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Incidence of malaria in UNHCR refugee camps in Africa and Asia. The incidence rate for malaria (cases per 1000 under five population per month) during the period January 2006 to February 2010 in refugees under five years old in the UNHCR camps is shown by circles. The background represents the parasite prevalence in children 2 to 10 years of age from the Malaria Atlas Project. The size and color of the circles reflect the incidence rate quintiles for the refugee camps.
Source publication
United Nations High Commissioner for Refugees (UNHCR) refugee camps are located predominantly in rural areas of Africa and Asia in protracted or post-emergency contexts. Recognizing the importance of malaria, pneumonia and diarrheal diseases as major causes of child morbidity and mortality in refugee camps, we analyzed data from the UNHCR Health In...
Citations
... These factors contribute to a high-risk environment that increases the susceptibility, prevalence, and severity of infectious diseases such as diarrhea. [3][4][5][6][7][8] Diarrhea remains the second leading cause of death for children under-five years of age, while an estimated 2.5 billion cases account for 15 % (over 1600 children) of all deaths occurring daily. 3,9,10 In Africa, it has been estimated that every child has five episodes of diarrhea per year and that 800,000 children die each year from diarrhea and dehydration related cases. ...
... 11 Diarrhea is one of the leading causes of death and morbidity in displaced communities during humanitarian crises. 4,5,12 Few studies have been done in the past on the prevalence of diarrhea and its associated factors in children under five in IDP centers in developing countries and territories, such as in Hodan, Somalia (21 %), 13 Khartoum, Sudan (13.9 %), 3 and Northern Uganda (22 %). 14 The disposal practice of children's feces, hand-washing practice's, children's age, water treatment, access to latrines, lack of food safety, and adequate water supply were identified as predictors of diarrhea among children under the age of five. ...
Background: This study aimed to assess the prevalence of diarrhea and associated factors among internally displaced children under-five at school camps of Mekelle City, Northern Ethiopia.
Methods: A descriptive cross-sectional study was conducted in Mekelle City (Ethiopia) from July 2021 to August 2021. Fifteen out of twenty-five IDP centers with 415 children under the age of five were randomly selected. A face-to-face interview with a pretested and administered questionnaire was used to collect data. Bivariate and multivariate logistic regressions were used to identify the predictor variables.
Results: The result of this study showed that the two-week prevalence of diarrhea among under-five children in Mekelle IDPs was 52.3% (95% Confidence Interval (CI): 47.5–56.9). The multivariate logistic regression model revealed that educational status (Adjusted Odds Ratio (AOR): 2.93, 95%CI: 1.637–5.269), children's faecal matter disposal practice (AOR: 0.49, 95%CI: 0.282–0.879), water storage period (5.53, 95%CI: 2.269–13.486), water treatment practice (AOR: 4.57, 95%CI: 2.435–8.609), cleaning practice of water storage material (AOR: 2.62, 95%CI: 1.550–4.431), water supply (AOR: 3.34, 95%CI: 1.007–11.113) and hand-washing practice (AOR: 2.50, 95%CI: 1.012–6.179) had a significant association with diarrhea prevalence.
Conclusions: The prevalence of diarrhea among children under-five in the IDPs of Mekelle was significantly high, where educational status, disposal practice's of children faecal matter, drinking water storage period, water treatment practice, and cleaning practice of drinking water storage materials were the associated factors. Therefore, improvements on the water, sanitation and hygiene (WASH) facilities in the IDP centers are essential for intervention in reducing the burden of diarrhea.
Keywords: Children under-five, Diarrhea, Internally displaced persons, WASH
... The high burden and transmission of malaria in the study area may be a major contributor to the high number of malaria deaths. However, the implementation of several interventions such as the introduction of the seasonal chemoprophylaxis (26) and regular use of ITNs may contribute to reducing the burden of malaria deaths in the study area (27). Despite the seasonal variations in malaria occurrence, the increase in vector breeding in the rain season might be contributing to increases in malaria cases and deaths (27). ...
