Malaria as an occupational disease in seafarers in the period from 2004. – 2014.

Malarija je tropska zarazna bolest. Prenosi je komarac malaričar iz roda Anopheles a izazvana je krvnim parazitom roda Plasmodium. Egzistirajući kroz sva povijesna razdoblja malarija i dalje uzrokuje brojne socijalno-medicinske probleme. U nekim zemljama ona je i dalje endemično prisutna. U Hrvatskoj je malarija eradicirana 1964. godine te se uglavnom javlja nakon toga kao importirana. Autohtone infekcije ne bilježe se od 1958. godine. Hrvatska kao zemlja pomorske orijentacije broji od 20-30 tisuća pomoraca koji plove pod domaćim ili stranim zastavama. Bilježi se desetak importiranih slučajeva godišnje a većinu oboljelih čine pomorci. Plasmodium falciparum gotovo u 2/3 slučajeva je glavni uzročnik, nešto manje P. vivax dok je 80% registriranih slučajeva zaraženo u Africi. Kao glavni uzrok importirane malarije smatra se nedostatno provođenje kemoprofilakse ili neprovođenje. Cilj rada bio je prikazati broj oboljelih pomoraca od malarije u Hrvatskoj u razdoblju od 2004. -2014 godine, usporediti broj pomoraca s ukupnom populacijom oboljelih od iste bolesti te istražiti koliko oboljelih pomoraca je uzimalo kemoprofilaksu na pravilan način. Hipoteza ovog rada je da oboljeli pomorci nisu na pravilan način uzimali kemoprofilaksu. Specifični cilj rada bio je istražiti da li su oboljeli pomorci ostvarili prava s osnove profesionalne bolesti i prema kojim kriterijima. Svrha rada bila je analizirati obolijevanja pomoraca od malarije kako bi se mogla predložiti edukacija pomoraca za smanjenje rizika obolijevanja pri odlasku u endemska područja. Istraživanje je provedeno na osnovu anketa Hrvatskog zavoda za javno zdravstvo koju su popunili oboljeli pomorci, pregledom Epidemioloških vjesnika te Registra oboljelih od profesionalnih bolesti. Istraživanje je pokazalo da su u desetogodišnjem periodu oboljele ukupno 102 osobe od toga 25 pomoraca. Od ukupno 25 oboljelih pomoraca 17 ih nije uzelo kemoprofilaksu dok je 8 pomoraca uzelo ne poštujući upute o načinu uzimanja pa se sa sigurnošću može tvrditi da nijedan pomorac nije na pravilan način koristio zaštitu. Oboljeli pomorci nisu ostvarili prava s osnove profesionalne bolesti što ujedno predstavlja manjkavost ove studije jer nema sustavnog praćenja radnika migranata u ovom slučaju pomoraca koji plove pod stranim zastavama a jednako tome nemamo ni podataka o priznavanju profesionalne bolesti koju su možda ostvarili preko drugih osiguravajućih društava. Svi pomorci plovili su u područjima koja se za malariju smatraju endemskim. Ovim radom u potpunosti je dokazano da pomorci nisu uzimali kemoprofilaksu te ako su je i uzeli to nije bilo na pravilan način. Pomorce je potrebno educirati, ukazati im na korist preventivnih mjera, podučiti prepoznavanju simptoma te šteti koju mogu sebi nanijeti ako borave u endemskim područjima bez adekvatne zaštite. Potrebno je educirati i njihove poslodavce te pojačati zdravstveni nadzor od strane spec. medicine rada koji pomorcima izdaju zdravstvena uvjerenja. Predlaže se multidisciplinaran pristup problemu odnosno ostvarenje suradnje specijalista medicine rada, članova stručnih timova poslodavaca, Službe za epidemiologiju kao i edukacija kroz cjelokupno školovanje pomorca. Moguće je djelovanje na 5 točaka kontakta (srednja pomorska škola, pomorski fakultet, za vrijeme edukacije-polaganje i obnova breveta, izdavanje svjedodžbe spec. med. rada, Službe za epidemiologiju-žuta knjižica). U slučaju da i obole od malarije a poštovale su se preventivne mjere pomorci mogu ostvariti prava s osnove profesionalne bolesti te im se malarija priznaje kao profesionalna bolest.Malaria is a tropical contagious disease. It is transmitted by an Anopheles malarial mosquito and it is caused by a blood parasitic of Plasmodium species. Existing through all historical periods, malaria continues to cause numerous socio-medical problems. In some countries it is still endemic. In Croatia, malaria was eradicated in 1964 and it generally appears as imported. Autochthonous infections have not been recorded since 1958. Croatia as a country of maritime orientation has 20-30 thousand seamen sailing under domestic or foreign flags. There are dozens of imported cases per year and most of them are seamen. Plasmodium falciparum in almost two thirds of cases is the major cause, a little less P. vivax, while 80% of the registered cases are infected in Africa. The main cause of the imported malaria is considered to be insufficient taking or non-taking of chemoprophylaxis. The aim of the study was to present the number of malaria patients in Croatia in 2004 -2014, compare the number of seamen with the total population suffering from the same disease and investigate how many seamen were taking chemoprophylaxis in the proper way. The hypothesis of this paper is that the seamen were not taking chemoprophylaxis in the proper way. The specific aim of the work was to investigate whether seamen were able to obtain rights from the occupational disease and according to which criteria. The purpose of this paper was to analyse malaria diseases of the seamen in order to suggest their education to reduce the risk of illnesses when leaving the endemic areas. The survey was conducted on the basis of a survey of the Croatian National Institute of Public Health supplemented by seamen, the review of the Epidemiological Bulletin and the Register of Occupational Diseases. The study showed that in the ten year period, a total of 102 people suffered from malaria, of which 25 were seamen. Out of a total of 25 infected seamen, 17 were not taking chemoprophylaxis, while 8 seamen were taking it without respecting the instructions, so it can safely be asserted that no seamen used the protection properly. The infected seamen have not acquired rights from the occupational diseases, which is also a failure of this study because there is no systematic monitoring of migrant workers in the case of the seamen sailing under foreign flags, and equally no record of recognizing the occupational diseases that might have been achieved through other insurance companies. All seamen sailed in areas that are considered endemic for malaria. It has been fully proved by this paper that the seamen were not taking chemoprophylaxis and if they were taking it, it was not in the proper way. It is necessary to educate seamen and point them out the benefit of preventative measures, teach them to recognize the symptoms and the harm they can cause if they stay in endemic areas without the adequate protection. Moreover, it is necessary to educate their employers and encourage health counselling by the occupational medicine specialists who issue health certificates to seamen. A multidisciplinary approach to the problem is proposed, is the realization of cooperation between the occupational medicine specialists, members of professional teams of employers, the Epidemiology Department as well as the education through the seamen's overall education. It is possible to work on 5 points of contact (Maritime High School, Maritime Faculty, during the education-taking and renewing the certificate of competency, issuing the certificate of the Specialist in Occupational Medicine, Epidemiology Service-yellow booklet). If the seamen suffering from malaria respect the preventive measures they can claim rights from the occupational disease and then malaria is to be recognized as the occupational disease