APPENDIX A Malaria and HIV/AIDS Policies APPENDIX A APPENDIX A-1: MALARIA PROCEDURE FOR GHANA APPENDIX A-2: HIV/AIDS POLICY APPENDIX A-1: MALARIA PROCEDURE FOR GHANA APPENDIX A -1 NGGL MALARIA PROCEDURE FOR GHANA NOTE : THE CONTENTS OF THIS PROCEDURE ARE SUBJECT TO CHANGE WITH CHANGING MEDICAL CONDITIONS AND WILL BE UPDATED APPROPRIATELY. 1. Procedure Malaria is endemic in Ghana. Newmont Ghana is committed to reducing and controlling mosquito presence in and around company provided living, dining and recreational facilities and working locations thereby reducing the exposure to individuals of being bitten by mosquitoes and contracting malaria. The Malaria Guideline addendum to this Malaria Procedure provides substantial additional information about malaria, prevention techniques, descriptions of malaria prophylaxis, treatment, etc. IT IS STRONGLY RECOMMENDED THAT YOU THOROGHLY READ THE INFORMATION IN THE ADDENDUM AND FAMILIARIZE YOURSELF WITH THE PRACTICAL STEPS YOU CAN TAKE TO REDUCE YOUR RISK AND EXPOSURE TO MOSQUITO BITES AND CONTRACTING MALARIA. 2. Background Despite major campaigns to eradicate malaria, the disease remains one of the most important health problems in many parts of the world. According to the World Health Organization (WHO) 110 million clinical cases of malaria occur each year, and most of these cases are reported from Sub-Saharan Africa. The malaria parasites are transmitted to humans by the bite of an infected female Anopheles mosquito. Malaria is a parasitic infection of the liver and blood. When a person is bitten by an infected mosquito, it first injects saliva to prevent the blood from clotting and blocking its mouth parts. The saliva contains the infective form of the malaria parasite, which is transmitted into the human bloodstream. A maturing phase follows in which the parasite (sporozoite) will, within 6 days, develop into a mature liver form (Schizont). This is normally when the individual starts feeling ill. In the case of P. falsiparum, the period between the bite of the mosquito and the appearance of the first symptoms could vary between 7 to 30 days (usually around 10 days), and longer with other species. It may be very long in the case of P. ovale and P. vivax i.e. months or even more than a year. This is believed to be due to the dormant stage of the parasite in the liver. 3. Definitions As noted in the body and text of this policy and the Malaria Guideline addendum. 4. Responsibilities Director of Human Resources – For the development, implementation and maintenance of this policy and guideline addendum. Managers of Environmental and Safety Departments – For the safe use and application of anti-mosquito chemicals used in spraying and fogging activities. For standing water control. Contractor – for the implementation and management of mosquito control programs as outlined and directed by Newmont Ghana through purchase order or contract documents. Employees – Take anti-malaria precautions seriously to protect you and your dependents from mosquito bites. 5. Implementation Protective Measures Effective prevention of malaria incorporates various approaches: ¾ Personal protection measures (including appropriate information/education and measures to avoid mosquito bites) ¾ Measures aimed at vector control (control of mosquito) in the environment. ¾ Chemoprophylaxis (anti-malaria drugs) THESE PROTECTIVE MEASURES ARE FULLY EXPLAINED IN THE MALARIA GUIDELINES ADDENDUM. PLEASE READ AND FAMILIARIZE YOURSELF WITH THESE PROTECTIVE MEASURES. In addition, Newmont Ghana will initiate and maintain the following mosquito control activities: ¾ A focused mosquito control spraying and/or fogging program in and around company living, dining and recreational facilities and working locations. ¾ Installation and maintenance of other types of mosquito control devices such as zappers, lights, propane powered traps, etc., in and around facilities where appropriate. ¾ Provide and/or install and maintain mosquito netting over beds in all company provided living/housing facilities. In addition, it is anticipated that all living quarters will be stocked with aerosol cans of mosquito spray for individualized mosquito spraying when needed. ¾ Mosquito repellant for individual application will also be available to employees, dependents and visitors in company facilities and work locations. ¾ Provide for early detection blood testing at all site clinical locations and Accra. ¾ Where possible, build houses and villages away from marshy areas and water, which are potential larvae breeding sites. ¾ Make provision for optimal drainage of rainwater and household water near houses….eliminate or control standing water. ¾ Install and maintain screening in front of outside doors and windows in houses and office