A Venue Based Assessment of Malaria and Health Needs among Migrant Farm Workers in Ethiopia Público

Abstract

Abstract

A Venue Based Assessment of Malaria and Health Needs among Migrant Farm Workers in Ethiopia

By Rebekah Stewart Schicker

Background : Mobile populations present unique challenges to malaria control and elimination efforts. Each year, a large number of individuals travel to northwest Amhara Region, Ethiopia to seek seasonal employment on large-scale farms. Agricultural areas typically report the heaviest malaria burden within Amhara and migrant workers are likely at significant risk for infection. Yet little is known about them, including migration patterns, access to, and use of malaria prevention measures, housing accommodations, health care access and treatment-seeking behavior.

Methods and Findings :In July 2013, we conducted a venue-based survey of 605 migrant farmers in two districts of North Gondar, Amhara Region. Nearly all were male (97.7%); mean age was 22.8 years. Nearly all (95.6%) came from within Amhara Region, with more than half (51.6%) coming from within North Gondar zone. Most (76.9%) arrived in June or July, and 45.6% intended to leave in September. Around half (51.2%) lived in temporary shelters, while 20.5% slept outside. Only 11.9% of participants had access to an LLIN in the study area. Reported net use last night was 74.6% among those with net access and 8.8% overall. Plasmodium prevalence by rapid diagnostic test (RDT) was 12.0%; 28.4% were anemic (hemoglobin [Hb] <13 g/dl). Nearly one-third (30.1%) reported having fever within the past two weeks, of whom 31.3% sought treatment. Distance to a healthcare facility and cost were important reported barriers to seeking treatment.

Conclusions : The study population was found to be young and originate from relatively proximate areas. High prevalence of malaria and anemia were observed. Despite adequate malaria knowledge, low access to LLINs and transient sleeping arrangements place migrant farms workers at significant risk of malaria. Moreover, their access to care is limited, and they reportedly face substantial barriers to seeking appropriate healthcare while engaged in farm labor. Targeted interventions are needed to reduce the burden of malaria in this population.

Table of Contents

Table of Contents

CHAPTER 1: INTRODUCTION & LITERATURE REVIEW...................................................................................................................................................................................................................................................1

STUDY OBJECTIVE AND AIMS............................................................................................................................................................................................................................................................................10

CHAPTER 2: MANUSCRIPT....................................................................................................................................................................................................................................................................................................13

TITLE PAGE..............................................................................................................................................................................................................................................................................................................14

STUDENT CONTRIBUTION...................................................................................................................................................................................................................................................................................15

ABSTRACT................................................................................................................................................................................................................................................................................................................16

INTRODUCTION........................................................................................................................................................................................................................................................................................................17

MATERAL & METHODS.........................................................................................................................................................................................................................................................................................20

Study Area...................................................................................................................................................................................................................................................................................................20

Study Design & Venue Selection.................................................................................................................................................................................................................................................................20

Data Collection...........................................................................................................................................................................................................................................................................................22

Blood Testing...............................................................................................................................................................................................................................................................................................22

Sample Size Determination.........................................................................................................................................................................................................................................................................23

Data Analysis..............................................................................................................................................................................................................................................................................................23

Ethics Statement..........................................................................................................................................................................................................................................................................................23

RESULTS....................................................................................................................................................................................................................................................................................................................25

Survey Population.......................................................................................................................................................................................................................................................................................25

Demographics.............................................................................................................................................................................................................................................................................................25

Travel History.............................................................................................................................................................................................................................................................................................26

Malaria Risk Factors and Prevention Measures........................................................................................................................................................................................................................................27

Prevalence of Plasmodium Infection..........................................................................................................................................................................................................................................................27

Unadjusted Odds Ratio of Migration Variables association with Plasmodium Infection.............................................................................................................................................................................27

Prevalence of Anemia....................................................................................................................................................................................................................................................................................28

Malaria Knowledge.......................................................................................................................................................................................................................................................................................29

Health Care Concerns, Access and Care-Seeking Behavior.........................................................................................................................................................................................................................29

DISCUSSION..............................................................................................................................................................................................................................................................................................................30

Limitations..................................................................................................................................................................................................................................................................................................34

Conclusion..................................................................................................................................................................................................................................................................................................37

MANUSCRIPT REFERENCES................................................................................................................................................................................................................................................................................38

TABLES & FIGURES................................................................................................................................................................................................................................................................................................................43

TABLE 1: CHARACTERISTICS OF MIGRANT FARM WORKERS....................................................................................................................................................................................................................43

TABLE 2: MIGRATIONS PATTERNS OF MIGRANT FARM WORKERS...........................................................................................................................................................................................................44

TABLE 3: MALARIA RISK FACTORS AND PREVENTION MEASURES.........................................................................................................................................................................................................45

TABLE 4: RDT DIAGNOSED PLASMODIUM INFECTION................................................................................................................................................................................................................................46

TABLE 5: WOREDA BY PLASMODIUM INFECTION........................................................................................................................................................................................................................................46

TABLE 6: PLASMODIUM INFECTION BY AGE...................................................................................................................................................................................................................................................45

TABLE 7: UNADJUSTED ODDS RATIO OF MIGRATION VARIABLES WITH PLASMODIUM ASSOCIATION..........................................................................................................................................47

TABLE 8: ANEMIA PREVALENCE BY SEVERITY..............................................................................................................................................................................................................................................47

FIGURE 1: HOME AREA OF MIGRANT FARM WORKERS BY PERCENTAGE..............................................................................................................................................................................................48

CHAPTER 3: PUBLIC HEALTH IMPLICATIONS AND RECOMMENDATIONS.............................................................................................................................................................................................................49

REFERENCES FOR COMPLETE THESIS.............................................................................................................................................................................................................................................................................55

APPENDICES...........................................................................................................................................................................................................................................................................................................................61

APPENDIX 1: SURVEY TOOL WITH CODE........................................................................................................................................................................................................................................................61

APPENDIX 2: CONSENT FORMS..........................................................................................................................................................................................................................................................................79

Verbal Informed Consent for Interview......................................................................................................................................................................................................................................................79

Verbal Informed Consent for Malaria and Anemia Testing.......................................................................................................................................................................................................................83

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Palabra Clave	mobile populations migrants Ethiopia malaria venue-based sampling
Committee Chair / Thesis Advisor	Stephenson, Robert, Emory University
Committee Members	McFarland, Deborah A, Emory University Noland, Gregory S, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) International Non-governmental organization (e.g., CARE, Inc.)

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