Internally Displaced People Camps Research Articles

Prevalence of precancerous lesions and other cervical abnormalities among internally displaced women in Benue State Nigeria.

visual inspection is a low-cost screening strategy that can be used to prevent cervical cancer in women. These techniques can improve screening health outcomes for internally displaced women (IDW) who have poor sexual and reproductive health and rights' behaviors and outcomes. This study aimed to determine the prevalence of precancerous lesions and other clinical features using a visual inspection with acetic acid (VIA) technique during a cervical cancer screening campaign in two internally displaced people (IDP) camps in Benue State, Nigeria. this was a cross-sectional study of 166 IDW who voluntarily participated in the study during a VIA cervical cancer screening campaign in two IDP camps in Benue State, Nigeria the screening was done by a group of qualified and trained healthcare workers and data was collected using a structured, pretested questionnaire. a total of 99(60%) of the women had a first sexual experience at 16 years, while 78(47%) had more than 5 full-term pregnancies. Although only 72(43.4%) of the women acknowledged having more than one sexual partner, over 70% of the women stated that their sexual partner had another sexual partner. The prevalence of precancerous lesions among women was 10.8%. Smoking(p=0.003), age at menarche (p≤ 0.001) and sexual behaviors (p=0.009, p=0.004) were factors that had a statistically significant relationship with the presence of a precancerous lesion among the IDW. The study also highlights the high rate (95%) of cervicitis among the women and the relatively high rate (5.4%) of leukoplakia. the majority of IDW had sociodemographic and lifestyle characteristics that predisposed them to developing cervical cancer More targeted interventions aimed at improving the sociodemographic and lifestyle characteristics of IDW are recommended. In addition, there is a need to create awareness about cervical cancer among IDW and make screening available in camp facilities for early detection and management.

Assessing and improving the sanitation services in Kabarto 2 IDP camp using the Smart sanitation approach

Sanitation is a critical issue in internally displaced people (IDP) camps, where the lack of proper infrastructure and services can pose major health and environmental dangers. This paper presents a comprehensive analysis of the sanitation situation in Kabarto 2 IDP Camp in Iraq using the Smart Sanitation Approach comprising of three tools: SFD (Shit Flow Diagram), CSDA (Citywide Sanitation Diagnostic Assessment), and ECAM (Energy and Carbon Assessment for Environmental Management). The results show that the camp's sanitation infrastructure is wholly unsafe, with faecal sludge (FS) not being properly contained, emptied, or treated. The operation of the desludging trucks and the incomplete treatment are the main causes of the sanitation system's greenhouse gas emissions. The paper offers recommendations for enhancing the design and construction of the containment systems and restoring or upgrading the treatment plant. In conclusion, the study suggests improving data collection and monitoring, clear roles and responsibilities for the developing a faecal sludge management policy. The paper also makes suggestions for potential future applications of these tools, including the use of these technologies in more IDP camps or humanitarian settings to produce more data and knowledge about the provision of sanitation services in these settings and promote service improvement in the region.

Phenotypic characterization and antimicrobial susceptibility profiles of <i>Vibrio cholerae</i> isolates during the October 2022 and January 2023 outbreak in North-Kivu province, The Democratic Republic of Congo

