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

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2 responses to “The Lost Count: Malaria Quantification and People on the Move

  1. Hello and thank you for an excellent website. So-called environmentally induced migration is multi-level problem. According to Essam El-Hinnawi definition form 1985 environmental refugees as those people who have been forced to leave their traditional habitat, temporarily or permanently, because of a marked environmental disruption (natural or triggered by people) that jeopardised their existence and/or seriously affected the quality of their life. The fundamental distinction between `environmental migrants` and `environmental refugees` is a standpoint of contemporsry studies in EDPs.

    According to Bogumil Terminski it seems reasonable to distinguish the general category of environmental migrants from the more specific (subordinate to it) category of environmental refugees.

    Environmental migrants, therefore, are persons making a short-lived, cyclical, or longerterm change of residence, of a voluntary or forced character, due to specific environmental factors. Environmental refugees form a specific type of environmental migrant.

    Environmental refugees, therefore, are persons compelled to spontaneous, short-lived, cyclical, or longer-term changes of residence due to sudden or gradually worsening changes in environmental factors important to their living, which may be of either a short-term or an irreversible character.

  2. I am thankful for Mr. Kasongo words.
    Yes that is question how to count the invisible… I think the best strategies are to utilize record if there are any of small and possible illegal NGOs facilitating health care for this most vulnerable population.

    Prevalence can be guesstimated by taking a nation’s rates and transferring that on to the refugee, forced migrant and asylum seeking communities. That is if there is a number that can be placed on this population.

    Incidence rates though I guess are only possible through a structural change of policy in destination countries for migration that would allow for treatment which then allow for incidence rates to be documented.

    The same issue is true for a multiplicity of contagious diseases including MDR-TBs… unless we work together to change treatment policies in destination countries my guess is that these diseases will continue to be invisible…

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