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The number of refugees fleeing conflict to seek shelter in neighbouring countries peaked at 18.2 million in 1993. A further 24 million were estimated to be internally displaced. The risk of malaria is often high among refugees in tropical countries. What strategies should be used to protect them?
These questions are addressed through research by Health-Net International among Afghan refugees at the Pakistan-Afghanistan border and by the Shoklo Malaria Research Unit among Karen refugees at the Thailand-Myanmar border.
The main reasons why malaria flourishes in conditions of crisis and population displacement are:
The challenges posed by the epidemiology of malaria in these two refugee populations demand different strategies. The Afghan refugees had little or no immunity when they arrived at camps sited on land prone to mosquito breeding. Nomadic refugees may transport malaria to unaffected areas, are hard to follow up, and cannot be protected by house spraying of insecticide. Different strategies were used to prevent and control malaria in the camps, depending on the situation:
In Karen camps in Thailand in the late 1980s, malaria was the biggest cause of illness and mortality (15 percent of deaths). The burden was especially heavy in pregnancy. An estimated one percent of all pregnant women in the camps died of cerebral malaria each year. The malaria parasite, P. falciparum, is fully resistant to chloroquine and sulfadoxine-pyrimethamine in south-east Asia. In these camps:
The authors recommend that:
Source(s):
'Malaria epidemiology and control in refugee camps and complex
emergencies', Annals of Tropical Medicine and Parasitology 95 (8): 741-754, by
M.Rowland and F. Nosten, 2001
Funded by: European Commission; UNHCR; WHO/UNDP/World Bank Special Programme for Research and Training in Tropical Diseases; UK Department for International Development; Gates Foundation; Wellcome Trust
id21 Research Highlight: 08 May 2002
Further Information:
Mark Rowland
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK
Tel:
+44 (0)20 7299 4708
Fax:
+44 (0)20 7580 9075
Contact the contributor: mark.rowland@lshtm.ac.uk
London School of Hygiene and Tropical Medicine, UK
Francois Nosten
Shoklo Malaria Research Unit
736/2 Intrakiri Road
P.O Box 46
Mae Sod 63110
Tak
Thailand
Tel:
+66 55 531531
Fax:
+66 55 535440
Contact the contributor: shoklo@cscoms.com
Shoklo Malaria Research Unit, Thailand
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