Background: Cholera is an infectious disease characterized by severe watery diarrhea, frequently occurring in outbreaks which affects many communities in the Democratic Republic of the Congo (DRC). At the end of October 2022, a cholera outbreak was declared in the camp of internally displaced people (IDP) of Kanyaruchinya, 20 kilometers north of Goma, the provincial capital of the North-Kivu province in DRC, as well as in other IDP camps and settlements around the city of Goma. The aim of this study was to phenotypically characterize Vibrio cholerae isolates associated with this outbreak, and to determinate their antimicrobial susceptibility profiles.
 Methodology: Between October 31, 2022 and January 31, 2023, faecal swab samples were collected into Cary-Blair medium from 1604 and 538 patients with clinical signs of cholera at the Kanyaruchinya IDP, and IDPs camps and settlements around the city of Goma, respectively. After enrichment in 1% alkaline peptone water, the samples were cultured on thiosulphate-citrate-bile salt-sucrose (TCBS) agar for isolation and phenotypic characterization of V. cholerae O1 using conventional biochemical tests and serotyping technique. Antimicrobial susceptibility of selected isolates was peformed to a panel of 8 antibiotics by the disk diffusion method in accordance with EUCAST and CLSI guidelines.
 Results: Vibrio cholerae was cultured from 807 samples (50.3%) of 1604 patients from the Kanyaruchinya IDP, and from 206 samples (38.3%) of 538 patients around the city of Goma (p<0.01). All the V. cholerae isolates from the Kanyaruchinya IDP (807/807, 100.0%) were serotyped as V. cholerae O1 Inaba whereas 136 (66.0%), 67 (32.5%), and 3 (1.5%) V. cholerae O1 isolates from around Goma were serotyped as V. cholerae O1 Ogawa, V. cholerae O1 Inaba, and Hikojima respectively. Antimicrobial susceptibility test on 174 and 62 isolates selected randomly from the 807 and 206 V. cholerae isolates from the Kanyaruchinya IDP camp, and from around the city of Goma respectively, showed that all the tested V. cholerae O1 isolates were resistant to polymyxin and cotrimoxazole, while being susceptible to tetracycline and azithromycin. All tested V. cholerae O1 isolates from Kanyaruchinya IDP camp displayed a unique antimicrobial susceptibility profile characterized by resistance to ampicillin, cotrimoxazole and chloramphenicol, and susceptiblility to ciprofloxacin, norfloxacin, azithromycin, tetracycline and doxycycline. Their counterparts from settlements around the city of Goma displayed a more variable antimicrobial susceptibility profile.
 Conclusion: Our results suggest that a single V. cholerae O1 Inaba clone probably caused the cholera outbreak in the Kanyaruchinya IDP camp, whereas during the same period, several V. cholerae clones (Ogawa, Inaba and Hikojima) were associated with the cholera outbreak around the city of Goma.

A structural catalogue of the settlement morphology in refugee and IDP camps

In the past decade, the number of refugees and internally displaced people (IDP) has doubled. This prompted the construction of more refugee camps and the proliferation of existing camps with diverse structural morphologies. Satellite imagery and machine learning (ML) are increasingly utilized to map these camps. However, there exists no standardized inventory that systemizes the built-up structures of these camps. In this study, we conceptualize the settlement morphology of refugee and IDP camps from satellite images and create a structure catalogue. Using visual image interpretation (VII) of very-high-resolution and multitemporal imagery, we compile a global database of settlement structures from 285 camps across 1,053 observations. This catalogue is subsequently used to synthesize patterns in camp structures and temporal dynamics. The results show stark variations in settlement structures across camps. Despite some similar regional patterns, stark differences in morphologies are a testament to the global heterogeneous landscape of refugee and IDP camp structures. These findings highlight the importance of considering morphological differences in image analyses across camps in future designs of ML-based automated detection and monitoring efforts. Therein, the Structure Catalogue serves as an important foundation for future earth observation for humanitarian applications.

Prevalence and factors associated with post-traumatic stress disorder among internally displaced people in camps at Debre Berhan, Amhara Region, Ethiopia: a cross-sectional study

BackgroundPost-traumatic stress disorder (PTSD) is a common mental disorder after traumatic exposure that can have long-lasting physical and mental health consequences. In 2021, Ethiopia saw the highest number of internally displaced people (IDP) due to conflict and war with the scope of the internal displacement being very high in the study area and less attention has been given to mental health.ObjectiveTo determine the prevalence and associated factors of PTSD among internally displaced people in camps at Debre Berhan, Ethiopia.MethodsA cross-sectional study was conducted from December 1–30, 2021 among 406 IDPs, who were selected by random systematic sampling from the registration and proportionally allocated to three IDP camps in Debre Berhan. Post-traumatic stress disorder was measured by the PTSD checklist (DSM-5). Data were collected through an interviewer-administered pre-tested questionnaire, entered into EpiData version 3.1, and analyzed by Statistical Package for Social Sciences version 25. Bivariate binary logistic regression was used to select candidate variables with p < 0.25. Multicollinearity was checked by using the variance inflation factor and it was less than 10. Model adequacy was checked by Hosmer & Lemeshow goodness of test (p > 0.05). In the multivariable binary logistic regression, the association between outcome and independent variables was declared at p < 0.05 with its adjusted odds ratio (AOR) at a 95% confidence level.ResultsThe prevalence of PTSD among the respondents was 67.5% (95% CI: 63–72). Being a merchant (AOR = 0.41 [95% CI: 0.02–0.85]), witnessing the destruction of property (AOR = 1.67 [95% CI: 1.01–2.74]), facing trauma during displacement (AOR = 6.00 [95% CI: 2.75–13.10]), frequency of displacement (AOR = 0.31 [95% CI: 0.11–0.85]), being distressed (AOR = 5.42 [95% CI: 3.25–9.05]), and unemployment (AOR = 2.09 [95% CI: 1.24–3.54]) were factors significantly associated with PTSD.ConclusionThis study provides evidence of the high prevalence of PTSD among internally displaced people. Therefore, mental health and psychosocial support are urgently required to address the identified factors and help the displaced people against long-term avoidable suffering.