... However, the implementation of several interventions such as the introduction of the seasonal chemoprophylaxis (26) and regular use of ITNs may contribute to reducing the burden of malaria deaths in the study area (27). Despite the seasonal variations in malaria occurrence, the increase in vector breeding in the rain season might be contributing to increases in malaria cases and deaths (27). The seasonal harmattan winds might have contributed to the high susceptibility of respiratory illnesses by increasing the reach of infectious agents and the drying of respiratory tract mucosa lining leading to increased penetration of infectious agent (28). ...
This study assessed the causes of under-five (U5) deaths and examined the associated risk factors in northern Ghana. The study analyzed prospectively collected longitudinal data of children born between 1st January 2007 and 31st December 2012 and resident in the Navrongo Health and Demographic Surveillance System (NHDSS) area in northern Ghana. Data from 20,651 children were analyzed with 1,056 under-five deaths and 51,783 person-years of observation. The overall mortality rate was 19.5 per 1000 person-years of observation. The main cause of under-five deaths was malaria (19.5%). Being male (Hazards ratio [95% CI]; 1.20 [1.06 - 1.36]; p=0.004), children born to single mothers (1.3 [1.18 - 1.59]; p<0.001) and home deliveries (1.29 [1.12 - 1.48]; p<0.001) were associated with increased risk of mortality. Children born to women aged 20-34 years (0.81 [0.67 – 0.98]; p=0.0.25) were associated with relatively lower risk of death compared to those born to women aged 19 years and below. Children from high socioeconomic households had relatively lower risk of death even though not statistically significant (0.87 [0.74 - 1.03]; p=0.056). Malaria remains the leading cause of under-five deaths in the study area. Adherence to prevailing malaria prevention measures including use of insecticide treated bed-nets, seasonal chemo-prophylaxis, indoor-residual spraying and adequate access to healthcare will greatly improve child survival.
... The population subgroups considered to be at higher risk of contracting malaria include children under 5 years of age [15,16], pregnant women [17], and patients with HIV/AIDS [18]. Refugees are rendered vulnerable to malaria infections by their lack of protective immunity, increased concentration of people in exposed settings, limited distribution of ITNs, inadequate IRS, insufficient rapid clinical diagnostic and treatment responses [19,20]. ...
... These conditions make refugee settlements susceptible to high risks of malaria transmission. Elsewhere, it has been documented that malaria is among the leading causes of morbidity and mortality among children under 5 years of age in refugee settlements [16,21,25]. Despite these potential risks and challenges, studies on refugees in Uganda have concentrated much on adolescent sexual behaviour [26], psychosocial impact of COVID-19 [27], impact of COVID-19 on food security [28], access to education [29], agroforestry [30], environmental degradation [31] among others, with limited focus on malaria risk factors, treatment and preventive measures [25]. ...
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.
... Increased new patient visits were associated with an increase in patient visits for diarrhea in UNHCR refugee camps (IRR ¼ 1.90, 95% CI: 1.38-2.62) (Hershey et al. 2011). ...
Background: Diarrheal illnesses are mainly linked with poverty, and hygiene promotion programs can significantly reduce childhood diarrhea when interventions are tested in stable communities. However, there is no sufficient evidence in emergency context. Methods: A cluster-randomized controlled trial was conducted in Teirkidi and Pugnido refugee camps. Intention to treat was applied in analyses of the results of this trial. Logistic, poison regression and generalized estimating equation (GEE) models were used to evaluate changes in cluster-level hygiene behaviors and period prevalence and incidence of diarrhea with its confidence intervals (95% CI) and p < 0.05 significant cutoff point. Results: The reported diarrhea episodes were 1,307 (15.6 episodes per 100 person-weeks observation) among the intervention households and 1,619 (18.9 episodes per 100 person-weeks observation) in the control households. Under-five children living in households that received hygiene promotion had a 15% [p < 0.001; adjusted IRR: 0.85, 95% CI: 0.79 0.92] and a lower incidence of diarrhea compared with children living in control households. Conclusion: The study confirms that hygiene promotion intervention significantly reduces the incidence rate of childhood diarrhea in refugee camps. Hence, gains in the reduction of childhood diarrhea can be achieved in refugee camps through an enhanced hygiene promotion program.
