Malaria in Refugee Children Resettled to a Holoendemic Area of Sub-Saharan Africa

Abstract

Background Malaria is a leading cause of morbidity and mortality in refugee children in high-transmission parts of Africa. Characterizing the clinical features of malaria in refugees can inform approaches to reduce its burden. Methods The study was conducted in a high-transmission region of northern Zambia hosting Congolese refugees. We analyzed surveillance data and hospital records of children with severe malaria from refugee and local sites using multivariable regression models and geospatial visualization. Findings Malaria prevalence in the refugee settlement was similar to the highest burden areas in the district, consistent with the local ecology and leading to frequent rapid diagnostic test (RDT) stockouts. We identified 2,197 children hospitalized for severe malaria during the refugee crisis in 2017 and 2018. Refugee children referred from a refugee transit center (n = 63) experienced similar in-hospital mortality to local children and presented with less advanced infection. However, refugee children from a permanent refugee settlement (n = 110) had more than double the mortality of local children (p < 0.001), had lower referral rates, and presented more frequently with advanced infection and malnutrition. Distance from the hospital was an important mediator of the association between refugee status and mortality, but did not account for all of the increased risk. Interpretation Malaria outcomes were more favorable in refugee children referred from a highly outfitted refugee transit center than those referred later from a permanent refugee settlement. Refugee children experienced higher in-hospital malaria mortality due in part to delayed presentation and higher rates of malnutrition. Interventions tailored to the refugee context are required to ensure capacity for rapid diagnosis and referral to reduce malaria mortality.

Neurologic Care of Forcibly Displaced Persons

“…For example, movement into malaria-endemic regions by nonimmune populations results in epidemic numbers of cases including cerebral malaria among both children and adults. 39 When treating FDPs, neurologists must expand their diagnostic reasoning to consider disorders that may occur in patients' countries of origin and countries traversed along the migration journey, at-risk age groups, and who has existing immunity to specific diseases. Even basic epidemiologic data in some settings could inform better neurologic care.…”

Scientific Findings of the Southern and Central Africa International Center of Excellence for Malaria Research: Ten Years of Malaria Control Impact Assessments in Hypo-, Meso-, and Holoendemic Transmission Zones in Zambia and Zimbabwe

“…Annual case incidence in refugees was an estimated 654 to 764 cases per 1,000 population per year in 2019-2020 (not reflected in the preceding data) and refugee children experienced higher inpatient mortality than nonrefugee children (25 versus 13% for 2017-2020, P , 0.001). 52 Overall, health facility case incidence, community parasite prevalence, hospitalizations for malaria, and inpatient malaria-attributable case fatality in Nchelenge District remain high and essentially unchanged despite control efforts. TEN YEARS OF SCA ICEMR SCIENTIFIC FINDINGS Risk factors.…”

“…Annual case incidence in refugees was an estimated 654 to 764 cases per 1,000 population per year in 2019–2020 (not reflected in the preceding data) and refugee children experienced higher inpatient mortality than nonrefugee children (25 versus 13% for 2017–2020, P < 0.001). 52 …”