Risk factors associated with malaria deaths in travellers: a literature review.

Malaria is the most frequently imported acute, life-treating, tropical disease in international travellers. We did a literature review in PubMed using pre-defined search terms to identify possible risk factors for malaria deaths in travellers. After screening, a total of 51 papers were selected for inclusion and were intensively scrutinised for details of "case fatality rates" and risk factors for fatal malaria associated with travel. The main risk factors were: non-use or inappropriate use of chemoprophylaxis, age, delay in seeking care, incorrect treatment, delay in diagnosis, infection with Plasmodium falciparum, non-immunity, travelling as a tourist and sex. The "case fatality rate" in most of the studies lay in the range 0.2%-3%. Possible reasons for this case fatality rate variation are: small case series, different populations included in the studies with different physiological and social determinants, including different species of malaria parasite and different traveller destinations in the case series.