Missionary health: the great omission.

North American mission boards were surveyed to identify and prioritize missionary medical problems and determine initiatives for improving health. Malaria was the most common nontrivial medical complaint, and viral hepatitis the most serious. Nevertheless, only 72 percent of boards recommend malaria prophylaxis, 57 percent ascribe to regular immune globulin use, and 31 percent advocate hepatitis B immunization. Sub-Saharan Africa was considered the region of the world where missionary health was most in peril. Besides strategies to minimize the risks of malaria and hepatitis, recommendations for improving missionary health include greater use of rabies and typhoid vaccines; increased attention to mental health concerns and accident prevention, particularly seat belt use; increased health education regarding both clinical issues and public health principles; improved scheduling for relaxation and family time; and greater availability of comprehensive health services before departing, while abroad, and upon returning from an overseas assignment.