Doc. n.

STD-COR-HSE-012-E
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CORPORATE STANDARD

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CORPORATE STANDARD







MALARIA CONTROL PROGRAM




STD-COR-HSE-012-E










19/03/2004


02


Issued for update



MED

C. Chessa
ORGA

F. Mika
MED

S. De Sanctis
QHSE
Date Revision Description of Revision Prepared Checked Approved

This document is property of Saipem, who will safeguard its rights according to the civil and penal provisions of the Law.

Doc. n. STD-COR-HSE-012-E
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Summary of Revisions



Code


Date


Revision

Description of Revision Prepared Checked Approved

HSE-012-E

27/08/2003

01


Issued for approval



MED

C. Chessa
ORGA

F. Mika
MED

S. De Sanctis
QHSE

HSE-012-E


19/03/2004


02


Issued for update



MED

C. Chessa
ORGA

F. Mika
MED

S. De Sanctis
QHSE

Doc. n. STD-COR-HSE-012-E
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INDEX

1 SCOPE AND PURPOSE 4
2 REFERENCE DOCUMENTS 4
3 DEFINITIONS 4
4 RESPONSIBILITIES 5
4.1 CORPORATE RESPONSIBILITIES 5
4.2 OPERATING COMPANIES RESPONSIBILITIES 5
5. STANDARD 6
5.1 MALARIA INFORMATION AND AWARENESS COURSE 6
5.2 PRIMARY PROPHYLAXIS 6
5.2.1 Mans Role in Malaria Control 6
5.2.2 Vector Control 7
5.2.3 CHEMO PROPHYLAXIS 7
5.2.3.1 Compulsory Chemo Prophylaxis 8
5.3 EARLY DIAGNOSIS AND PROMPT TREATMENT 9
5.3.1 Site Medical Facilities 9
5.3.2 Referrals 9
5.3.3 Severe / Complicated Cases of Malaria 9
5.3.3.1 Central Nervous System Involvement in P. Falciparum Malaria 9
5.3.3.2 Neurological Signs in Cerebral Malaria 9
5.3.3.3 Management of Cerebral Malaria 9
5.3.3.4 Treatment of Severe P. Falciparum Malaria 9
5.4 MALARIA CASE REPORTING 9
6 ATTACHMENTS 9


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1 SCOPE AND PURPOSE

The scope of this Standard is to provide Corporate guidelines and information to Management of Operating
Companies for developing site-specific Malaria control program in order to:

minimize the risk of Malaria contamination to the lowest reasonably possible level for all employees
working or accommodated on site;
achieve a zero fatality rate among employees.


2 REFERENCE DOCUMENTS

Corporate Policy "Health Safety and Environment (Doc. no. POL-COR-HSE-001-E)
Corporate Standard Health Plan (Doc. no. STD-COR-HSE 005-E)
Management of the Health of Foreign and Expatriate Personnel" (Doc. no. WI-SPA-HSE-004-E)
WHO Expert Committee on Malaria (Twentieth Report)
WHO International Travel and Health Recommendations


3 DEFINITIONS

Chemo Prophilaxis Regular intake of a specific drug regimen aimed to prevent the onset of illness
even after exposure to the causative factor.

Malaria Disease, distributed mainly in tropical areas of Africa, Asia, and Latin America
caused by a parasite of the genus Plasmodium and is transmitted through a
bite of an obligatory vector, a mosquito (Anopheles).

Non-immune Individual Employees who do not live in Malaria endemic arias and witch did not
developed partial immunity against the disease.

Primary Prophylaxis Rules to follow and measures to be taken, collectively or by individuals, to
defend against infectious diseases.

Semi-immune Individual Person who has acquired partial immunity against a disease (Malaria) due to
their longevity of exposure to the disease.

Vector Control Specific measures in order to reduce or eliminate the presence of vectors
(mosquitoes), and consequently prevent bites.

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4 RESPONSIBILITIES

Malaria is a parasitic disease, caused by one among four Plasmodium genus parasites to which the humans
are susceptible. It is transmitted by a bite of infected mosquito (Genus Anopheles). It is a main cause of
death among the population is Sub-Saharan Africa. Within the Oil and Gas industry it is the second cause of
death among the work force related to the diseases, coming immediately after cardio-vascular incidents, and
third or fourth as overall cause of death where the road traffic accidents lead.

4.1 CORPORATE RESPONSIBILITIES

Saipem Corporate Medical Department is responsible for:

assuring that a Non-immune Individual going to visit or work in a Malaria endemic area is dully informed
about the potential risks and methods of prevention prior to his departure;
supplying of medicines, diagnostic equipment and devices not available locally;
assuring a 24/7/365 on-the-phone counselling regarding Malaria prophylaxis and treatment.

