Malaria in camps for internally-displaced persons in Uganda: evaluation of an insecticide-treated bednet distribution programme

Abstract

Summary Malaria is a key health problem among displaced populations in malariaendemic areas. Mass distribution of insecticide-treated bednets (ITN) to prevent malaria is often carried out in complex emergencies, but there are few data on the outcome or operational effectiveness of such programmes. In June 2001, Médecins Sans Frontières completed a mass distribution of ITNs (Permanet ® ) to internally displaced persons in Bundibugyo, southwest Uganda, distributing one to four nets per household, and aiming to provide coverage for all residents. In July 2002, we did a cross-sectional survey using three-stage cluster sampling to evaluate the programme. A total of 1245 individuals from 835 households were interviewed. An ITN was present in 75.6% (95% CI 72.7-78.5) of the households, but only 56.5% (95% CI 52.3-60.4) of individuals were sleeping under an ITN, and nets were often damaged. The prevalence of malarial parasitaemia was 11.2% (95% CI 9.4-13.0), and was significantly lower in ITN users compared to non-users (9.2% vs. 13.8%, relative risk [RR] 0.63, 95% CI 0.46-0.87); ITNs with severe damage remained effective (RR for severely damaged net 0.58, 95% CI 0.35-0.98). There was no significant difference in haemoglobin concentration between ITN users and non-users.

Reports of long-lasting insecticidal bed nets catching on fire: a threat to bed net users and to successful malaria control?

“…A 2002 evaluation of bed net implementation in Uganda among displaced persons showed that after two years, 2.5% of the bed nets had burned [17]. In a double-blind controlled trial in Thailand, 1.2% bed nets (4/350) burned in 1991 [18].…”

“…Only the evaluation in Uganda [17] and the trial in Thailand [18] estimated frequency: 2.5% and 1.2%, respectively. But the Thai study is old and dealt with cotton bed nets, while the Spencer study investigates Permanet ® bed nets but used in a specific context: a refugee camp.…”

“You need to take care of it like you take care of your soul”: perceptions and behaviours related to mosquito net damage, care, and repair in Senegal

“…The number of washes and location of drying are correlated with the amount of residual insecticide; nets that are washed less frequently and dried in the shade retain more insecticide than those that are washed frequently and dried in the sun [17, 18]. Other documented causes of net damage include tears on bed frames and mattresses, fire, domestic animals, rats, toenails, drying, children playing, and contact between the net and the walls of the house [12, 13]. …”

“…In a previous study, it was shown that user-determined end of net life was defined largely by the condition of the net and the presence of mosquitoes in the net due to holes [20]. Observational studies show that more holes in the net make the net less effective at preventing mosquito entry [12, 21]. …”

Challenges of poor surface water drainage and wastewater management in refugee camps

“…Over ninety United Nations High Commissioner for Refugees (UNHCR) refugee camps in Africa and Asia are affected by malaria [8][9], Cholera and Malaria in refugee camps along the border between Syria and Turkey [10] and measles in refugee camps in Kenya, Ethiopia, Tanzania and other UNHCR refugee camps across Africa and Asia [9;11;12]. Other diseases that have been reported include Hepatitis E among refugees and IDPs in Upper Nile, South Sudan [10;13], bloody diarrhoea, watery diarrhoea and fever of unknown origin in Kosovar refugee camps in the former Yugoslav Republic of Macedonia and again over ninety refugee camps across Africa and Asia [9;14].…”