Decentralized sanitation solutions for temporal Internally Displaced people (IDPs) and refugees camps and residential complexes in Duhok province – Case study

The conditions of the settlements are often very poor with deficiencies in basic supplies like water. This study aims to: (i) assess the sanitation service level for Internally Displaced People (IDPs) and refugee camps in Duhok province / Kurdistan of Iraq (ii) assess the performance of wastewater treatment plants (WWTPs) and offer different scenarios to improve the sanitation service level in the Duhok province (iii) propose various decentralized treatment approaches. To demonstrate the efficiency of WWTPs, samples of generated wastewater at the effluent of 12 residential projects were collected to conduct the COD test. The results of COD test were found to exceed the permissible level of 100 mg/L set by Iraqi wastewater standard except in New Zakho and Avro city projects. The highest generation rates of grey and black wastewater were in Chamishko and Kaberto1 IDP camps and were 1013 and 3000 m 3 /day respectively. Both Avro city and War city residential complexes were notably discharging the highest rates of wastewater at the effluent with 5610 and 2484 m 3 /day respectively. Lelav city, New Jin city, and Dabin projects were found to have the maximum organic loading rate of COD with 745, 578, and 332 kg/day respectively. This study proposed Waste Stabilization Pond (WSP) systems to be constructed in both Domiz1 refugee camp and Chameshko IDP camp. In order to be more achievable, it is suggested that the regulations of disposed wastewater at the effluent be amended and categorized on a class basis rather than using a single effluent number.

Community-based surveillance in internally displaced people\u2019s camps and urban settings during a complex emergency in Yemen in 2020

BackgroundThe need for early identification of coronavirus disease (COVID-19) cases in communities was high in Yemen during the first wave of the COVID-19 epidemic because most cases presenting to health facilities were severe. Early detection of cases would allow early interventions to interrupt the transmission chains. This study aimed to describe the implementation of community-based surveillance (CBS) in in internally displaced people (IDP) camps and urban settings in Yemen from 15 April 2020 to 30 September 2020.MethodsFollowing the Centers for Disease Control and Prevention guidance for evaluation of surveillance systems, we assessed the usefulness and acceptability of CBS. For acceptability, we calculated the proportion of trained volunteers who reported disease alerts. To assess the usefulness, we compared the alerts reported through the electronic diseases early warning system (eDEWS) with the alerts reported through CBS and described the response activities implemented.ResultsIn Al-Mukalla City, 18% (14/78) of the volunteers reported at least one alert. In IDP camps, 58% (18/31) of volunteers reported at least one alert. In Al-Mukalla City, CBS detected 49 alerts of influenza-like illness, whereas health facilities detected 561 cases of COVID-19. In IDP camps, CBS detected 91 alerts of influenza-like illness, compared to 10 alerts detected through eDEWS. In IDP camps, CBS detected three other syndromes besides influenza-like illness (febrile illness outbreak suspicion, acute diarrhoea, and skin disease). In IDP camps, public health actions were implemented for each disease detected and no further cases were reported.ConclusionsIn Yemen, CBS was useful for detecting suspected outbreaks in IDP camps. CBS implementation did not yield expected results in general communities in urban areas in the early stage of the COVID-19 pandemic when little was known about the disease. In the urban setting, the system failed to detect suspected COVID-19 cases and other diseases despite the ongoing outbreaks reported through eDEWS. In Yemen, as in other countries, feasibility and acceptability studies should be conducted few months before CBS expansion in urban communities. The project should be expanded in IDP camps, by creating COVID-19 and other disease outbreak reporting sites.

