BMJ dit on Malaria in Afghanistan


Book Reviewer
Got a link to a dit on the current BMJ ( but my Athens account is down)



Many troops in Afghanistan have inadequate malaria prophylaxis

Malaria is common at certain times of the year in all low lying areas of Afghanistan. But protection measures for soldiers serving there are chaotic and often inconsistent with the available evidence, according to a survey. Representatives from 28 of the 36 nations contributing troops described 27 different combinations of drugs and other measures to prevent malaria. France and the Republic of Ireland were the only two nations with identical protocols (prophylaxis with chloroquine and proguanil). Mefloquine was the most common prophylactic agent (15 nations, 54%). Only five nations recommended evidence based prophylaxis with either atovaquone-proguanil or doxycycline. Six still recommended chloroquine, despite resistance in local Plasmodium falciparum.

Almost half the respondents (13, 46%) said their troops wore uniforms treated with insecticide, and 11 (39%) issued treated bed nets, which are also likely to work. But troops from four nations used only mosquito coils or electronic buzzers, which aren't.
As I can't access the full dit - grateful for a qual drain sniffer view of this piece ?


Don Cabra - safe and sound in the sunny South
I've not read the BMJ article however the summary posted above does not surprise me. On Telic 1 there was zero pre-deployment education on avoiding arthropod spread infection and I suspect many people (even within my field hospital) did not bother to take anti-malarial prophylaxis. The emphasis was all wrong anyway, i.e. an order to start taking it but no orders to help prevent getting bitten in the first place which should always be the first line of defence (e.g. long sleeves after dusk etc). Some years ago I saw two people die from malaria acquired in Afghanistan and it was not a pretty sight. One might have thought given the recent (on-going??) legal actions by members of the Parachute Regt after they acquired malaria on ops in Sierra Leone that UK Forces would be more compliant than most in preventing this infection. There again one might have thought that given the outbreak of norovirus at 34 Field Hospital in Afghanistan in 2004 that infection prevention in field hospitals on Telic 1 might have been better than the shambles it was.


Book Reviewer
Pangur_Ban said:
What part of the article are you particularly interested in?
Er...the bit that says which of the 36 nations represented in AFG are using best practice and which are not!

Bottom line: are we doing the best we can for our people ?

Not sure what the strains are out there and not qual'd to comment but would be interested to see what the article had to say ( or does it go into micropatholigical Porton style detail ? If so, might be quicker to get my Athens account sorted out!)


Don Cabra
Iraq and Afghanistan are considered very low risk for Malaria, Iraq used to be high because of the marshes but thanks to Saddam, that no longer exists!

As for Afghanistan, believe me, non-existent.

Now as for Sierra Leone 8O


A number of US cases reported here a few years ago in Afghanistan

In 2002 the World Health Organisation estimated there were three million cases of malaria in the country. In the 1970s before the war the annual figure was between 40,000 and 80,000.
Only one percent of cases were caused by Plasmodium falciparum before the war. By 1996 this had risen to 20 percent because the parasite had developed resistance to the drug chloroquine.
Many people live in mountain valleys and cannot be reached for months during the winter while strong Islamic beliefs make it hard to reach women.

Full Reference

So slightly more than non-existent


Book Reviewer
Thanks Doc Pee.

Blood donors should note.

( I imagine that it's one of those awkward buggesr to give theatre-wide advice on - 'cos if you're in somewhere oop north like Kunduz at the top of glacier then no threat but down next to the river watch your six and seasonal ?)

I'll take a look at the library copy of the article and see what's what....VMTs all.

Lee Shaver

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