Epidemic malaria in a protracted refugee situation: implications for prevention and control Open Access

Sonaty, Griffin Thomas (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/jh343s72z?locale=en
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Abstract

Background: Malaria is a risk to many in refugee settlements in sub-Saharan Africa. Population movement, food insecurity, and lack of sustained preventive measures can coalesce with environmental factors suitable for malaria transmission to enable epidemics in semi-arid regions. Displacement crises present challenges in epidemic detection and response, and few studies have examined the morbidity, mortality, and case management of malaria in refugee settlements. The purpose of this assessment was to describe the epidemiology of malaria in Kakuma refugee camp in the context of an upsurge in late 2015 following El Niño rains to inform recommendations for prevention and control.

Results: Malaria incidence rate for December 2015 and January 2016 exceeded a 5-year C-SUM epidemic threshold. From January 2010 to July 2016, monthly malaria incidence rate increased, on average, by 0.0165 cases per 1,000 persons per month, (R2 = 0.134, p < 0.0001). A census of clinic registers from December 2015 and January 2016 revealed heterogeneities in confirmed malaria burden across age, sex, and location of residence: those aged 12-17 were at the highest risk compared to adults aged 18-59, OR=2.57 (95% CI: 2.47-2.67). Males were at higher risk compared to females, OR=1.16 (95% CI: 1.12-1.19). Hot spots of malaria incidence among refugees under five were detected in Kakuma I sub-camp using Anselin Moran's I at a fixed-distance band value of 585 m. Differential management of malaria cases was observed across the six outpatient clinics in Kakuma.

Conclusions: Epidemic malaria was detected in a semi-arid protracted displacement crisis following climatic abnormalities and reports of food insecurity. Geographic and demographic heterogeneities were detected, but incidence was high throughout the camp. Intervention measures should include universal coverage and community promotion of long-lasting insecticidal nets; clinician refresher training on malaria case management; monitoring of malaria diagnostic and therapeutic stocks; and vector control, such as indoor residual spraying, to decrease the baseline malaria incidence.

Table of Contents


Chapter 1. Introduction....................1
Chapter 2. Review of Literature.........7
Chapter 3. Manuscript.....................18
Background...................................21
Methods........................................22
Results..........................................26
Discussion.....................................31
Conclusions...................................35
References....................................36
Figures..........................................45
Chapter 4. Conclusion and Recommendations...50
Appendix 1....................................55

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