Analysis of Erythrocyte Indices of Children in Internally Displaced People Camp of Yola, Northeast Nigeria

Background/Objectives: Erythrocyte indices constitute important parameters useful in clinical care of children. Analysis of erythrocyte indices for children in IDP (Internally Displaced People) camps in Adamawa State like in most states in Nigeria was not fully studied. Therefore, this study aims to analyze the erythrocyte indices of children in Fufore IDP camp in Yola. Materials and Methods: This study enrolled 297 children (137 females and 160 males) in the camp with age range of 12 to 61 months old and 201 apparently healthy school children as control group. 3ml of blood were collected from children and transferred into K3-EDTA vacutainer tubes. Full blood count was determined within four hours of blood collection using the Sysmex XP300 hematological analyzer. Results: Mean erythrocyte count of subjects and control was 3.1 ± 0.7 X109/l and 4.3 ± 0.7 X109/l respectively at P&lt;0.05 and red cell distribution width (RDW) of subjects was 16.9% while that of control was 13.5%. Hemoglobin level of subject and control was 9.7 ± 1.1 g/dl and 12.4 ± 1.3 g/dl respectively. The mean Pack Cell Volume (PCV) of subjects was 32.7 ± 0.3% while the PCV of control group was 37.0 ± 0.2%. The Mean Cell Volume (MCV) of subject and control group was 74.8 ± 0.6 fl and 81 ± 0.5 fl respectively while Mean Cell Hemoglobin (MCH) of the control and subject group was 26.9 ± 0.9 pg and 27 ± 0.4 pg respectively at P&lt;0.05. Conclusion: Children in IDP camp had lower RBC count, PCV, MCV, Hemoglobin values and higher RDW value than the control group at P&lt;0.05. Hence microcytic and iron deficiency anemia was observed among children in Fufore IDP camp in Yola.

School Feeding Reduces Anemia Prevalence in Adolescent Girls and Other Vulnerable Household Members in a Cluster Randomized Controlled Trial in Uganda

ABSTRACTBackgroundFood for education (FFE) programs that include school meals are widely used to improve school participation and performance, but evidence on nutritional benefits is limited.ObjectiveThis study tested whether food fortified with multiple micronutrients provided in FFE programs reduced anemia prevalence of primary-school-age adolescent girls, adult women, and preschool children.MethodsThrough the use of a cluster randomized controlled trial with individual-level repeated cross-sectional data, we measured impacts on anemia prevalence from 2 FFE programs, a school feeding program (SFP) providing multiple-micronutrient-fortified meals and a nutritionally equivalent take-home ration (THR). Camps for internally displaced people (IDP) (n = 31) in Northern Uganda were randomly assigned to SFP, THR, or a control group with no FFE. Rations were provided for 15 mo at SFP and THR schools. A survey of households (n = 627) with children aged 6–17 y was conducted (baseline and 18 mo later). Analyses used difference-in-differences by intent to treat.ResultsAdolescent girls aged 10–13 y in FFE schools experienced a significant (P < 0.05) 25.7 percentage point reduction (95% CI: −0.43, −0.08) in prevalence of any anemia [hemoglobin (Hb) <11.5 g/dL, age 10–11 y; Hb <12 g/dL, age 12–13 y] and a significant 19.5 percentage point reduction (95% CI: −0.35, −0.04) in moderate-to-severe anemia (Hb <11 g/dL) relative to the control group, with no difference in impact between SFP and THR. The THR reduced moderate-to-severe anemia prevalence (Hb <11g/dL) of adult women aged ≥18 y (12.8 percentage points, 95% CI: −0.24, −0.02). All IDP camps initially received micronutrient-fortified rations through a separate humanitarian program; in one district where most households stopped receiving these rations, SFP reduced moderate-to-severe anemia of children aged 6–59 mo by 22.1 percentage points (95% CI: −0.42, −0.02).ConclusionsFFE programs reduced any anemia and moderate-to-severe anemia in primary-school-age adolescent girls and reduced moderate-to-severe anemia for adult women and preschool children. This study was registered with clinicaltrials.gov as NCT01261182.