It is the responsibility of Saipem Management to ensure that all the proper means are implemented to
prevent the disease among the work force, both non- and Semi-immune Individuals, by assuring that:

all the employees are properly informed about the risks and possible consequences of the disease, as
well as about the preventive measures to be applied;
all the means of prevention are available and applied as reasonable as possible;
adequate diagnosis facilities are available on sites;
adequate and immediate treatment is available to each individual on site;
counselling is made available for Saipems employees at all times even during the individuals leave
period;
Subcontractors are informed about the Malaria prophylaxis requirements.

4.2 OPERATING COMPANIES RESPONSIBILITIES

Saipem Medical Department in Operating Companies is responsible for:

the development and implementation of the Malaria Prevention Program;
the organisation and carrying out of information and training courses regarding Malaria;
the hygiene surveillance, outdoor and indoor disinfections;
the adequate quantities of Malaria prevention and treatment drugs are readily available on site;
the immediate application of adequate treatment on site;
the implementation and availability of quick diagnosis procedures on sites;
the availability of written information to the employees family doctor and the hand-over of such
information to all non-immune employees.

Saipem Site Managers responsibility is to assure that all necessary resource, human, material, financial, etc,
are available to in order to implement and make efficient the prevention program. They also have to assure
that the personnel is available for training and information courses.

Saipems employees are responsible for:

attending information and training courses regarding Malaria prevention;
observing Saipems recommendations and requirements fro Malaria prophylaxis;
strictly following the prescribed medical treatment in case of confirmed disease.

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5. STANDARD

Malaria prevention program consists of information course, Primary Prophylaxis and Chemo-Prophylaxis.

5.1 MALARIA INFORMATION AND AWARENESS COURSE

All non-immune employees arriving on any of Saipem Projects will have to undergo Malaria awareness
course. This course, developed, organised and carried out by Saipem Medical Personnel is focused on:

information and education regarding prevention and vector transmission;
motivation to change high risk behaviour, i.e. staying outdoors during dusk to dawn;
behavioural skills for performing specific preventive acts.

Malaria prevention course is structured in a way to provide general information about Malaria (parasites,
presence in the area, world wide distribution, etc), way of transmission, symptoms (both during incubation and
during the various stages of disease), Primary Prophylaxis, Chemo Prophylaxis (methods, drugs, duration,
benefits, risks if not taken, availability on site, possible side effects, etc.), diagnostic procedures and treatment.

Once the presentation is over, and after all the questions from the attendees regarding the matter have been
answered, a letter shown in the Annex F, is given to each of them. The purpose of this letter is to give more
information to the employees family doctor regarding Malaria, its symptoms and available treatment.
Furthermore, each attendee will be asked to sign a declaration of participation at the Malaria prevention course
as shown in Annex E.
The attendance at the information courses will be registered on the format (Annex G) and monthly submitted as
part of medical reporting to the Saipem Managers and Saipem Corporate Medical Department.

5.2 PRIMARY PROPHYLAXIS

There are three determinants to be considered in an effective Malaria control program. These are:

Man (the host);
Plasmodia (the agent);
Anopheles mosquito (the vector).

To achieve a sustainable outcome, Saipem is addressing control of the above three living beings and their
environment. Man, the host, is a moving target and can take the disease with him far and wide. Mosquitoes
are moving and highly adaptable. It is therefore important to target non-flying eggs and larvae. The parasite
also is highly adaptable, hides in humans and mosquitoes and has also developed resistance to drugs.
Therefore, for effective Malaria control, target man first, control mosquitoes next and keep trying to tackle the
parasite with development of effective drugs. To promote an effective and long lasting program, it is
imperative that all parameters concerned should be given adequate attention and enough support to attain
and sustain the program in the long run yielding a positive long lasting effect.

5.2.1 Mans Role in Malaria Control

Man is the most important link in the Malaria control chain. He can be made to understand the problem and
he can help in breaking the chain at multiple points. For example, by taking personal protective measures,
three things can be achieved prevention of Malaria in the given individual, thus reduced parasite load and
reduction in spread, and by denying blood meal to the mosquito the egg laying is also hampered. In the
recent years, more emphasis is being laid on early diagnosis and treatment and on personal protective
measures. By these means, it is intended to minimize the use of potentially harmful chemical insecticides.

Person concerned should avoid exposure of any part of the body to mosquito bites. Positive behavioural
patterns would include:

not staying out between dusk to dawn;
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proper choice of clothing materials, preferably thick clothes with long sleeves;
avoiding areas notorious for mosquito infestation;
interactive communication with the Medical Department and workers on matters pertaining to Malaria;
simple but effective ways in controlling potential breeding areas like proper disposal of water retaining
litters; i.e. bottles, cans, used tires, etc.

At each working site in a high-Malaria risk aria sufficient quantities of recognized quality repellents, creams or
sprays, will be available in the clinic in order to be distributed to the workforce whenever needed/ asked.

5.2.2 Vector Control

It is impossible to control Malaria without controlling the anopheles mosquitoes, the vector for Malaria. But
controlling these highly adapted, flying and hiding vectors is indeed a formidable task.
Development of resistance to insecticides has compounded to the problem.

