1
|
Yu Q, Qu Y, Zhang L, Yao X, Yang J, Chen S, Liu H, Wang Q, Wu M, Tao J, Zhou C, Alage IL, Liu S. Spatial spillovers of violent conflict amplify the impacts of climate variability on malaria risk in sub-Saharan Africa. Proc Natl Acad Sci U S A 2024; 121:e2309087121. [PMID: 38557184 PMCID: PMC11009658 DOI: 10.1073/pnas.2309087121] [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: 05/31/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
Africa carries a disproportionately high share of the global malaria burden, accounting for 94% of malaria cases and deaths worldwide in 2019. It is also a politically unstable region and the most vulnerable continent to climate change in recent decades. Knowledge about the modifying impacts of violent conflict on climate-malaria relationships remains limited. Here, we quantify the associations between violent conflict, climate variability, and malaria risk in sub-Saharan Africa using health surveys from 128,326 individuals, historical climate data, and 17,429 recorded violent conflicts from 2006 to 2017. We observe that spatial spillovers of violent conflict (SSVCs) have spatially distant effects on malaria risk. Malaria risk induced by SSVCs within 50 to 100 km from the households gradually increases from 0.1% (not significant, P>0.05) to 6.5% (95% CI: 0 to 13.0%). SSVCs significantly promote malaria risk within the average 20.1 to 26.9 °C range. At the 12-mo mean temperature of 22.5 °C, conflict deaths have the largest impact on malaria risk, with an approximately 5.8% increase (95% CI: 1.0 to 11.0%). Additionally, a pronounced association between SSVCs and malaria risk exists in the regions with 9.2 wet days per month. The results reveal that SSVCs increase population exposure to harsh environments, amplifying the effect of warm temperature and persistent precipitation on malaria transmission. Violent conflict therefore poses a substantial barrier to mosquito control and malaria elimination efforts in sub-Saharan Africa. Our findings support effective targeting of treatment programs and vector control activities in conflict-affected regions with a high malaria risk.
Collapse
Affiliation(s)
- Qiwei Yu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Ying Qu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Liqiang Zhang
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Xin Yao
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Jing Yang
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Siyuan Chen
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Hui Liu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Qihao Wang
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Mengfan Wu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Junpei Tao
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Chenghu Zhou
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Science and Natural Resources, Chinese Academy of Sciences, Beijing100101, China
| | - Isiaka Lukman Alage
- Space Research and Development Division, African Regional Centre for Space Science and Technology Education in English Ile ife, Ile ife, Osun220282, Nigeria
| | - Suhong Liu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| |
Collapse
|
2
|
Pattanshetty S, Dsouza VS, Shekharappa A, Yagantigari M, Raj R, Inamdar A, Alsamara I, Rajvanshi H, Brand H. A Scoping Review on Malaria Prevention and Control Intervention in Fragile and Conflict-Affected States (FCAS): A Need for Renewed Focus to Enhance International Cooperation. J Epidemiol Glob Health 2024; 14:4-12. [PMID: 38224386 PMCID: PMC11043240 DOI: 10.1007/s44197-023-00180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024] Open
Abstract
Malaria is a major public health problem in developing countries. The burden of malaria in fragile and conflict-affected states (FCAS) is increasing year by year. Moreover, the population living in FCAS is often the most vulnerable and at high risk of malaria due to factors, such as deteriorating healthcare system, mass relocations, and reduced resilience to shocks. Therefore, this scoping review aims to map the interventions that are conducted at the FCAS on malaria prevention among the general population. In addition, this review can help policy-makers and international health bodies, providing a comprehensive overview that can lead to more targeted, effective, and context-specific interventions. Databases, such as PubMed, EBSCO-CINAHL, Web of Science, ProQuest, and Cochrane Central Register of Controlled Trials, were searched using specified search terms. A total of 3601 studies were retrieved from the search. After screening, 62 studies were included in the synthesis that met the eligibility criteria. Narrative analysis of the findings was done. The results revealed that in fragile countries, interventions for children below 5 years of age included IPTi, TDA, and ACT. In conflicted countries, interventions for children below 5 years of age included TDA, LLINs, SMC, drug trials, and vaccination. Similar interventions were reported for other age groups and populations. Despite ongoing conflicts, malaria interventions have been maintained in these countries, but a persistent high burden of malaria remains. To achieve the goals of malaria elimination, the results of the review highlight the need for continued research and evaluation of malaria control interventions to assess their effectiveness and impact. Strengthening health systems, building partnerships, utilizing digital health technologies, and conducting context-specific research are recommended to improve healthcare access and reduce the burden of malaria in FCAS.
Collapse
Affiliation(s)
- Sanjay Pattanshetty
- Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of International Health, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute-CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Viola Savy Dsouza
- Centre for Regulatory Science, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Anupama Shekharappa
- Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Rohit Raj
- Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Jamshedpur, India
| | - Aniruddha Inamdar
- Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Issam Alsamara
- Department of International Health, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute-CAPHRI, Maastricht University, Maastricht, The Netherlands
| | | | - Helmut Brand
- Department of International Health, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute-CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|