Abstract
BackgroundAlmost two-thirds of refugees, internally displaced persons, returnees and other persons affected by humanitarian emergencies live in malaria endemic regions. Malaria remains a significant threat to the health of these populations.MethodsData on malaria incidence and mortality were analyzed from January 2006 to December 2009 from the United Nations High Commissioner for Refugees Health Information System database collected at sites in Burundi, Chad, Cameroon, Ethiopia, Kenya, Sudan, Tanzania, Thailand, and Uganda. Data from three countries during 2006 and 2007, and all nine countries from 2008 to 2009, were used to describe trends in malaria incidence and mortality. Monthly counts of malaria morbidity and mortality were aggregated into an annual country rate averaged over the study period.ResultsAn average of 1.18 million refugees resided in 60 refugee sites within nine countries with at least 50 cases of malaria per 1000 refugees during the study period 2008-2009. The highest incidence of malaria was in refugee sites in Tanzania, where the annual incidence of malaria was 399 confirmed cases per 1,000 refugees and 728 confirmed cases per 1,000 refugee children younger than five years. Malaria incidence in children younger than five years of age, based on the sum of confirmed and suspected cases, declined substantially at sites in two countries between 2006 and 2009, but a slight increase was reported at sites within four of seven countries between 2008 and 2009. Annual malaria mortality rates were highest in sites in Sudan (0.9 deaths per 1,000 refugees), Uganda and Tanzania (0.7 deaths per 1000 refugees each). Malaria was the cause of 16% of deaths in refugee children younger than five years of age in all study sites.ConclusionsThese findings represent one of the most extensive reports on malaria among refugees in post-emergency sites. Despite declines in malaria incidence among refugees in several countries, malaria remains a significant cause of mortality among children younger than five years of age. Further progress in malaria control, both within and outside of post-emergency sites, is necessary to further reduce malaria incidence and mortality among refugees and achieve global goals in malaria control and elimination.
Highlights
Almost two-thirds of refugees, internally displaced persons, returnees and other persons affected by humanitarian emergencies live in malaria endemic regions
Morbidity and mortality using United Nations High Commissioner for Refugees (UNHCR)’s health information system (HIS) data from 60 refugee sites in nine countries with at least 50 cases of malaria per 1,000 refugees
Indicators used by the HIS to measure malaria control activities include total and under-5 incidence of both suspected and confirmed malaria; the proportion of malaria cases confirmed by diagnostic tests; total and under-5 proportionate morbidity due to malaria; total and under-five malaria mortality by sex; total and under-5 proportionate mortality due to malaria; percentage of pregnant women receiving an long-lasting insecticide-treated nets (LLITNs) or insecticide-treated nets (ITNs) during pregnancy; and the percentage of pregnant women presenting at antenatal care who received two doses of sulfadoxine-pyrimethamine (SP) for IPTp
Summary
Almost two-thirds of refugees, internally displaced persons, returnees and other persons affected by humanitarian emergencies live in malaria endemic regions. All-cause mortality rates in refugee populations living in camps have decreased since the 1990s [1]. Despite these declines, infectious diseases are responsible for most refugee deaths [2]. With almost two-thirds (63%) of the world’s refugees, internally displaced persons (IDPs), returnees and other persons of concern (PoCs) to the United Nations High Commissioner for Refugees (UNHCR) living in malaria endemic regions, malaria remains a significant threat to the health of refugee populations, in subSaharan Africa [3]. Migration from regions of low to high malaria endemicity heightens malaria risk in susceptible refugee populations [5]. Influxes of refugee populations from regions of high to low endemicity may result in malaria transmission to susceptible host country populations if suitable vectors are present
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