The following are the steps in mosquito control:

egg laying should be discouraged;
development of laid eggs into larvae and adults should be prevented;
grown adults should be killed;
un-killed adults should not be let into places of human dwelling;
mosquitoes that have already entered should not be allowed to bite human beings.

In order to control the vectors effectively, Saipem has taken the following steps:

External and internal fumigation are regularly done on all areas of the camp. Fumigation is scheduled
and a written notice is posted on the particular area a day before the procedure is carried out. Swing fogs
using insecticides are used for external fumigation. It is performed by a trained safety personnel with
prior approval from the Safety Coordinator, Medical Coordinator, and Camp Boss. Each area is
fumigated at least once a month. Internal fumigation is occupant-based. Insecticide sprays are supplied
to each room monthly and regular spraying is left at the prerogative of the room occupant.
Mosquito magnets using propane gas attract mosquitoes and trap them inside a one-way net is provided.
These are strategically placed around the camp in order to promote maximum coverage for mosquito
attraction. This equipment effectively diverts mosquito movement by luring them to the nets preventing
infestation of the camp.
Accommodation rooms in the camp are designed to be mosquito proof. Rubber seals on doors and
windows are placed to prevent entry of mosquitoes as well as other insects inside the rooms. All rooms
are air conditioned and comfortably designed to discourage occupants from leaving their rooms open. In
the sites, ergonomically designed caravans are used. They are tightly sealed, air conditioned for single
occupancy provided with a toilet and bath. This offers both privacy and convenience to the occupant
which results to less insect exposure when conveying from one caravan to the other (as in camps using
common bath and latrine).
Regular maintenance of the camp premises is a major activity. Tending and pruning of ornamental
plants, maintenance of grass/weed height, and landscaping prevents insect proliferation and is visually
gratifying. Daily cleaning and inspection of drainage is strictly implemented to assure continuous flow of
both sewage and runoff water.
A hygiene control program is being implemented to define and maintain standard of cleanliness within
the camp. It is extensively discussed in a separate work instruction document.

5.2.3 CHEMO PROPHYLAXIS

To permit the employer to protect employees health, the employer reminds each employee that he shall take
care of his own health and security assuring that the best practice is followed. Therefore, the medical team of
the employer will provide to the employee a specific medical prescription for prophylactic therapy and the
employee shall inform the employer, when such therapy is considered by the employer to be compulsory, if
he decides not to take such therapy and the reason of such refusal.

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Throughout the years, a lot of research have proven chemoprophylaxis to be beneficial in preventing Malaria
infection for people visiting known endemic areas, especially for expatriates who would be staying there on a
short-term basis. Up to now there are no evidences as to the physiologic effectiveness and safety in long-
term use. Prevention of Malaria through drug intake (chemoprophylaxis) is highly recommended but it is
considered a voluntary act of the individual employee.

Recent guidelines give emphasis to the importance of balancing the risk of adverse reactions against anti-
Malaria drugs. The main determinants of Malaria-risk are the geography, duration of stay, conditions of
accommodation, work and social patterns of the site (particularly dusk to dawn activities).
Saipems Medical personnel in charge of the worksites will provide pertinent information on disease
prevention, and administer prophylactic drug regimens.
The purpose of chemoprophylaxis is to prevent the onset of the illness in case of exposure. No matter being
the best protection measure, it does not guarantee total protection from acquiring the disease, however, it
can limit the illness to its less severe, uncomplicated form.

Before starting the drug regimen, the following prerequisites are required:

Thorough anamnesis should be taken form the individual. Special attention should be given to the
cardiac and circulatory history, familial predisposition and personal history. History of allergic reactions,
Cardiac arrhythmias, hypertension, past ECG abnormalities, present medications (if any).
Complete physical examination with special attention to cardio-circulatory system.
Laboratory examinations should include routine CBC, liver function tests (Transaminases), renal function
tests, FBS.

These ancillary procedures are aimed to provide a baseline for future references. ECG recordings should be
done prior to selecting the most appropriate prophylaxis among the ones pre-approved by Corporate Medical
Department (Annex C). These drugs shall be available in all working sites.
Prophylactic therapy should be started prior to exposure or travel to endemic areas. Strict coordination and
compliance among the clinics from the country of origin and site clinic should be empowered. The
prescription issued prior to departure shall be presented to the site medical doctor which will enable that the
prescribed prophylactic therapy is continued by the site physician.
The most common and anticipated problem which poses a threat to a successful prophylactic therapy is
Compliance. A centralized way of administering the drug is the most effective in monitoring and ensuring that
the schedule is strictly complied with.
The use of Chemo Prophylaxis will be monitored by the site physician.

