Discourse on malaria elimination: Where do forcibly displaced persons fit in these discussions?

Malaria Journal (Impact Factor: 3.11). 04/2013; 12(1):121. DOI: 10.1186/1475-2875-12-121
Source: PubMed


Individuals forcibly displaced are some of the poorest people in the world, living in areas where infrastructure and services are at a bare minimum. Out of a total of 10,549,686 refugees protected and assisted by the United Nations High Commissioner for Refugees globally, 6,917,496 (65.6%) live in areas where malaria is transmitted. Historically, national malaria control programmes have excluded displaced populations.

The current discourse on malaria elimination rarely includes discussion of forcibly displaced persons who reside within malaria-eliminating countries. Of the 100 malaria-endemic countries, 64 are controlling malaria and 36 are in some stage of elimination. Of these, 30 malaria-controlling countries and 13 countries in some phase of elimination host displaced populations of ≥50,000, even though 13 of the 36 (36.1%) malaria-elimination countries host displaced populations of ≥50,000 people.

Now is the time for the malaria community to incorporate forcibly displaced populations residing within malarious areas into malaria control activities. Beneficiaries, whether they are internally displaced persons or refugees, should be viewed as partners in the delivery of malaria interventions and not simply as recipients.

Until equitable and sustainable malaria control includes everyone residing in an endemic area, the goal of malaria elimination will not be met.

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    • "These displaced people play an important role in the transmission of malaria due to inadequate control and preventive measures. The displaced people face unreliable access to basic services including health care (Williams et al., 2013). People living in conflict zones, such as the Karen, have higher mortality rates irrespective of malaria incidence (Lee et al., 2006). "
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    ABSTRACT: Movement of malaria across international borders poses a major obstacle to achieving malaria elimination in the 34 countries that have committed to this goal. In border areas, malaria prevalence is often higher than in other areas due to lower access to health services, treatment-seeking behaviour of marginalized populations that typically inhabit border areas, difficulties in deploying prevention programmes to hard-to-reach communities, often in difficult terrain, and constant movement of people across porous national boundaries. Malaria elimination in border areas will be challenging and key to addressing the challenges is strengthening of surveillance activities for rapid identification of any importation or reintroduction of malaria. This could involve taking advantage of technological advances, such as spatial decision support systems, which can be deployed to assist programme managers to carry out preventive and reactive measures, and mobile phone technology, which can be used to capture the movement of people in the border areas and likely sources of malaria importation. Additionally, joint collaboration in the prevention and control of cross-border malaria by neighbouring countries, and reinforcement of early diagnosis and prompt treatment are ways forward in addressing the problem of cross-border malaria. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Jun 2015 · Advances in Parasitology
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    • "Describing people as hotpops and reservoirs of infection establishes particular groups not as people to be protected from malaria and benefit from elimination, but to the contrary as sources of infection and threats to public health. As Williams and colleagues [14] point out, the elimination literature consistently describes displaced persons as a source of imported malaria, while little attention is given to the health needs of this group. While recognizing that accurate surveillance is important for achieving elimination, a strong focus on migrants as the primary source of ongoing malaria transmission and on poor border communities as ‘reservoirs of infection’ established a basis for a disproportionate blaming of malaria persistence on migrants and other vulnerable groups. "
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    ABSTRACT: This commentary offers a note of caution about the negative social impact that may be inadvertently generated through malaria elimination activities. In particular, the commentary is concerned with the practice of describing people who remain at risk of malaria in low transmission settings as 'hotpops' or 'reservoirs of infection.' The authors argue that since those at risk of malaria in elimination settings are often already socially marginalized - such as migrants, indigenous groups, ethnic minorities and poor rural communities - that care should be taken to avoid implementing programmes in ways that may inadvertently add to the social stigmatization of those most at risk of malaria in a low transmission setting. Programmes should avoid using language that identifies particular groups as a source of infection, and instead begin a broader shift in orientation toward engaging constructively with communities within elimination strategies. Programmes should promote monitoring and evaluation to ensure that unintended negative consequences such as stigma do not occur; advocate for appropriate resourcing (human, financial, other) to minimize the risk of short cuts being used to achieve an end game that may discriminate against specific groups; and strengthen community engagement activities in elimination setting to avoid targeting stigmatized groups and to empower communities to prevent outbreaks and re-introduction of malaria. In this way malaria elimination can be achieved without stigmatization.
    Full-text · Article · Sep 2014 · Malaria Journal
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    • "Such close quarters and poor conditions may lead to poor health conditions and the easy spread of directly transmitted infectious diseases. Previous researchers have discussed the implications of migration, and forced migration in particular, with regard to various health outcomes [16,20,21]. Because of the dangers inherent in working in a conflict zone, the researchers were unable to accurately document the extent to which the general population grew during this time period. "
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    ABSTRACT: Malaria within the Greater Mekong sub-region is extremely heterogeneous. While China and Thailand have been relatively successful in controlling malaria, Myanmar continues to see high prevalence. Coupled with the recent emergence of artemisinin-resistant malaria along the Thai-Myanmar border, this makes Myanmar an important focus of malaria within the overall region. However, accurate epidemiological data from Myanmar have been lacking, in part because of ongoing and emerging conflicts between the government and various ethnic groups. Here the results are reported from a risk analysis of malaria slide positivity in a conflict zone along the China-Myanmar border. Surveys were conducted in 13 clinics and hospitals around Laiza City, Myanmar between April 2011 and October 2012. Demographic, occupational and educational information, as well as malaria infection history, were collected. Logistic models were used to assess risk factors for slide positivity. Age patterns in Plasmodium vivax infections were younger than those with Plasmodium falciparum. Furthermore, males were more likely than females to have falciparum infections. Patients who reported having been infected with malaria during the previous year were much more likely to have a current vivax infection. During the second year of the study, falciparum infections among soldiers increased signficiantly. These results fill some knowledge gaps with regard to risk factors associated with malaria slide positivity in this conflict region of north-eastern Myanmar. Since epidemiological studies in this region have been rare or non-existent, studies such as the current are crucial for understanding the dynamic nature of malaria in this extremely heterogeneous epidemiological landscape.
    Full-text · Article · Oct 2013 · Malaria Journal
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