Risk factors for asymptomatic malaria infections from seasonal cross-sectional surveys along the China\u2013Myanmar border

BackgroundBorder malaria, a shared phenomenon in the Greater Mekong Sub-region of Southeast Asia, is a major obstacle for regional malaria elimination. Along the China–Myanmar border, an additional problem arose as a result of the settlement of internally displaced people (IDP) in the border region. Since asymptomatic malaria significantly impacts transmission dynamics, assessment of the prevalence, dynamics and risk factors of asymptomatic malaria infections is necessary.MethodsCross-sectional surveys were carried out in 3 seasons (March and April, July and November) and 2 sites (villages and IDP camps) in 2015. A total of 1680 finger-prick blood samples were collected and used for parasite detection by microscopy and nested RT-PCR (nRT-PCR). Logistic regression models were used to explore the risk factors associated with asymptomatic malaria at individual and household levels.ResultsThe prevalence of asymptomatic Plasmodium infections was 23.3% by nRT-PCR, significantly higher than that detected by microscopy (1.5%). The proportions of Plasmodium vivax, Plasmodium falciparum and mixed-species infections were 89.6, 8.1 and 2.3%, respectively. Asymptomatic infections showed obvious seasonality with higher prevalence in the rainy season. Logistic regression analysis identified males and school children (≤ 15 years) as the high-risk populations. Vector-based interventions, including bed net and indoor residual spray, were found to have significant impacts on asymptomatic Plasmodium infections, with non-users of these measures carrying much higher risks of infection. In addition, individuals living in poorly constructed households or farther away from clinics were more prone to asymptomatic infections.ConclusionsSub-microscopic Plasmodium infections were highly prevalent in the border human populations from IDP camps and surrounding villages. Both individual- and household-level risk factors were identified, which provides useful information for identifying the high-priority populations to implement targeted malaria control.

The Traditional Methods of Dealing with Conflicts among IDPs in Duhok Governorate in Iraqi Kurdistan; including a case study of Yesidi mediators

The recent influx of internally displaced people (IDPs) into Kurdistan Region-Iraq with little hope of returning home has made peaceful coexistence within and between religious groups (both in host communities and IDP camps) a priority for local and international bodies. However, in Iraq, minority groups’ cultural norms lack representation in national laws and practices which are based in Islamic traditions and sometimes contradict minority religions’ customs and beliefs. This serves to undermine their traditions’ ability to confer the dignity and positive identity essential to a peaceful, stable society, and even to erode those traditions themselves to the point of extinction. &#x0D; Nevertheless, the practice of traditional methods of conflict resolution has shaped social interactions, bridging social divisions and enabling the mending of broken relations within and among groups. Based on a collaborative project (GIZ-funded and implemented by forumZFD and the University of Duhok in 2016) to promote social cohesion and identify conflict-resolution methods used by religious groups in six camps near Duhok, this paper focuses specifically on those of the Yesidiz. This religious group comprises about 85% of IDPs in the area and tends to experience most resentment in their adopted neighbourhoods; however, their use of traditional methods was found to be higher than other groups. Yezidi mediators include middle level and grassroots actors, making them well placed to be effective in peacebuilding because of their extensive interaction with disputing parties and their capacity to constantly adapt traditional methods to situations. &#x0D; After discussing the methods used generally by displaced religious minorities, the paper presents the characteristics of Yezidi mediators and concludes that these methods are essential to developing sustainable peace because Yezidis in Kurdistan are proud to conform to them, hence, helping to improve understanding and reduce resentment.&#x0D; KEYWORDS: Mediator, Traditional methods, IDPs, Conflict, Conflict resolution

An Instructional Design Model for Better Refugee and IDP Education

Education in refugee and internally displaced people (IDP) camps is out of the ordinary. Both teachers and students in these settings go through unimaginable experiences that need extreme measures to try to meet very basic educational needs as known in the fields of curriculum and instruction, and instructional design. This paper presents an instructional design model proposed for refugee and IDP education in Central Africa. It is based on a recent phenomenological study conducted in one refugee camp and one IDP camp in Central Africa. The paper starts with a synthesis of most common instructional design models that were part of a theoretical framework of a recent study on the lived experiences of teachers in refugee and IDP camps (Wa-Mbaleka, 2013). It briefly summarizes the findings of the study before presenting the proposed instructional design model.

