A geostatistical analysis of the association between armed conflicts and Plasmodium falciparum malaria in Africa, 1997-2010.

Luigi Sedda,Qiuyin Qi,Andrew J. Tatem

doi:10.1186/s12936-015-1024-5

Abstract

BackgroundThe absence of conflict in a country has been cited as a crucial factor affecting the operational feasibility of achieving malaria control and elimination, yet mixed evidence exists on the influence that conflicts have had on malaria transmission. Over the past two decades, Africa has seen substantial numbers of armed conflicts of varying length and scale, creating conditions that can disrupt control efforts and impact malaria transmission. However, very few studies have quantitatively assessed the associations between conflicts and malaria transmission, particularly in a consistent way across multiple countries.MethodsIn this analysis an explicit geostatistical, autoregressive, mixed model is employed to quantitatively assess the association between conflicts and variations in Plasmodium falciparum parasite prevalence across a 13-year period in sub-Saharan Africa.ResultsAnalyses of geolocated, malaria prevalence survey variations against armed conflict data in general showed a wide, but short-lived impact of conflict events geographically. The number of countries with decreased P. falciparum parasite prevalence (17) is larger than the number of countries with increased transmission (12), and notably, some of the countries with the highest transmission pre-conflict were still found with lower transmission post-conflict. For four countries, there were no significant changes in parasite prevalence. Finally, distance from conflicts, duration of conflicts, violence of conflict, and number of conflicts were significant components in the model explaining the changes in P. falciparum parasite rate.ConclusionsThe results suggest that the maintenance of intervention coverage and provision of healthcare in conflict situations to protect vulnerable populations can maintain gains in even the most difficult of circumstances, and that conflict does not represent a substantial barrier to elimination goals.

Highlights

The absence of conflict in a country has been cited as a crucial factor affecting the operational feasibility of achieving malaria control and elimination, yet mixed evidence exists on the influence that conflicts have had on malaria transmission
When considering Africa as a whole, a pattern emerged with west Sub-Saharan Africa and southeast Africa showing increases in Plasmodium falciparum parasite rate (PfPR) following conflicts, and the greater Horn of Africa and Central Africa showing decreases in PfPR after conflict (Fig. 2; Table 1)
Even for some of the most conflict-affected countries, such as Zimbabwe, Somalia, Democratic Republic of Congo, and Sudan, significantly lower prevalences were evident in the months after conflict events, compared to before

Summary

Introduction

The absence of conflict in a country has been cited as a crucial factor affecting the operational feasibility of achieving malaria control and elimination, yet mixed evidence exists on the influence that conflicts have had on malaria transmission. The number of ongoing armed conflicts in the world has declined steadily through the 1990s and early 2000s, with a 40 % reduction from peak years shortly after the end of the Cold War [1]. The civil war in Tajikistan during 1992– 1993 led to an increase in annually reported malaria cases from 200 in 1992 to almost 30,000 in 1997 [20]

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