Year: 2022
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Malaria is a leading cause of morbidity and mortality in refugee children in high-transmission parts of Africa. Characterizing the clinical features of malaria in refugees can inform approaches to reduce its burden. METHODS: The study was conducted in a high-transmission region of northern Zambia hosting Congolese refugees. We analyzed surveillance data and hospital records of children with severe malaria from refugee and local sites using multivariable regression models and geospatial visualization. RESULTS: Malaria prevalence in the refugee settlement was similar to the highest burden areas in the district, consistent with the local ecology and leading to frequent rapid diagnostic test stockouts. We identified 2197 children hospitalized for severe malaria during the refugee crisis in 2017 and 2018. Refugee children referred from a refugee transit center (n = 63) experienced similar in-hospital mortality to local children and presented with less advanced infection. However, refugee children from a permanent refugee settlement (n = 110) had more than double the mortality of local children (P < .001), had lower referral rates, and presented more frequently with advanced infection and malnutrition. Distance from the hospital was an important mediator of the association between refugee status and mortality but did not account for all of the increased risk. CONCLUSIONS: Malaria outcomes were more favorable in refugee children referred from a highly outfitted refugee transit center than those referred later from a permanent refugee settlement. Refugee children experienced higher in-hospital malaria mortality due in part to delayed presentation and higher rates of malnutrition. Interventions tailored to the refugee context are required to ensure capacity for rapid diagnosis and referral to reduce malaria mortality.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciac417
Institutions: University of Basel, University Children's Hospital Zurich, Tropical Diseases Research Centre, Johns Hopkins University, Office of the United Nations High Commissioner for Refugees, University Children’s Hospital Basel, Royal Children's Hospital, The University of Melbourne, Luzerner Kantonsspital, Johns Hopkins Medicine
Language: English
Topic: Malaria Research and Control
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Bill and Melinda Gates Foundation, GAVI Alliance, Johns Hopkins University, Bloomberg Philanthropies, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, European and Developing Countries Clinical Trials Partnership
OpenAlex ID: W4282921531