EVALUATION OF COMMUNITY POLICING MODEL USED IN UNITED NATIONS AND AFRICAN UNION PEACEKEEPING MISSION IN DARFUR

ObjectiveTo carry out evaluation of Community Policing of United Nations and African Union Mission in Darfur(UNAMID) to assess its efficiency in establishing link between Internally Displaced People (IDPs) and GoS...

(P1-109) Violence, Health and Human Rights: Analysis of the Right to Health for Conflict Displaced Persons Living In IDP Camps in Northern Sri Lanka

This presentation explores the nexus between collective violence (in the form of violent civil conflict) and health and human rights in Sri Lanka, focusing specifically on persons displaced during the most recent conflict in Northern Sri Lanka beginning in November 2008. After exploring the normative framework in relation to the right to health, the local legal framework governing internal displacement, and the related component on healthcare access, service provision, and standards will be described. By examining health cluster reports, health surveys, and case-studies, this presentation describes how the health sector responded in providing healthcare services to those war displaced living in internally displaced people (IDP) camps in Vavuniya District. The “rights based approach to health” is examined in relation to the health sector response, and key issues and challenges in meeting health protection needs are highlighted. A conceptual framework on the right to health for IDPs in Northern Sri Lanka is presented. This presentation also explores how some health interventions in the post-conflict Sri Lankan context may have acted as a bridge for peace building and reconciliation.

Bacteriological quality of drinking water in Nyala, South Darfur, Sudan

The objective of this study was to determine the bacterial contaminations in drinking water in Nyala city, South Darfur, Sudan with special reference to the internally displaced people camps (IDPs). Two hundred and forty water samples from different sites and sources including bore holes, hand pumps, dug wells, water points, water reservoir and household storage containers were collected in 2009. The most probable number method was used to detect and count the total coliform, faecal coliform and faecal enterococci. Results revealed that the three indicators bacteria were abundant in all sources except water points. Percentages of the three indicators bacteria count above the permissible limits for drinking water in all samples were 46.4% total coliform, 45.2% faecal coliform and 25.4% faecal enterococci whereas the highest count of the indicators bacteria observed was 1,600U/100ml water. Enteric bacteria isolated were Escherichia coli (22.5%), Enterococcus faecalis (20.42%), Klebsiella (15.00%), Citrobacter (2.1%) and Enterobacter (3.33%). The highest contamination of water sources was observed in household storage containers (20%) followed by boreholes (11.25%), reservoirs (6.24%), hand pumps (5.42%) and dug wells (2.49%). Contamination varied from season to season with the highest level in autumn (18.33%) followed by winter (13.75%) and summer (13.32%), respectively. All sources of water in IDP camps except water points were contaminated. Data suggested the importance of greater attention for household contamination, environmental sanitation control and the raise of awareness about water contamination.

Malaria control in Timor-Leste during a period of political instability: what lessons can be learned?

BackgroundMalaria is a major global health problem, often exacerbated by political instability, conflict, and forced migration.ObjectivesTo examine the impact of political upheaval and population displacement in Timor-Leste (2006) on malaria in the country.MethodCase study approach drawing on both qualitative and quantitative methods including document reviews, in-depth interviews, focus group discussions, site visits and analysis of routinely collected data.FindingsThe conflict had its most profound impact on Dili, the capital city, in which tens of thousands of people were displaced from their homes. The conflict interrupted routine malaria service programs and training, but did not lead to an increase in malaria incidence. Interventions covering treatment, insecticide treated nets (ITN) distribution, vector control, surveillance and health promotion were promptly organized for internally displaced people (IDPs) and routine health services were maintained. Vector control interventions were focused on IDP camps in the city rather than on the whole community. The crisis contributed to policy change with the introduction of Rapid Diagnostic Tests and artemether-lumefantrine for treatment.ConclusionsAlthough the political crisis affected malaria programs there were no outbreaks of malaria. Emergency responses were quickly organized and beneficial long term changes in treatment and diagnosis were facilitated.