5.2.3.1 Compulsory Chemo Prophylaxis

In certain cases and in base of the Health Risk Assessment carried out by its Medical Department, local laws
and regulations, best international practice and/or Clients contractual requirements, Saipem could ask both
its own and Subcontractors non-immune employees to take the Chemo Prophylaxis compulsory during the
assignment to a specific Project. In such case, each employee prior to his/her mobilisation shall be asked by
the Personnel Department to sign an employee statement of understanding and compliance with the Malaria
chemoprophylaxis requirements.
This statement will include the employees agreement to be subject to unannounced, random and periodic
testing to determine his/her compliance with the requirement that he/she is taking approved Malaria Chemo
Prophylaxis. For this testing he/she will be asked to provide the urine sample for laboratory verification.
This sample will be sent for analysis to an approved laboratory. The laboratory will provide the tests results,
positive and negative, to the Saipems designated Medical Officer. Should the result show an individuals
non-compliance with the prescribed regimen, he/she will be invited, in a written manner, to fulfil the
requirement.
Should an individual result negative on two consecutive tests, his/her name shall be forwarded to the
Projects Management in order for them to eventually undertake any appropriate action.
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5.3 EARLY DIAGNOSIS AND PROMPT TREATMENT

In case of a suspected illness, early diagnosis and prompt treatment of Malaria is the dictum on all the sites
located in endemic areas to achieve zero fatality rate among employees. To attain this goal, the following
requisites are put in place.

5.3.1 Site Medical Facilities

All Company sites located in Malarial areas (and barges when operating in such areas) must have the
facilities to rapidly confirm or exclude the diagnosis of Malaria in a suspected case.
These can include:

standard laboratory equipment with adequate staining techniques, and/or
advanced microscopic diagnosis facilities (QBC Rapid Malaria Identification Test), and/or
ICT rapid diagnostic tests.

Medical personnel assigned to these locations have to be competent and trained, fully able to perform and
interpret Malaria tests.

Adequate anti Malarial drugs for treatment of severe Malaria must also be available on all sites. Corporate
approved Malaria treatment protocols for uncomplicated and complicated cases as tabulated below is
established and closely adhered to by site doctors (Annex B).

5.3.2 Referrals

All confirmed Malaria cases among non-immune employees have to be reported to the Saipems Medical site
staff or directly to the Head Office .
In case that the local medical support is not sufficient for the treatment of Malaria or its suspected related
complications, the evacuation of the affected person should be done to the closest medical facility equipped
for this purpose.

5.3.3 Severe / Complicated Cases of Malaria

The implementation of adequate prevention measures, the diagnosis and treatment of Malaria patients on
time shall limit the occurrence of severe and complicated cases to practically zero. Nevertheless, such
cases can not be completely ruled out and it is extremely important to recognise them on time and treat them
correctly. Due to the specificity of Plasmodium species and drug resistance the general rule is to treat
Malaria in the area where it has been acquired. In case local structures cannot meet the needs for a modern
and adequate life support, necessary for the treatment of complicated cases, a non.-immune individual shall
be evacuated using the resources and equipment of specialised MEDEVAC providers that Company has
contracted for.

5.3.3.1 Central Nervous System Involvement in P. Falciparum Malaria

This is the most common cause of death in severe P. falciparum Malaria. C.N.S manifestations in Malaria
could be due not only to severe P. falciparum Malaria, but also high grade fever, anti Malarial drugs,
hypoglycaemia, hyponatremia and severe anaemia. Therefore, it is extremely important to differentiate
between these so as to avoid unnecessary anxiety and improper treatment. Focal neurological deficits, neck
rigidity, photophobia, papilloedema, and neurological sequelae are very rare in P. falciparum Malaria and
such a picture would therefore suggest other possibilities.

Manifestations of cerebral dysfunction include any degree of impaired consciousness, delirium, abnormal
neurological signs, and focal and generalized convulsions. In severe P. falciparum Malaria, the neurological
dysfunction can manifest suddenly following a generalized seizure or gradually over a period of hours.
A strict definition of cerebral Malaria has been recommended for sake of clarity and this requires the
presence of unarousable coma, exclusion of other encephalopathies and confirmation of P. falciparum
infection. However, all patients with P. falciparum Malaria with neurological manifestations of any degree
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should be treated as cases of cerebral Malaria.

5.3.3.2 Neurological Signs in Cerebral Malaria

As per the definition, patient should have unarousable coma, not responding to noxious stimuli with a
Glasgow coma scale of <7/15. Mild neck stiffness may be seen; however, neck rigidity and photophobia and
signs of raised intracranial pressure are absent. Retinal haemorrhages occur in about 15% of cases,
exudates are rare. Pupils are normal. Papilloedema is rare and should suggest other possibilities. A variety
of transient abnormalities of eye movements, especially disconjugate gaze, are observed. Fixed jaw closure
and tooth grinding (bruxism) are common. A pout reflex may be elicitable but other primitive reflexes are
usually absent. The corneal reflexes are preserved except in case of deep coma. Motor abnormalities like
decerebrate rigidity, decorticate rigidity and opisthotonus can occur. Deep jerks and plantar reflexes are
variable. Abdominal and cremesteric reflexes are not elicitable. These signs help in distinguishing from
behavioural problems due to fever of other causes.