HIGHLIGHTS
My research could evaluate the burden of childhood diarrheal diseases and try to address the problem in the refugee context.;
Reducing childhood diarrhea burden.;
... The prevalence of pneumonia in under-fives was not affected by the educational status and occupation of parents. This finding is consistent with the findings from a case-control study in Pakistan where there was no statistically significant difference in the prevalence of pneumonia between educated and non-educated parents (Hershey et al. 2011). The case-control study, however, reported that maternal occupation was significantly associated with pneumonia, which is contrary to the finding in this study. ...
Background
Childhood pneumonia is the commonest cause of suffering worldwide. Among under-five children where it accounts for more than one out of seven under-five death globally. It is the single leading cause of death in Ethiopia, accounting for 18% of all under-five mortality burdens. These deaths are easily preventable and treatable through simple and cost-effective interventions. The study aims to assess the prevalence and associated factors of pneumonia among under-five children at Angolela Tera district, North Shoa, Ethiopia, 2021. A community-based cross-sectional study was conducted on a simple random sample with a sample size of 414 registered mothers with 6–59 months of children. Semi-structured questionnaires were used to collect data. The data were entered using the EpiData version 3.1, and analysis was done by SPSS version 24. Bivariable and multivariable logistic regression analysis was used.
Results
The prevalence of pneumonia in children under five was 5.8% (95% CI 3.6–8.2%). Based on the multivariable logistic regression analysis of this study, child male sex, have no family toilet, children having fever in the last 2 weeks, lack of maternal ANC follow-up and children with stunted were associated with pneumonia.
Conclusions
The study shows that the prevalence of under-five pneumonia was low as compared to recent EDHS 2016. Therefore, by making interventions on potential determinates such as by improving family latrine utilization, improving the nutritional status of children, and early control of respiratory tract infection and fever, we can reduce under-five pneumonia.
... Adjusted analysis suggested that the risk of pneumonia was higher in camps that were larger, had poorer access to water, and where health facilities had a higher proportion of first visits (likely representing newer arrivals) -and that geography was not a significant predictor after these factors had been accounted for (incidence rate ratio, Asia compared to Africa = 1.65, 95% confidence interval (CI) = 0.79-3.43) [17]. ...
... In four studies looking at pneumonia in outpatient settings, pneumonia represented 12%-34% of diagnoses for children U5 [17,[19][20][21]. No studies included older children or adolescents. ...
... Hershey et al's study was the only study that reported proportional morbidity from a refugee camp setting, finding that pneumonia accounted for 17% of presentations across camps in 15 countries. This study found that pneumonia accounted for 34% and 13% of presentations to camps in Asia and Africa respectively, with malaria predominating in African settings [17]. ...
Background:
Humanitarian emergencies increase many risk factors for pneumonia, including disruption to food, water and sanitation, and basic health services. This review describes pneumonia morbidity and mortality among children and adolescents affected by humanitarian emergencies.
Methods:
We searched MEDLINE, EMBASE, and PubMed databases for publications reporting pneumonia morbidity or mortality among children aged 1 month to 17 years in humanitarian emergencies (eg, natural disaster, armed conflict, displacement) in low- and middle-income countries (LMICs).
Results:
We included 22 papers published between January 2000 and July 2021 from 33 countries, involving refugee/displaced persons camps (n = 5), other conflict settings (n = 14), and natural disaster (n = 3). Population pneumonia incidence was high for children under 5 years of age (73 to 146 episodes per 100 patient-years); 6%-29% met World Health Organization (WHO) criteria for severe pneumonia requiring admission. Pneumonia accounted for 13%-34% of child and adolescent presentations to camp health facilities, 7%-48% of presentations and admissions to health facilities in other conflict settings, and 12%-22% of admissions to hospitals following natural disasters. Pneumonia related deaths accounted for 7%-30% of child and adolescent deaths in hospital, though case-fatality rates varied greatly (0.5%-17.2%). The risk for pneumonia was greater for children who are: recently displaced, living in crowded settings (particularly large camps), with deficient water and sanitation facilities, and those who are malnourished.