Hydrological modeling of geophysical parameters of arboviral and protozoan disease vectors in Internally Displaced People camps in Gulu, Uganda

BackgroundThe aim of this study was to determine if remotely sensed data and Digital Elevation Model (DEM) can test relationships between Culex quinquefasciatus and Anopheles gambiae s.l. larval habitats and environmental parameters within Internally Displaced People (IDP) campgrounds in Gulu, Uganda. A total of 65 georeferenced aquatic habitats in various IDP camps were studied to compare the larval abundance of Cx. quinquefasciatus and An. gambiae s.l. The aquatic habitat dataset were overlaid onto Land Use Land Cover (LULC) maps retrieved from Landsat imagery with 150 m × 150 m grid cells stratified by levels of drainage. The LULC change was estimated over a period of 14 years. Poisson regression analyses and Moran's I statistics were used to model relationships between larval abundance and environmental predictors. Individual larval habitat data were further evaluated in terms of their covariations with spatial autocorrelation by regressing them on candidate spatial filter eigenvectors. Multispectral QuickBird imagery classification and DEM-based GIS methods were generated to evaluate stream flow direction and accumulation for identification of immature Cx. quinquefasciatus and An. gambiae s.l. and abundance.ResultsThe main LULC change in urban Gulu IDP camps was non-urban to urban, which included about 71.5 % of the land cover. The regression models indicate that counts of An. gambiae s.l. larvae were associated with shade while Cx. quinquefasciatus were associated with floating vegetation. Moran's I and the General G statistics for mosquito density by species and instars, identified significant clusters of high densities of Anopheles; larvae, however, Culex are not consistently clustered. A stepwise negative binomial regression decomposed the immature An. gambiae s.l. data into empirical orthogonal bases. The data suggest the presence of roughly 11% to 28 % redundant information in the larval count samples. The DEM suggest a positive correlation for Culex (0.24) while for Anopheles there was a negative correlation (-0.23) for a local model distance to stream.ConclusionThese data demonstrate that optical remote sensing; geostatistics and DEMs can be used to identify parameters associated with Culex and Anopheles aquatic habitats.

Adherence of community caretakers of children to pre-packaged antimalarial medicines (HOMAPAK®) among internally displaced people in Gulu district, Uganda

BackgroundIn 2002, home-based management of fever (HBMF) was introduced in Uganda, to improve access to prompt, effective antimalarial treatment of all fevers in children under 5 years. Implementation is through community drug distributors (CDDs) who distribute pre-packaged chloroquine plus sulfadoxine-pyrimethamine (HOMAPAK®) free of charge to caretakers of febrile children. Adherence of caretakers to this regimen has not been studied.MethodsA questionnaire-based survey combined with inspection of blister packaging was conducted to investigate caretakers' adherence to HOMAPAK®. The population surveyed consisted of internally displaced people (IDPs) from eight camps.ResultsA total of 241 caretakers were interviewed. 95.0% (CI: 93.3% – 98.4%) of their children had received the correct dose for their age and 52.3% of caretakers had retained the blister pack. Assuming correct self-reporting, the overall adherence was 96.3% (CI: 93.9% – 98.7%). The nine caretakers who had not adhered had done so because the child had improved, had vomited, did not like the taste of the tablets, or because they forgot to administer the treatment. For 85.5% of cases treatment had been sought within 24 hours. Blister packaging was considered useful by virtually all respondents, mainly because it kept the drugs clean and dry. Information provided on, and inside, the package was of limited use, because most respondents were illiterate. However, CDDs had often told caretakers how to administer the treatment. For 39.4% of respondents consultation with the CDD was their reported first action when their child has fever and 52.7% stated that they consult her/him if the child does not get better.ConclusionIn IDP camps, the HBMF strategy forms an important component of medical care for young children. In case of febrile illness, most caretakers obtain prompt and adequate antimalarial treatment, and adhere to it. A large proportion of malaria episodes are thus likely to be treated before complications can arise. Implementation in the IDP camps now needs to focus on improving monitoring, supervision and general support to CDDs, as well as on targeting them and caretakers with educational messages. The national treatment policy for uncomplicated malaria has recently been changed to artemether-lumefantrine. Discussions on a suitable replacement combination for HBMF are well advanced, and have raised new questions about adherence.