facilities. Living areas (verandas) can also be screened off to minimize exposure to mosquitoes. ¾ Maintain good housekeeping and environmental practices to reduce and/or eliminate mosquito breeding habitats, i.e., unsanitary rubbish dumps, stacked tires, etc. ¾ Provide mosquito protection and anti-malaria prevention education and awareness sessions to all members of the workforce. Chemoprophylaxis (Anti-malarial Drugs) NOTE: WHEN CONSIDERING DRUGS, SPECIFIC RECOMMENDATIONS ARE BEST MADE ON AN INDIVIDUAL BASIS AFTER DISCUSSION WITH A DOCTOR FAMILIAR WITH TROPICAL MEDICAL CONDITIONS AND/OR YOUR PERSONAL DOCTOR FAMILIAR WITH YOUR PARTICULAR PERSONAL MEDICAL HISTORY. NEWMONT GHANA IS NOT, BY THIS MALARIA PROCEDURE OR GUIDELINES ADDENDUM, REQUIRING OR DIRECTING INDIVIDUALS TO TAKE OR USE MALARIA PROPHYLAXIS. HOWEVER, IT IS STRONGLY RECOMMENDED YOU CONSIDER TAKING MALARIA PROPHYLAXIS AS A PROTECTIVE MEASURE. THE USE OF MALARIA PROPHYLAXIS SHOULD ONLY BE DONE IN CONJUNCTION WITH YOUR DOCTORS ADVICE. In considering malaria prophylaxis, one is always concerned with balancing the risk and benefit. One must remember that chemoprophylaxis never provides complete protection against malaria, and that one must take other personal protection measures. Conclusion In conclusion, it is clear that despite major campaigns to eradicate malaria, the disease remains one of the most important health problems in Africa. Individual measures to prevent mosquito bites remain the mainstay of prophylaxis and people must be aware of the signs of malaria in order to seek medical treatment quickly. Where possible, each case must be assessed individually, rather than using a blanket recommendation. Too often individualized advice also gets advertised as a general recommendation in the employee community, which more often than not ends up being the wrong advice to somebody! It cannot be overstressed that a visit to the doctor in Ghana is important and the advice received there is made to that specific individual. It is recommended that the malaria control program form part of an overall medical plan, developed to address specific needs as identified by the company MALARIA PROCEDURE ADDENDUM - GUIDELINE FOR GHANA NOTE : THE CONTENTS OF THIS GUIDELINE ARE SUBJECT TO CHANGE WITH CHANGING MEDICAL CONDITIONS AND WILL BE UPDATED APPROPRIATELY. Note : Substantially most of the information provided in this Malaria Guideline was taken from a medical audit report dated 20 October 2003 and provided to Newmont Ghana by Medical Services International and Crusader Health Ghana Limited. This procedure – guideline addendum is copyright protected by MSI and the Expatriate Medical Assistance Group and only for the use of MSI/EMAG clients and not for distribution to third parties or other medical companies. Malaria is endemic in Ghana. Newmont Ghana is committed to reducing and controlling mosquito presence in and around company provided living, dining and recreational facilities and working locations thereby reducing the exposure to individuals for contracting malaria. Despite major campaigns to eradicate malaria, the disease remains one of the most important health problems in many parts of the world. According to the World Health Organization (WHO) 110 million clinical cases of malaria occur each year, and most of these cases are reported from Sub-Saharan Africa. The majority of cases are infections with the Plasmodium falciparum parasite, which gives rise to the most virulent form of the disease and is often life threatening, particularly if not treated quickly. Other Plasmodium parasites e.g. P. vivax, P. ovale and P. malariae can also cause malaria, but more often present as a low grade chronic infection, with characteristic fever patterns and the potential to relapse over a number of years. P. vivax and P. ovale cause fever every 48 hours and P. malariae every 72 hours. The high risk of malaria transmission is often associated with high rainfall. The risk in Central Africa is high (endemic proportions), except in some high altitude areas. The malaria parasites are transmitted to humans by the bite of an infected female Anopheles mosquito. Malaria is a parasitic infection of the liver and blood. When a person is bitten by an infected mosquito, it first injects saliva to prevent the blood from clotting and blocking its mouth parts. The saliva contains the infective form of the malaria parasite, which is transmitted into the human bloodstream. A maturing phase follows in which the parasite (sporozoite) will, within 6 days, develop into a mature liver form (Schizont). This is normally when the individual starts feeling ill. In the case of P. falsiparum, the period between the bite of the mosquito and the appearance of the first symptoms could vary between 7 to 30 days