5.3.3.3 Management of Cerebral Malaria

Nursing care: Meticulous nursing is the most important aspect of management in these patients:
Maintain a clear airway. In cases of prolonged, deep coma, endotracheal intubation may be
indicated.
Turn the patient every two hours.
Nurse in semi-prone position with foot-ent elevated to prevent aspiration.
Maintain strict intake/output record. Observe for high coloured or black urine.
Monitor vital signs every 4-6 hours.
Changes in levels of sensorium, occurrence of convulsions should also be observed.
If the temperature is above 39
0
C, tepid sponging must be done.
Naso-gastric aspiration to prevent aspiration pneumonia.
Urethral catheter needs to be inserted for monitoring urine output.
Phenobarbitone injection, 10-15mg/kg body weight should be given intramuscularly to prevent
convulsions. And when convulsions do occur, they can be treated with Diazepam by slow intravenous
injection, 0.15mg/kg, maximum of 10mg.
Do not administer the following: corticosteroids; other anti-inflammatory drugs; anti-oedema drugs like
mannitol; adrenaline; heparin; hyper baric oxygen etc.
Antimalarial treatment: Parenteral Quinine has been the treatment of choice for cerebral Malaria.
Artemisinin derivatives have been proved to be equally effective in treating cerebral Malaria.

5.3.3.4 Treatment of Severe P. Falciparum Malaria

It is safer to treat cases of severe P. falciparum Malaria as chloroquine resistant. It is better to use two drugs,
one rapid acting and one slower acting. Severe Malaria should always be treated with parenteral
antimalarials to ensure adequate treatment.


QUININE

Intravenous 20mg of salt/kg diluted in 10ml/kg isotonic fluid,
infused over 4 hrs; then 10mg of salt/kg over 4
hrs, every 8-12 hrs until patient can swallow.
Intramuscular 20mg of salt/kg diluted to 60mg/ml by deep i.m
injection, (divided into two sites); then 10mg of
salt/kg every 8 hours.
Oral 600mg of salt 3 times a day for 7 days (max. of
1800mg/day).
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In areas where resistance to quinine is known or suspected, add single dose of
pyrimethamine/sulphadoxine OR Tetracycline or Doxycycline for 7 days.


ARTEMISININ DERIVATIVES

Preparation Dose and administration
Artemether (Availability: 80mg/ml inj. and
40mg cap)
I.M: 3.2mg/kg as loading dose, followed by
1.6mg/kg daily, until the patient is able to
swallow or for 5 days.
Oral: 160mg in two doses on the first day, then
80mg/day for total 5 days.
Artesunate (Availability: 60mg powder with
1ml of 5% sodium bicarbonate ampoule for
injection and 50mg tablet)
Injection: The powder should be reconstituted in
1 ml of 5% sodium bicarbonate and then further
diluted with isotonic saline or 5% dextrose (to a
total of 3ml for i.m and 6ml for i.v use). DOSE:
2.4mg/kg on the first day (additional 1.2mg/kg
after 4 hours in case of severe falciparum
Malaria), followed by 1.2mg/kg daily until patient
is able to swallow or for a maximum of 7 days.
Oral: 100mg on the first day, followed by
50mg/day for 7 days.


OTHER DRUGS

Drug Dose
Mefloquine 15-25mg/kg (max. of 1500mg), given as two
doses, 6-8 hrs apart
Tetracycline 250mg 4 times a day for 7 days
Doxycycline 100mg twice a day for 7 days


NOTE:

Most blood schizonticidal drugs prevent the development of the forthcoming erythrocytic cycle of
parasitic development and hence have no or little effect on the ongoing cycle that is already causing
fever. Therefore, it would take at least 48 hours for the treatment to be effective.
Artemisinin derivatives can be used in cases of hyperparasitaemia or life threatening complications on
account of their ability to clear the parasitaemia earlier compared to other anti-malarial drugs.
Most anti Malarial drugs have a long plasma half-life. Therefore, adding similar drugs half way through
the treatment will only add to the adverse effects and not to the therapeutic benefit. The following
combinations should therefore be avoided, concurrently or within a short interval:
Cloroquine + Quinine
Chloroquine + Mefloquine
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Quinine + Mefloquine
Quinine + Halofantrine

5.4 MALARIA CASE REPORTING

In order to keep incidence of Malaria cases amongst non-immune population working at Saipems locations
low Malaria awareness courses are regularly conducted with particular attention on preventive measures.
For an accurate and complete evaluation of the situation regarding Malaria prevention issues and cases two
specific forms from all project doctors/nurses working in the Malaria high-risk areas have to be sent to the
Medical Coordinators/Overseas Health Manger on monthly basis. These two forms are:

Malaria Control Program Log (MCP log);
Stewardship Malaria Case report.

