We have looked at the exacerbation of malaria in conflict situations before, and unfortunately will probably need to look at the issue again.Â A new article in Malaria Journal shows that even when refugees escape from the conflict zone, they may still be confronted by malaria in their camps.
Bayoh and colleagues looked at Kakuma refugee situated in Turkana District in the semi-arid north-west region of Kenya, an area that is normally not too hospitable to malaria. The researchers found that human activity was responsible for mosdquitoe breeding. “All of the habitats encountered in the dry season were associated directly with tap-stands, and were either cemented pits, soil-lined pits, drainage channels, or run-off puddles whose water source was from the tap-stands.”
Even in the short rainy season, “The habitats encountered … were primarily maintained by water from tap-stands.” These included cemented pits, soil-lined pits, drainage channels, and run-off puddles (90% of all habitats). Transportation lent a hand through wet tire tracks and roadside puddles.
The researchers in Kakuma were aided by rapid diagnostic tests and microscopy in diagnosing and subsequently treating those suffering from malaria.Â This is not always the case. Akello-Ayebara and co-workers documented inappropriate treatment of refugee children in northern Uganda. Obviously self-diagnosis presented problems, but misdiagnosis by local health care providers was common.
They concluded that, “The local diagnostic system needs to be improved, not only so that malaria can be reliably diagnosed but also so that alternative diagnoses can be confirmed or rejected, otherwise the current over-consumption of antimalarial drugs may simply be replaced with an over-consumption of antibiotics.”
Malaria problems for refugees are not confined to Africa. Basseri and colleagues document that in Asia refugees coming into a malaria endemic area are less likely to have protective measures like nets than the indigenous population.
The last two examples clearly show the disadvantage that refugees have when trying to survive among the indigenous populations where they have fled. The Kakuma example is more depressing in that circumstances in camps where refugees are supposed to be safe actually expose them to malaria risk.Â Overall, this is a neglected population, and unless attention is paid to conflicts and the peoples displaced by conflict, malaria cannot be eliminated.