Conclusion:
Pneumonia is a leading cause of morbidity and mortality in children and adolescents affected by humanitarian emergencies. Future research should address population-based pneumonia burden, particularly for older children and adolescents, and describe contextual factors to allow for more meaningful interpretation and guide interventions.
... Infectious diseases including malaria, tuberculosis (TB) and intestinal parasites are reported to be the leading causes of mortality among the refugee population [9]. Among refugee children aged under five years old in Asia and Africa, a high mortality rate associated with malaria and pneumonia has been reported. ...
... Among refugee children aged under five years old in Asia and Africa, a high mortality rate associated with malaria and pneumonia has been reported. [9]. Lack of immunization can advance to the occurrence of potentially fatal infections and cause a rise in a number of infections amongst the community [4]. ...
The Rohingyas fled from their home to escape ethnic persecution. Due to their status as refugees they have difficulties in accessing healthcare leading to avoidable mortality and morbidity. Infectious diseases are reported to be among the causes. To ease access to healthcare, IMAM Response and Relief Team (IMARET) provides a free monthly clinic for them. The objective of this study is to determine the proportion of infectious diseases and appropriateness of antimicrobial usage among its pediatrics patients. It was conducted in 2017, through universal sampling. Information retrieved were via interviews and medical records. The majority diagnosis were infectious diseases (57.1%), which include respiratory infections (77.3%), skin (13.6%), gastrointestinal (4.5%), eye and ear infection (both 1%). Albendazole (40.7%) was the most prescribed. Only 7.4% were appropriately prescribed antimicrobials. Age (p = 0.005) and BMI (p = 0.006) were significantly associated with infections.
... Infectious diseases including malaria, tuberculosis (TB) and intestinal parasites are reported to be the leading causes of mortality among the refugee population [9]. Among refugee children aged under five years old in Asia and Africa, a high mortality rate associated with malaria and pneumonia has been reported. ...
... Among refugee children aged under five years old in Asia and Africa, a high mortality rate associated with malaria and pneumonia has been reported. [9]. Lack of immunization can advance to the occurrence of potentially fatal infections and cause a rise in a number of infections amongst the community [4]. ...
The Rohingyas fled from their home to escape ethnic persecution. Due to their status as refugees they have difficulties in accessing healthcare leading to avoidable mortality and morbidity. Infectious diseases are reported to be among the causes. To ease access to healthcare, IMAM Response and Relief Team (IMARET) provides a free monthly clinic for them. The objective of this study is to determine the proportion of infectious diseases and appropriateness of antimicrobial usage among its pediatrics patients. It was conducted in 2017, through universal sampling. Information retrieved were via interviews and medical records. The majority diagnosis were infectious diseases (57.1%), which include respiratory infections (77.3%), skin (13.6%), gastrointestinal (4.5%), eye and ear infection (both 1%). Albendazole (40.7%) was the most prescribed. Only 7.4% were appropriately prescribed antimicrobials. Age (p = 0.005) and BMI (p = 0.006) were significantly associated with infections.
... affecting a high number of children with CAP (Krenke, K. et al., 2016). In UNHCR refugee camps, pneumonia remains one of the most prevalent diseases and one of the main causes of death in children below the age of 5 (17% of child morbidity) (Hershey, C. L. et al., 2011). When considering refugees and migrant populations, particularly those living in refugee camps, it is known that they are at a higher risk of disease due to the absence of basic amenities or social distancing (Kluge, H. H. P. et al., 2020). ...