The MCP Log monitors the following parameters:

number of expatriate employees present on site (including those at home for leave period) who attended
the MCP awareness course following Saipems standards;
number of expatriate employees present on site (including those at home for leave period) who did not
attended the MCP awareness course following Saipems standards;
number of employees who attended the MCP awareness course and have signed the MCP course
attendance Certificate.

Developing site/project specific MCPes this log, following particular local legislation, Clients or contractual
requirements other elements can be added, but the basic structure must remain the same.

Stewardship Malaria Case report form contains 4 principal parameters registered for each employee group
(non-immune, semi-immune and subcontractors personnel):

Number of Fatal Malaria Cases.
Total Number Stewardable Malaria Cases. For the non-immune employees this parameter covers all
Malaria fatalities and all confirmed Malaria cases. In semi-immune employees it includes confirmed
cases with any of the following:
hospitalisation for treatment;
5% parasitemia;
the patient meets the criteria for severe Malaria according to WHO standards.
Hospitalisation should be interpreted as the confinement of a patient in a hospital or clinic for the purpose
of administrating medically supervised treatment. Out patient and emergency room treatment where the
patient is released after examination, observation only and/or provided medication to self-administer are
not considered to be hospitalisation.
Exposure hours monitor the man-hours worked. Wherever possible the table must be filled in with the
actual man-hours worked for the indicated group. Where a breakdown of man-hours is not available for
the indicated groups (e.g. non-immune, semi-immune and subcontractors personnel), the percentage
composition of the work force to calculate (e. g. total contractor man-hours worked multiplied by the
percentage of each employee group) shall be utilised.
Malaria case rate (MCR). This indicator represents the total number of Stewardable Malaria Cases
multiplied by 200 000 work-hours and divided by man-hours worked for particular work force. Malaria
Case information is stewarded separately.

Except to the Medical Department Management the reports shall be sent monthly to the HSE Department
and Mangers at local and Corporate levels. Malaria trends shall be observed and corrective action, if needed,
implemented.
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6 ATTACHMENTS

The following documents are integral part of this Corporate Standard:

Annex A: Global Malaria Status
Annex B: Reported Falciparium Drug Resistance
Annex C: List of Recommended Drugs for Chemoprophylaxis
Annex D: List of Recommended Drugs for Chemotherapy
Annex E: Declaration of Attendance and Comprehension (Form: COR-HSE-064-E)
Annex F: Letter to Family / Attending Physician (Form: COR-HSE-065-E)
Annex G: Attendance Sheet for Information Courses (Form: COR-HSE-066-E)
Annex F: Malaria Control Program Log (Form: COR-HSE-067-E, Pages 1-2)
Annex H: Malaria Cases Stewardship Report (Form: COR-HSE-068-E)

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ANNEX A: GLOBAL MALARIA STATUS




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ANNEX B: REPORTED FALCIPARIUM DRUG RESISTANCE




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MALARIA CONTROL PROGRAM
Page 16 of 27

ANNEX C: LIST OF RECOMMENDED DRUGS FOR CHEMOPROPHYLAXIS







Drug Preparation Dose Route
Mefloquine
(Lariam) *
250mg tablet 1 tablet once a
week
Oral
Proguanil+Atovaquon
e
(Malarone) **
Proguanil 100mg +
Atovaquone 250mg
tablet
1 tablet once daily Oral
Doxycycline ** Doxycycline 100mg
cap
1 capsule once
daily
Oral


Duration of prophylaxis.

Mefloquine: start two and a half weeks before travel, throughout the stay and continue four weeks after
return.
Doxycycline: start two days before travel, throughout the stay in the endemic area and continue for four
weeks after return.
Malarone: start two days before travel, throughout the stay in an endemic area and continue for one week
after return.




Doc. n. STD-COR-HSE-012-E
Rev. 02 Date 19/03/2004


CORPORATE STANDARD

MALARIA CONTROL PROGRAM
Page 17 of 27

ANNEX D: LIST OF RECOMMENDED DRUGS FOR CHEMOTHERAPY



DRUG DOSE
Chloroquine tablet and ampoule

600mg base initially, 300mg base in 6 hrs, then
300mg base at 24 and 48 hrs.
Sulfadoxine 500mg, Pyrimethamine 25mg tablet
(Fancidar)
3 tablets in a single dose.
Sulphamethoxypyrazine + Pyrimethamine tablet
(Metakelfin)
2 tablets in a single dose to adults with a body weight
of 50-70kg; 3 tablets over 70kg.
Artemether 80mg amp
(Paluther)
3 Day Treatment: one ampoule containing 80mg
twice a day by intra muscular injection (i.e. 160
mg/day) for 3 days
5 Day Treatment: 1 ampoule containing 80mg twice
a day by intra muscular injection the first day (i.e.
160mg). Then one ampoule containing 80mg for the
next 4 days.

