BACKGROUND: In May 2000, the United Kingdom deployed a joint force to Sierra Leone on an operation covering four phases. Each phase was characterized by high exposure risk of falciparum malaria but with varying risks due to the combat environment that affected implementation of malarial protection policy. AIM: This study will describe the risks managed concerning malarial protection for the force and match these to the attack rates (AR) suffered by the force. METHODS: The evidence concerning current malarial protection will be revisited. The risks attributable to disease and combat environment will be described and AR calculated using disease notifications as the numerator and operational personnel returns as the denominator. RESULTS: ARs appeared to be higher where the risk of hostile activity was higher. The evidence base concerning the use of malarial protection measures remains valid. The AR associated with deployment of a force to a high malaria risk area with a high associated risk of hostile action appears to be 0.78 cases per person-years exposure. The AR for personnel deployed to a high malaria risk area with a low risk of hostile action appears to be 0.078 cases per person-years exposure.
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