Background

Malaria is a common illness in people migrating to the West. Hospital care, including intensive care unit stays, can result in significant financial costs. Pre-departure anti-malarial treatment of migrants to Canada from malaria-endemic countries could prevent morbidity and reduce costs to Canada’s universal health care system.
 
Methods

Health records for children diagnosed with malaria at the Children’s Hospital of Eastern Ontario were retrospectively reviewed from 2010-2017. Patient demographics, details of care, and costs of inpatient and outpatient care related to malaria were determined and compared between migrants (immigrants/refugees) versus children who acquired malaria while traveling to visit friends and relatives. 

Results

24 migrants and 9 VFRs with malaria were identified. 20/24 (83%) migrants and 9/9 (100%) VFRs had Plasmodium falciparum malaria; 18/24 (75%) migrants and 3/9 (33%) VFRs were from East Africa, and 5/24 (21%) and 6/9 (67%) were from West/Central Africa. Migrants were median 12.0 years (IQR 8.8, 14.0) versus VFRs 6.4 years (4.0, 11.0) (p=0.09). Time from arrival to Canada to onset of symptoms was similar between groups (migrants – median 5 days; VFRs – 3 days). Similar proportions of migrants and VFRs were admitted to hospital (80% and 71%) and admitted to intensive care unit (27% and 29%). Total cost of care for migrant malaria over the study period was $174,485 CAD, and for VFRs was $61,656 CAD.
  
Conclusions

A significant burden of malaria among migrant children was found in this study, shortly after arriving to Canada. Assuming a cost of empiric pre-departure treatment for malaria of $3.45/person, the cost of treating all newcomers from Africa to Canada in the same 8-year period (194,267) would be ~$670,221 CAD, only four times the cost of treating children at a single tertiary care center.

ESPID 2018