Halofantrine hydrochloride 250mg tablet
(Halfan)
2 tablets (i.e. 500 mg) every 6 hours for 3 doses, not
with meals. Repeat dose in 7 days.
Quinine sulphate 300mg tablet and 600mg/2ml
ampoule
2 tablets (600mg) 3 times a day for 7 days.
I/V Infusion: 20mg of salt/kg diluted in 10ml/kg
isotonic fluid, infused over 4 hrs; then 10mg of
salt/kg over 4 hrs, every 8-12 hrs until patient can
swallow.
Mefloquine 250mg tablet
(Lariam)
3 tablets (i.e. 750 mg) followed in 12 hrs by 2 tablets
(i.e 500mg).
Proguanil 100mg +Atovaquone 250mg tablet
(Malarone)
4 tablets (i.e 1000mg Atovaquone and 400 mg
Proguanil) once daily for 3 days.

Doc. n. STD-COR-HSE-012-E
Rev. 02 Date 19/03/2004


CORPORATE STANDARD

MALARIA CONTROL PROGRAM
Page 18 of 27

ANNEX E: DECLARATION OF ATTENDANCE AND COMPREHENSION

Company name / logo :
Form: COR-HSE-064-E


DECLARATION OF ATTENDANCE AND
COMPREHENSION


Page 1 of 1


DECLARATION


I, the undersigned hereby declare that on (date) I attended the Malarial
Preventive course as per Saipem program. During this course the following topics had been
discussed.

1. Details regarding Malaria, signs and symptoms
2. Ways of transmission
3. Health risks related to Malaria
4. Presence of Malaria in specific area
5. Primary Prophilaxis
6. Chemo Prophilaxis benefits and risk

I state that I was fully informed regarding the subject. I confirmed that benefits of Chemo Prophilaxis were
clearly explained and I dont have further questions regarding this tropical disease.

Furthermore, I was given a letter and to be given to the Doctor from my country of origin during the time of
my vacation if something unusual symptoms related to such disease will occur.

Signed by:


____________________________
Doc. n. STD-COR-HSE-012-E
Rev. 02 Date 19/03/2004


CORPORATE STANDARD

MALARIA CONTROL PROGRAM
Page 19 of 27

ANNEX F: LETTER TO FAMILY / ATTENDING PHISICIAN

Company name / logo :
Form: COR-HSE-065-E


LETTER TO FAMILY / ATTENDING
PHYSICIAN


Page 1 of 1


MEDICAL DEPARTMENT


TO THE FAMILY / ATTENDING PHYSICIAN


Dear Colleague:
I would like to inform you that the bearer, our employee, just arrived from a Malaria-endemic country
in one of our worksites. In lieu of this, we send this letter to forewarn you on any untoward events that may
occur during his vacation period.
The most common problem we have encountered with our expatriate personnel is Malaria. Other
tropical diseases like Typhoid, etc do occur seldom. P. falciparum has an incubation period of 48 hrs. Signs
and symptoms usually involve a general sense of not being well, malaise, arthromyalgia, spiking fever,
tremors, nausea, vomiting. No particular focus is present to attribute the symptoms. With our experience in
the field, an early recognition of the illness can be contained with simple treatment regimens and does not
require long-term hospitalisation.
The drugs commonly used are: Chloroquine phosphate 250 mg tablet; 4 tablets as initial dose, 2
tablets after 6 hrs from initial dose, then 1 tablet every 12 hrs thereafter for 4 doses. However, for
Cloroquineresistant cases, Artemeter 80 mg ampule; 1 ampule deep IM every 12 hours for 6 doses can be
given. If Artemeter is not available, Quinine 300 mg tablet; 2 tablets every 8 hours for 7 days, with regular
monitoring of blood pressure and cardiac rate. Usual complications with Quinine therapy is hypotension and
arrythmias. Anti-malaria regimen is usually coupled with antipyretics and antiemetics if indicated.
For confirmation and monitoring, a peripheral smear is very helpful in determining the Malaria variant
and efficacy of the treatment, but sometimes it can give false negative results. That is why, in suspected
cases, it has to be repeated even several times.
We would be glad to accommodate any query from you regarding this matter. You can get in touch
with us thru Pronto Dottore telephone number +390252034777. We hope that this simple note would
prove useful in the management of your patient.

Thank you and best regards.



Cordially,

Medical Coordinator

Doc. n. STD-COR-HSE-012-E
Rev. 02 Date 19/03/2004


CORPORATE STANDARD

MALARIA CONTROL PROGRAM
Page 20 of 27

ANNEX G: ATTENDANCE SHEET FOR INFORMATION COURSES

Company name / logo :
Form: COR-HSE-066-E


ATTENDANCE SHEET FOR
INFORMATION COURSES


Page 1 of 1



COUNTRY SITE/VESSEL

COURSE TITLE CARRIED OUT IN LANGUAGE

FROM _______________________ TO _____________ OCLOCK TOTAL HOURS

CARRIED OUT FROM ______________ TILL ______________ LECTURER


NR. NAME AND SURNAME BADGE N. POSITION NATIONALITY WORK AREA SIGNATURE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Doc. n. STD-COR-HSE-012-E
Rev. 02 Date 19/03/2004


