The Lost Count: Malaria Quantification and People on the Move

Live Savers: Mosquito nets help protect the most vulnerable, including pregnant women and infants. © UNHCR/Zalmaï

In the global efforts to combat malaria, accurate assessment of the public health burden of the disease and its distribution is central to monitoring, control, and decision-making. In an article published this month in The Lancet found that, the 2010 Malaria World Report released by the World Health Organization (WHO) underestimated global malaria mortality by 50 percent. The study led by Dr. Christopher J L Murray from Institute for Health Metrics and Evaluation (IHME) in Seattle estimated the 2010 malaria mortality to be 1.2 million compared to 655 thousands reported by WHO. The study used subnational population data to analyze trends in malaria mortality from 1980 to 2010. The study also found that there has been a systematic underestimation of global malaria mortality. Some of the limitations cited in the paper were the lack of representativeness and misclassification of deaths in the subnational data due to the variability in intensity of malaria transmission, incompleteness, and inconsistency of surveillance data. In addition, results from time-trend and time-series data analysis, which was used in this paper, can be affected if there is migration within the population under review.

We believe at ICMHD that this raises the problem of how to quantify malaria incidence, prevalence, and mortality when there are very large numbers of people on the move who do not fall within national health registration systems. The 2011 World Development Report estimated that by the end of 2009 there were some 42.3 million people displaced globally as a result of conflict, violence, and human rights violations. Of these, 27.1 million were internally displaced persons (IDPs) while 15.2 million were refugees outside their country of nationality or country of habitual residence. The United Nations and the United Nations World Tourism Organization has projected that by 2020 there will be 50 million environmental refugees and nearly 1.6 billion international tourist arrivals.

These figures make evident the urgency in developing more consistent methods on measuring malaria distribution and identifying populations at risk. The different approaches that have been used in determining malaria incidence, prevalence, and mortality have led to highly variable results. Moreover, many malaria trends analyses rarely factor in migrating populations.

At ICMHD we think that unless the international community is willing to pay more attention to migrants and other people on the move, malaria control efforts will fail.

By Talubezie Kasongo

Pakistan: Forced Displacement and Climate Change

Pakistan: Forced Displacement and Climate Change

Manuel Carballo

In the space of little more than 3 weeks, more than 5 million people in Pakistan have been displaced from their homes, their farms, their villages, their communities, and their livelihoods. Predictions are that over the course of the next few weeks, the situation could become even worse and hundreds of thousands more people could be displaced. It will be many months, or even years, before we are able to assess the full extent of the human wastage and damage done, but already a number of assumptions can be made that call for urgent action.

Mohammad Sajjad, Associated Press

The first of these assumptions is that many families will have been disrupted and that many community structures will have been disorganised. In the case of the current situation in Pakistan, this means that millions of families are being affected in ways that will make coping all the more precarious and that will limit the capacity of individuals and groups to begin the difficult, but necessary, process of recovery and reconstruction.

The second assumption is that most of the communities or locations where people are moving to, or being moved to,  are ill-prepared to deal with this influx of women, men, and children of all ages. The load this will place on the healthcare system in these locations will be huge, and it is unlikely that in the absence of massive external assistance, they will be able to respond to the needs of this new population of displaced people.

The third assumption that can be made is that within the ranks of these displaced people, many were already in poor health even before the crisis happened. Pakistan has never been a wealthy country, and as many as a third of its people were struggling to live on less than $1 per day. Malnutrition was widespread, tuberculosis was rampant, and malaria common. Maternal and infant death rates were among the highest in Asia, and life expectancy among the poor was very short. Many of the diseases and health conditions these populations suffered from, now risk being aggravated and spread to other parts of Pakistan.

Associated Press photo

From a psychosocial perspective, the process of displacement will also have affected millions of people in far-reaching ways. Many, irrespective of age or gender, will have been traumatised to such an extent that their capacity to cope will have been lessened. Losing homes, farms, communities, and local cultures will inevitably have introduced a sense of hopelessness and despair that could debilitate the capacity to cope and prepare for a new life. Tragically, there is also reason to believe that the incidence of rape and other forms of gender-based violence will have gone up as well.

All these problems will be made worse by the fact that many of the people concerned are poorly educated and unfamiliar with disease prevention principles and with the healthcare systems that hopefully will become available to them in the coming months. Unless comprehensive and well-coordinated relief and recovery programmes are put into place quickly, Pakistan could be faced with a complex range of new and worsened old health problems.

Tragically, the crisis in Pakistan may be a foretaste of things to come on an equally large scale, and over a wider geographical region. For no matter what global warming and climate change is due to, the fact remains that extreme weather conditions, including heavy and seasonally unpredictable rains, are becoming more common in some parts of the world, while in others, extreme drought and lack of water are becoming common.

K.M.Chaudary/Associated Press

The response to the crisis in Pakistan has been slow in coming. Even now, it is clear that more funding is being proposed from the World Bank, the International Monetary Fund (IMF), and regional banks, than is coming from voluntary contributions. These loans will have to be paid back, and for the foreseeable future, Pakistan will move into a process of long-term indebtedness that will undermine the country’s economy even more so, and place vast numbers of people into greater poverty.

If the international community cannot respond in a more forceful fashion than it has done to date, this will bode ill for Pakistan’s people and their health. It will bode equally ill for all the other countries and the hundreds of millions of people who could be exposed to equally disastrous climatic events in the future.

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