The use of stand-by emergency treatment (SBET) for malaria in travellers: A systematic review and meta-analysis of observational studies - 09/12/18

Doi : 10.1016/j.jinf.2018.09.007

Pietro Ferrara ^a, Cristina Masuet-Aumatell ^b,^c, Fernando Agüero ^b,^c,^{^{1
Both the authors contributed equally to this work.}}, Josep Maria Ramon-Torrell ^b,^c,^{^{1
Both the authors contributed equally to this work.},}^⁎
^a Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 5, Via Luciano Armanni, Naples 80138, Italy
^b Bellvitge Biomedical Research Institute (IDIBELL), Preventive Medicine Department, University Hospital of Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Catalonia, Spain
^c Clinical Science Department, School of Medicine, University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Catalonia, Spain

^⁎Corresponding author at: Bellvitge Biomedical Research Institute (IDIBELL), Preventive Medicine Department, University Hospital of Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Catalonia, Spain.Bellvitge Biomedical Research Institute (IDIBELL), Preventive Medicine DepartmentUniversity Hospital of BellvitgeFeixa Llarga s/n, L'Hospitalet de LlobregatCatalonia08907Spain

Highlights

•	SBET is a strategy conceived for the treatment of suspected malaria in travellers.
•	Concerns raised since SBET conception and recent studies cast doubts on its feasibility.
•	The present meta-analysis found that the overall SBET use among travellers is 2%.
•	Travellers’ adherence to carry SBET and seek medical care abroad is suboptimal.
•	Studies assessing the cost-effectiveness and safety of SBET are needed.

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Abstract

Background

Since SBET is a controversial strategy for malaria self-treatment, this study aims to systematically review primary studies on its use amongst travellers.

Methods

Once studies were independently selected and data extracted, the pooled effect estimates (ES) were calculated through meta-analysis. Number of SBET users, of travellers carrying medications abroad, of subjects experiencing fever, of users complying with correct dosage, of those experiencing adverse effects, of those seeking medical care following SBET use, and those with positive malaria diagnostic test were collected and analysed. Subgroup and sensitive analyses were also performed.

Results

Of 935 titles and abstracts screened, 9 articles were included in the qualitative synthesis and 7 in the meta-analysis for the main outcome, with a pooled ES of the overall use of SBET in the studied population of 2%. There was significant heterogeneity for all studies. The pooled ES of travellers who carried SBET medications abroad and of SBET users seeking medical care after self-administration was 65% and 52%, respectively.

Conclusions

This meta-analysis indicated that the vast majority of travellers prescribed with SBET did not use it and the adherence to pre-travel recommendations on SBET use is suboptimal. Further studies to assess SBET cost-effectiveness and safety are needed.

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Keywords : Malaria, Malaria prevention, Stand-by emergency treatment, Adherence, Travel medicine, Travellers

Abbreviation : AE, CI, ES, NOS, RDT, SBET, WHO