CORPORATE STANDARD

MALARIA CONTROL PROGRAM
Page 21 of 27

ANNEX H: MALARIA CONTROL PROGRAM LOG

Company name / logo :
Form: COR-HSE-067-E


MALARIA CONTROL PROGRAM LOG


Page 1 of 2

MALARIA CONTROL PROGRAM

Project / Site / Vessel:
_____________________ Date: _________________________
Country and Client: _______________________________
Prepared by:
__________________

No Surname & Name
Attended
the course
(Yes/No)
Signed
Declaration of
attendance
(Yes/No)
Signed
Attestation form
(Yes/No)For
ExxonMobile
Projects ONLY
Chemoprophylaxis
taken (Name of
medicines)
Position Nationality Company
1
2
3
4


5
6
7
8
9
10

Doc. n. STD-COR-HSE-012-E
Rev. 02 Date 19/03/2004


CORPORATE STANDARD

MALARIA CONTROL PROGRAM
Page 22 of 27

ANNEX H: MALARIA CONTROL PROGRAM LOG

Company name / logo :
Form: COR-HSE-067-E


MALARIA CONTROL PROGRAM LOG


Page 2 of 2



MALARIA CONTROL PROGRAM


Project / Site / Vessel: _____________________ Date: ________________________
Country and Client: _________________________________ Prepared by: _________________

Signed Attestation form ( for Exxon Mobile
projects ONLY)

Nationality
No. of Personnel who
attended the course
No. of Personnel who did not
attend the course
YES NO

Nationality


Nationality

Nationalities






..


A
S
I
A
N
S

0 0 0 0
Nationalities

..


..

.

.

..
..

.

E
U
R
O
P
E
A
N
S

0 0 0 0
Nationalities
..



..
O
T
H
E
R
S

0 0 0 0

GRAND
TOTAL 0 0 0 0

Doc. n. STD-COR-HSE-012-E
Rev. 02 Date 19/03/2004


CORPORATE STANDARD

MALARIA CONTROL PROGRAM
Page 23 of 27

ANNEX I: MALARIA STEWARDSHIP REPORT

Company name / logo :
Form: COR-HSE-068-E


MALARIA STEWARDSHIP REPORT


Page 1 of 1

Project/Site/Vessel: Date:
Country and Client: Prepared by:
Enter the data in light blue cells. All yellow cells are formulas for this sheet.
Duble click tab and rename as in-country organization name (The header will be corrected automatically)
Ja
n
Fe
b
Marc
h
Apri
l
Ma
y
Jun
e
Jul
y
Au
g
Sep
t
Oc
t
No
v
De
c
1
q
2
q
3
q
4
q
Mid
-
yea
r
Year
-end
YT
D
Saipems Non-immune (Expat)
Fatal
Malaria
Cases
N
o

Total
Stewardabl
e Malaria
Cases
N
o

Exposure
Hours
N
o

Malaria
Cases
Rate

Saipems Semi-immune (Nationals)
Fatal
Malaria
Cases
N
o

Total
Stewardabl
e Malaria
Cases
N
o

Exposure
Hours
N
o

Malaria
Cases
Rate

Subcontractors Personnel
Fatal
Malaria
Cases
N
o

Total
Stewardabl
e Malaria
Cases
N
o

Exposure
Hours
N
o

Malaria
Cases
Rate



Notes:
1.Stewardable Malaria Case
All Malaria fatalities.
All confirmed Malaria cases in non-immunes.
Confirmed cases in semi-immunes with any one of the following (consult physician): Hospitalization(4) for treatment, 5%
parasitemia, Patient meets criteria for severe Malaria according to World Health Organization standards.
2.Man-Hours Worked. Wherever possible, use actual man-hours worked for indicated groups. Where a breakdown of man-hours is not
available for the indicated groups (e.g., Non-Immunve and Semi-Immune), utilize the percentage composition of the workforce to
calculate.(e.g., Total contractor man-hours multiplied by the percentage of Non-Immune and Semi-Immune personnel).
3.Malaria Case Rate (automatically calculated on this sheet). MCR = (Total number of Stewardable Malaria Cases x 200,000) divided by
man-hours worked for particular workforce. The number of confirmed Malaria cases and the corresponding Malaria case rates are not
to be combined with SHE stewardship data. Malaria case information is stewarded separately.
Doc. n. STD-COR-HSE-012-E
Rev. 02 Date 19/03/2004


CORPORATE STANDARD

MALARIA CONTROL PROGRAM
Page 24 of 27

4. Hospitalization: Hospitalization should be interpreted as the confinement of a patient in a hospital or clinic for the purpose of
administering medically supervised treatment. Out-patient and emergency room treatment where the patient is released after
examination, observation only and/or provided medication(s) to self-administer are not considered to be hospitalization.