Malaria epidemiology and control in refugee camps and complex emergencies

Abstract

Owing to the breakdown of health systems, mass population displacements, and resettlement of vulnerable refugees in camps or locations prone to vector breeding, malaria is often a major health problem during war and the aftermath of war. During the initial acute phase of the emergency, before health services become properly established, mortality rates may rise to alarming levels. Establishing good case management and effective malaria prevention are important priorities for international agencies responsible for emergency health services. The operational strategies and control methods used in peacetime must be adapted to emergency conditions, and should be regularly re-assessed as social, political and epidemiological conditions evolve. During the last decade, research on malaria in refugee camps on the Pakistan-Afghanistan and Thailand-Burma borders has led to new methods and strategies for malaria prevention and case management, and these are now being taken up by international health agencies. This experience has shown that integration of research within control programmes is an efficient and dynamic mode of working that can lead to innovation and hopefully sustainable malaria control. United Nations' humanitarian and non-governmental agencies can play a significant part in resolving the outstanding research issues in malaria control.

Cross-Border Malaria: A Major Obstacle for Malaria Elimination

“…The benefits of sleeping under LLINs need to be highlighted through education, and LLINs being made available through social marketing, as has been done for refugees from Afghanistan in Pakistan (Rowland and Nosten, 2001). Alternative approaches such as the provision of insecticide-treated hammocks for people frequenting forest areas in border areas (Magris et al, 2007;Thang et al, 2009), deltamethrin-sprayed tarpaulins or tents, and premethrin-treated blankets and top sheets provide more promising options for people overnighting in the forest (Graham et al, 2002;Rowland and Nosten, 2001). These protective measures achieve the goal of reducing exposure to infected vectors for populations who do not live in traditional housing each night, a feature common to people in border areas.…”

Sulfadoxine-pyrimethamine remains efficacious against uncomplicated,Plasmodium falciparummalaria in north-eastern Afghanistan

“…Sulfadoxinecare, a crumbling infrastructure and the pyrimethamine (SP) has been incorporated destruction of irrigation systems have all into the national treatment protocol, as a contributed to the increased importance second-line drug, since 1997 but its use is of malaria (Kazmi and Pandit, 2001; not wide-spread. The aim of the present Rowland and Nosten, 2001;Rowland et al, study was to collect more data on the eYcacy 2002a, b). Transmission is seasonal, unstable, of SP in Afghanistan, to provide support for and temperature-, humidity-and altitudethe use of this drug combination in the rstdependant.…”

Child health in complex emergencies

“…21,22 As in stable situations, prevention of infection with insecticide-treated bednets, along with case-diagnosis and treatment, are important interventions to reduce morbidity and mortality. Indoor residual…”