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Mertens JE. A History of Malaria and Conflict. Parasitol Res 2024; 123:165. [PMID: 38504009 PMCID: PMC10951023 DOI: 10.1007/s00436-024-08167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
It is supposed that in all armed conflicts until World War II more humans died of infectious diseases than of the actual violence. Especially malaria left a crucial imprint on wars throughout history. The disease aggravates wartime conditions, is thus responsible for significant morbidity and mortality in conflict zones, and is at the same time more commonly found in these areas. Malaria has halted many military campaigns in the past, with prominent examples ranging from antiquity through the medieval period and into the modern era. The parasitosis still continues to play an important role in the outcome of warfare and follow-up events today and is of special public health importance in areas of the Global South, where most of its endemicity and some of the most brutal conflicts of our time are located. Vice versa, wars and ensuing population movements increase malaria transmission and morbidity as well as impede control efforts. Awareness of this and the development of strategies to overcome both malaria and wars will massively improve the well-being of the population affected.
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Affiliation(s)
- Jonas E Mertens
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Semakula HM, Liang S, Mukwaya PI, Mugagga F, Swahn M, Nseka D, Wasswa H, Kayima P. Determinants of malaria infections among children in refugee settlements in Uganda during 2018-2019. Infect Dis Poverty 2023; 12:31. [PMID: 37032366 PMCID: PMC10084630 DOI: 10.1186/s40249-023-01090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/29/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND While 5% of 247 million global malaria cases are reported in Uganda, it is also a top refugee hosting country in Africa, with over 1.36 million refugees. Despite malaria being an emerging challenge for humanitarian response in refugee settlements, little is known about its risk factors. This study aimed to investigate the risk factors for malaria infections among children under 5 years of age in refugee settlements in Uganda. METHODS We utilized data from Uganda's Malaria Indicator Survey which was conducted between December 2018 and February 2019 at the peak of malaria season. In this national survey, household level information was obtained using standardized questionnaires and a total of 7787 children under 5 years of age were tested for malaria using mainly the rapid diagnostic test. We focused on 675 malaria tested children under five in refugee settlements located in Yumbe, Arua, Adjumani, Moyo, Lamwo, Kiryadongo, Kyegegwa, Kamwenge and Isingiro districts. The extracted variables included prevalence of malaria, demographic, social-economic and environmental information. Multivariable logistic regression was used to identify and define the malaria associated risk factors. RESULTS Overall, malaria prevalence in all refugee settlements across the nine hosting districts was 36.6%. Malaria infections were higher in refugee settlements located in Isingiro (98.7%), Kyegegwa (58.6%) and Arua (57.4%) districts. Several risk factors were significantly associated with acquisition of malaria including fetching water from open water sources [adjusted odds ratio (aOR) = 1.22, 95% CI: 0.08-0.59, P = 0.002], boreholes (aOR = 2.11, 95% CI: 0.91-4.89, P = 0.018) and water tanks (aOR = 4.47, 95% CI: 1.67-11.9, P = 0.002). Other factors included pit-latrines (aOR = 1.48, 95% CI: 1.03-2.13, P = 0.033), open defecation (aOR = 3.29, 95% CI: 1.54-7.05, P = 0.002), lack of insecticide treated bed nets (aOR = 1.15, 95% CI: 0.43-3.13, P = 0.003) and knowledge on the causes of malaria (aOR = 1.09, 95% CI: 0.79-1.51, P = 0.005). CONCLUSIONS The persistence of the malaria infections were mainly due to open water sources, poor hygiene, and lack of preventive measures that enhanced mosquito survival and infection. Malaria elimination in refugee settlements requires an integrated control approach that combines environmental management with other complementary measures like insecticide treated bed nets, indoor residual spraying and awareness.
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Affiliation(s)
- Henry Musoke Semakula
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P. O Box 7062, Kampala, Uganda.
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, 2055 Mowry Rd, Gainesville, FL, 32610, USA.
| | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, 2055 Mowry Rd, Gainesville, FL, 32610, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Paul Isolo Mukwaya
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Frank Mugagga
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Monica Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, NW, USA
| | - Denis Nseka
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Hannington Wasswa
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Patrick Kayima
- Department of Geography, Geo-informatics and Climatic Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
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Messenger LA, Furnival-Adams J, Chan K, Pelloquin B, Paris L, Rowland M. Vector control for malaria prevention during humanitarian emergencies: a systematic review and meta-analysis. Lancet Glob Health 2023; 11:e534-e545. [PMID: 36925174 DOI: 10.1016/s2214-109x(23)00044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Humanitarian emergencies can lead to population displacement, food insecurity, severe health system disruptions, and malaria epidemics among individuals who are immunologically naive. We aimed to assess the impact of different vector control interventions on malaria disease burden during humanitarian emergencies. METHODS In this systematic review and meta-analysis, we searched ten electronic databases and two clinical trial registries from database inception to Oct 19, 2020, with no restrictions on language or study design. We also searched grey literature from 59 stakeholders. Studies were eligible if the population was affected by a humanitarian emergency in a malaria endemic region. We included studies assessing any vector control intervention and in which the primary outcome of interest was malaria infection risk. Reviewers (LAM, JF-A, KC, BP, and LP) independently extracted information from eligible studies, without masking of author or publication, into a database. We did random-effects meta-analyses to calculate pooled risk ratios (RRs) for randomised controlled trials, odds ratios (ORs) for dichotomous outcomes, and incidence rate ratios (IRR) for clinical malaria in non-randomised studies. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This study is registered with PROSPERO, CRD42020214961. FINDINGS Of 12 475 studies screened, 22 studies were eligible for inclusion in our meta-analysis. All studies were conducted between Sept 1, 1989, and Dec 31, 2018, in chronic emergencies, with 616 611 participants from nine countries, evaluating seven different vector control interventions. Insecticide-treated nets significantly decreased Plasmodium falciparum incidence (RR 0·55 [95% CI 0·37-0·79]; high certainty) and Plasmodium vivax incidence (RR 0·69 [0·51-0·94]; high certainty). Evidence for an effect of indoor residual spraying on P falciparum (IRR 0·57 [95% CI 0·53-0·61]) and P vivax (IRR 0·51 [0·49-0·52]) incidence was of very low certainty. Topical repellents were associated with reductions in malaria infection (RR 0·58 [0·35-0·97]; moderate certainty). Moderate-to-high certainty evidence for an effect of insecticide-treated chaddars (equivalent to shawls or blankets) and insecticide-treated cattle on malaria outcomes was evident in some emergency settings. There was very low certainty evidence for the effect of insecticide-treated clothing. INTERPRETATION Study findings strengthen and support WHO policy recommendations to deploy insecticide-treated nets during chronic humanitarian emergencies. There is an urgent need to evaluate and adopt novel interventions for malaria control in the acute phase of humanitarian emergencies. FUNDING WHO Global Malaria Programme.
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Affiliation(s)
- Louisa A Messenger
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA.
| | - Joanna Furnival-Adams
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Kallista Chan
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Bethanie Pelloquin
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; School of Tropical Medicine and Global Health, University of Nagasaki, Nagasaki, Japan
| | | | - Mark Rowland
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Allan R, Weetman D, Sauskojus H, Budge S, Hawail TB, Baheshm Y. Confirmation of the presence of Anopheles stephensi among internally displaced people's camps and host communities in Aden city, Yemen. Malar J 2023; 22:1. [PMID: 36593465 PMCID: PMC9806911 DOI: 10.1186/s12936-022-04427-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Declines in global malaria cases and deaths since the millennium are currently challenged by multiple factors including funding limitations, limits of, and resistance to vector control tools, and also recent spread of the invasive vector species, Anopheles stephensi-especially into novel urban settings where malaria rates are typically low. Coupled with general increases in urbanization and escalations in the number of conflicts creating rapid and unplanned population displacement into temporary shelter camps within host urban areas, particularly in the Middle East and sub-Saharan Africa, increased urban malaria is a major threat to control and elimination. METHODS Entomological monitoring surveys (targeting Aedes aegypti) of water containers across urban areas hosting internally displaced people (IDP) communities in Aden city, Yemen, were performed by The MENTOR Initiative, a non-governmental organisation. As part of these surveys in 2021 23 larvae collected and raised to adults were morphologically identified as An. stephensi. Twelve of the samples were sent to Liverpool School of Tropical Medicine for independent morphological assessment and genetic analysis by sequencing the ribosomal ITS2 region and the mitochondrial COI gene. RESULTS All twelve samples were confirmed morphologically and by sequence comparison of the single ITS2 and COI haplotype detected to the NCBI BLAST database as An. stephensi. Phylogenetic analysis with comparable COI sequences indicated close relationship to haplotypes found in Djibouti and Ethiopia. CONCLUSION The study results confirm the presence of An. stephensi in Yemen. Confirmation of the species in multiple urban communities hosting thousands of IDPs living in temporary shelters with widescale dependency on open water containers is of particular concern due to the vulnerability of the population and abundance of favourable breeding sites for the vector. Proactive monitoring and targeted integrated vector management are required to limit impacts in this area of typically low malaria transmission, and to prevent further the spread of An. stephensi within the region.
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Affiliation(s)
- Richard Allan
- The MENTOR Initiative, Burns House, Harlands Road, Haywards Heath, RH16 1PG UK
| | - David Weetman
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Hendrik Sauskojus
- The MENTOR Initiative, Burns House, Harlands Road, Haywards Heath, RH16 1PG UK
| | - Sophie Budge
- The MENTOR Initiative, Burns House, Harlands Road, Haywards Heath, RH16 1PG UK
| | - Tarek Bin Hawail
- The MENTOR Initiative, Burns House, Harlands Road, Haywards Heath, RH16 1PG UK
| | - Yasser Baheshm
- Ministry of Health in Yemen, National Malaria Control Programme, Aden, Yemen
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