Low frequency of complications in imported falciparum malaria: A review of222 cases in south-eastern Norway

We performed a retrospective study of 222 cases of falciparum malaria diagn osed in Oslo and Akerhus counties, Norway, from January 1988 to December 19 97, Except for 12 cases, all had acquired the disease in sub-Saharan Africa . Sixty-four (28.8%) cases occurred in assumed non-immune individuals; of t hese, 41 (64.1%) were compliant to recommended antimalarial chemoprophylaxi s, The mean time lag from first symptom to diagnosis (total diagnosis delay ) was 4.6 d (median 3 d, range 0-30 d) and the mean time from presentation to diagnosis (doctor's delay) was 1.3 d (median 0 d, range 0-25 d), There m ere no fatal cases, and only 8 (3.6%) had a complicated course. The followi ng factors were significantly associated with development of complicated di sease: higher age, non-immunity combined with chemoprophylaxis non-complian ce, prolonged doctor's delay and prolonged total diagnosis delay (p less th an or equal to 0.05), Our data suggest that complicated disease in imported falciparum malaria may largely be prevented by high chemoprophylaxis compl iance rates in non-immune travellers and a high index of suspicion in physi cians evaluating febrile travellers.