Epidemiological experience in the mission of the United Nations Transition Assistance Group (UNTAG) in Namibia

Epidemiological data have rarely been generated during United Nations (UN) missions to Third World countries, even in situations where there is hardly any combat involvement. Continuous surveillance was therefore carried out during the 12-month stay of UN personnel in Namibia in 1989-90. In this population of 7114 persons, mostly young men, the mortality rate was 255 per 100,000; death was mainly due to traffic accidents. Hospitalization was chiefly because of fever of unknown origin or trauma. Repatriation to the country of origin was necessary in 46 patients, frequently for psychiatric reasons including alcoholism. Over this one-year period there were, on average, 2.7 new consultations per person for treatment (mostly for dental problems), and 0.8 per person for prophylactic measures. The extremely high mortality due to traffic accidents indicates a need for prevention. In the selection process for future missions, more emphasis should be given to the psychological and dental health of volunteers. All military contingents and civilian groups should learn about effective preventive measures prior to their arrival, and adhere to them

Malaria chemoprophylaxis among European tourists in tropical Africa : use; adverse reactions; and efficacy

In order to determine knowledge, attitudes and practices towards malaria prophylaxis, as well as its side-effects and efficacy, a self-administered questionnaire was distributed to European travellers on return flights from tropical Africa to Europe. Between 1985 and 1988 the questionnaire was completed by 44,472 passengers (80.1% of those on board) on 242 flights. A follow-up questionnaire was completed by 42,202 (94.9%) of the same travellers 3 months later. Almost all knew about the risk of malaria, but 10% relied solely on advice from nonmedical sources. While 55.6% had taken at least one measure against mosquito bites, only 4.5% adopted three such measures (used repellents and insecticides and wore long clothing after dusk). Compliance with chemoprophylaxis use was reported by 57.0% of travellers who spent less than 3 months in Africa, compared with 29.2% who stayed 3-12 months. Depending on the antimalaria regimen taken, 11-44% of the travellers experienced adverse effects, while four deaths were attributed to the chemoprophylaxis. The incidence of malaria per month of exposure for travellers who took no chemoprophylaxis was 15.2 per 1000 in East Africa and 24.2 per 1000 in West Africa. In East Africa, the prophylactic efficacy of the currently recommended antimalaria regimens (relative to that of no chemoprophylaxis) was zero for a chloroquine dosage of 300 mg base per week (4 malaria fatalities), 64.1% for a chloroquine dosage of 600 mg base per week (P = 0.03), and 94.0% for mefloquine (P = 0.003)