Public Health England's guidance for malaria prevention advises that the malaria situation has improved significantly in certain regions.

Nevertheless, patients travelling to malaria hotspots – such as parts of Africa, Asia, the Far East and South East Asia – should be encouraged to seek early medical advice about appropriate preventative measures, including prophylactic medication.

Refer to up-to-date guidance when providing advice on malaria.
Consider the diagnosis in patients returning from malaria-prevalent areas.

Delays in diagnosis

Fortunately, most doctors will rarely see a case of suspected malaria; this is reflected in the small number of cases referring to the disease being reported to the MDU.

Where claims arising from malaria cases do occur, they most commonly involve:

an allegation of a failure or delay in diagnosis, or
an allegation of a failure to provide adequate prophylaxis.

Case study

A man in his 30s consults his GP, complaining of fever, diarrhoea and vomiting. He explains he has recently returned from a trip to Malawi and that he has taken malaria prophylaxis. In light of this information, the GP attributes the symptoms to viral gastroenteritis.

Several days later, the man collapses in the street and, on admission to hospital, is diagnosed with cerebral malaria. He later dies. It transpires he had not completed his course of anti-malarial medication, discarding it when he returned home.

His family makes a claim against the GP for the delay in diagnosis. The expert appointed by the MDU is unsupportive of the GP, identifying inadequate history-taking and a failure to consider malaria in the differential diagnosis.

It is also established that, but for the delay in diagnosis, the patient would have survived with no adverse consequences. The claim is settled for a substantial sum, in reflection of the fact that the patient was a successful businessman supporting a young family.

MDU advice

Consider the following risk management advice when advising patients.

Before travel

When advising prospective travellers, refer to up-to-date guidance on appropriate malarial prophylaxis. Combine this advice with discussion about the general measures recommended for prevention of mosquito bites.
Warn your patients that compliance with prophylactic medication does not provide absolute protection.

After travel

If you consider the diagnosis of malaria, take appropriate steps to exclude it.
Make adequate contemporaneous records of your history and examination findings.
Clearly record your management plan. Let the patient know what to do if their symptoms persist or deteriorate. Revisit your working diagnosis, as necessary, as the clinical picture unfolds.
Record all patient contacts in the records, including advice and treatment given during home visits and telephone encounters.

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