Introduction: Pneumonia remains one of the main conditions leading to morbidity and mortality around the world, both among adults and children. In UNHCR refugee camps, pneumonia remains one of the most prevalent diseases and one of the main causes of death in children below the age of 5 years. Objective: The study aims to show the difference in severity of CAP requiring hospitalization among Lebanese children and refugees’ children comparing 2 populations belonging to the same age group, and to compare pneumonia severity between Lebanese and Syrian children. Methodology: This is an observational, retrospective study of the Lebanese and Syrian children aged between 2 months and 5 years admitted to Rafik Hariri University hospital for community acquired pneumonia from February 2015 till February 2020. The study includes 201 patients diagnosed having CAP. The data collected from the patients’ medical records includes demographic data, clinical data, physical exam, laboratory and radiology results, treatment data and vital signs. Results: Out of 5852 pediatric admission during the study period, CAP occurred in 3.4% of patients, with lower rates among Lebanese children (1.2%) compared to Syrian children (2.2%). Patients with CAP had comparable gender and age between study groups. The most prevalent clinical symptoms observed were fever (98%), cough (93%), irritability (73.1%), and decreased feeding (45.8%). Syrian children were significantly more likely to exhibit irritability and decreased feeding. Physical exam findings were more frequently observed among Syrian children, who showed significantly more illness, noisy breathing, respiratory distress, rhonchi, grunting and nasal flaring. Severe CAP was diagnosed in 57.7% and was significantly higher in Syrian patients (88.7%) compared to Lebanese patients (37.1%). Syrian children had a higher need for mechanical ventilation, IV fluids, and PICU admission. Radiological findings showed that infiltration was more prevalent in Lebanese patients (82.9%) and consolidation was more prevalent in Syrian patients. Updated vaccination was less frequent among Syrian children, who required a longer period of treatment and length of hospital stay. Biomarkers of pneumonia severity (WBC and CRP) were consistently higher among Syrian children. Conclusion: This study showed that Syrian patients have significantly higher prevalence and severity of CAP. The notable differences between the two patient populations shows the clear impact of the humanitarian crisis, particularly among resource-deprived refugee and migrant populations.
... Camp settings, especially informal ones, are associated with increased disease susceptibility due to suboptimal living conditions, poor nutrition, scarcity of safe water and inaccessibility of healthcare. 12,[29][30][31] Evidence of these gaps has previously been presented in the related audit assessment conducted in the IDP locations visited for this study. 32 The audit outlined details of the selected camps and an overview of assessable resource comparison to international standards. ...
... Factors identified to significantly influence the increased likelihood of illnesses in this study have also been reported in similar settings. 31,53,54 Roberts et al. stated that factors associated with the poor physical health of IDPs in Uganda were being female, absence of soap and lack of food, water and medical care. 54 Hershey et al. also showed that proximity to water sources and camp population size were risk factors for malaria, pneumonia and diarrhoeal diseases among children in camps. ...
... 54 Hershey et al. also showed that proximity to water sources and camp population size were risk factors for malaria, pneumonia and diarrhoeal diseases among children in camps. 31 The effects of poor sanitary conditions, including experience with rodents and disease-causing vectors, had the greatest impact on health outcomes and supported the evidence in other studies that showed the relationship between high malaria incidence, water and sanitation, among displaced groups. 46,55 Although not statistically significant, duration of stay in the camp locations could be considered a weak risk factor. ...
Background: Conflict in Nigeria displaced millions of people, and some settled in camp-like locations within the country. Evidence on the association between living conditions and health outcomes among these populations are limited. This study investigated the risk factors associated with illnesses among camp-dwelling internally displaced persons (IDPs) in northern Nigeria.
Methods: A cross-sectional study was conducted in nine camps in 2016. Self-reported data on socio-demography, resource utilization and disease outcomes were collected. Association between health conditions and various factors, including sanitation and healthcare access, was investigated.
Results: Data from 2253 IDPs showed 81.1% (CI = 79.5–82.7) experienced one or more health conditions; however, over 20% did not access healthcare services. Most common diseases were malaria, fever, typhoid and diarrhoea. Multivariable logistic regression presented as adjusted odds ratios(aOR) and 95% confidence intervals(CIs) showed factors significantly associated with increased likelihood of illnesses included being
female (aOR = 1.53;CI = 1.19–1.96), overcrowding (aOR = 1.07;CI = 1.00–1.36), long-term conditions (aOR = 2.72;CI = 1.88–3.94), outdoor defecation (aOR = 2.37;CI = 1.14–4.94) and presence of disease-causing vectors (aOR = 3.71;CI = 1.60–8.60).
Conclusion: Most diseases in the camps were communicable. Modifiable risk factors such as overcrowding and poor toilet facilities were associated with increased poor health outcomes. This evidence highlights areas of high priority when planning humanitarian public health interventions.
Keywords morbidity and mortality, public health, refugees
