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Researchers call attention to malaria epidemic in DRC
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A recent correspondence published in Clinical Infectious Diseases highlights the substantial malaria burden among internally displaced people in the Democratic Republic of the Congo, or DRC, where an estimated 19 million cases occur each year.
“Data are scarce from the DRC because of challenges to research and public health interventions in remote zones affected by violent conflict,” Hannah M. Brooks, of the University of Alberta, Canada, and colleagues wrote. “Thus, the DRC is considered the world’s least feasible country for malaria elimination and may be overlooked in global control efforts. We wish to call attention to the burden of malaria in the DRC and its vulnerable population of internally displaced persons (IDPs), providing an illustrative snapshot of malaria in an IDP camp in war-torn DRC.”
The researchers analyzed data on IDPs seeking shelter from violent conflict at the largest IDP camp in the region of Masisi. The analysis included 751 patients presenting with a febrile illness at the only health care center in the area between January and July 2014.
Of the 751 febrile patients, 43% (n = 323) were diagnosed with malaria. More than half (n = 169) were children younger than 5 years of age. The annual incidence of medically attended malaria among children younger than 5 years of age was estimated to be at least 910 per 1,000. In contrast, the researchers reported that the annual risk for malaria is 246 per 1,000 children in the WHO African region.
Overall, 90% of malaria cases were uncomplicated, and 9.6% were considered severe. There were four deaths, two of which occurred in young children.
Although free bed nets were distributed in the camp, coverage was incomplete, especially among recent arrivals, the researchers wrote. Nearly 60% of febrile patients reported living in a house with a net, and 59% of those patients reported sleeping under a net. However, those who did sleep under a net were significantly less likely to have malaria (8.9% vs. 62%; P < .0001). In a multivariable analysis, significant predictors of malaria included age younger than 5 years (adjusted OR = 2.97; 95% CI, 1.84-4.81), lack of bed net use (aOR = 15.63; 95% CI, 9.09-27.03), and recent arrival at the camp (aOR = 18.18; 95% CI, 11.63-28.57).
“This case series from an IDP camp deep within the zone of insecurity in the DRC serves as a reminder of the malaria burden in complex, chronic humanitarian crises in the tropics,” the researchers concluded. “Almost two-thirds of refugees and IDPs live in regions where malaria is endemic, including 1.5 million IDPs in the DRC alone. Hard-to-reach populations affected by violent conflict should not be forgotten in global malaria control efforts.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
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