institute
European Petroleum Industry Association
Institut Français du Pétrole
South African Petroleum Industry Association
World Petroleum Congress

  • Contents of this Guide:
  • The Appendices
  • 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
  • Pocket Guide to MMPs
  • Source:

    This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Proteomics reveals multiple routes to the osteogenic phenotype in mesenchymal stem cells BMC Genomics 2007, 8:380 Kristin P Bennett () Charles Bergeron Scott L Vandenberg ()

    Securing the pharmaceutical supply chain

    Track and Trace in the Pharmaceutical Supply Chain Edmund W. Schuster Visiting Operations Researcher Associate Director Massachusetts Institute of Technology husetts institute of technology, 400 technology sq, building ne46, 6th floor, cambridge, ma 02139-4307, usa Abstract The complexity of the United States health care system is increasing rapidly. Demographic changes, along with a host of new drugs, are causing greater volumes of raw materials and finished products to move through the pharmaceutical supply chain. Because drugs are expensive, there is always the possibility of counterfeit. Several recent cases of counterfeit medicines have raised American awareness of the problem. Information is an effective tool to combat counterfeit, however, new supply chain structures and relationships will need to emerge to organize and exchange information