The use of stand-by emergency treatment (SBET) for malaria in travellers: A systematic review and meta-analysis of observational studies

Background: Since SBET is a controversial strategy for malaria self-treatment, this study aims to systematically review primary studies on its use amongst travellers. Methods: Once studies were independently selected and data extracted, the pooled effect estimates (ES) were calculated through meta-analysis. Number of SBET users, of travellers carrying medications abroad, of subjects experiencing fever, of users complying with correct dosage, of those experiencing adverse effects, of those seeking medical care following SBET use, and those with positive malaria diagnostic test were collected and analysed. Subgroup and sensitive analyses were also performed. Results: Of 935 titles and abstracts screened, 9 articles were included in the qualitative synthesis and 7 in the meta-analysis for the main outcome, with a pooled ES of the overall use of SBET in the studied population of 2%. There was significant heterogeneity for all studies. The pooled ES of travellers who carried SBET medications abroad and of SBET users seeking medical care after self-administration was 65% and 52%, respectively. Conclusions: This meta-analysis indicated that the vast majority of travellers prescribed with SBET did not use it and the adherence to pre-travel recommendations on SBET use is suboptimal. Further studies to assess SBET cost-effectiveness and safety are needed.