MALARIA CONTROL DURING MASS POPULATION MOVEMENTS AND NATURAL DISASTERS
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by a grant to the National Academy of Sciences and the Mailman School of Public Health of Columbia University by the Andrew W. Mellon Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
Library of Congress Cataloging-in-Publication Data
Bloland, Peter B.
Malaria control during mass population movements and natural disasters / Peter B. Bloland and Holly A. Williams ; [presented to] Roundtable on the Demography of Forced Migration, Committee on Population and Program on Forced Migration and Health, Mailman School of Public Health, Columbia University.
p. ; cm.
Includes bibliographical references.
ISBN 0-309-08615-9 (pbk.)
1. Malaria—Epidemiology. 2. Disaster medicine. 3. Emigration and immigration—Health aspects.
[DNLM: 1. Malaria—prevention & control. 2. Emigration and Immigration. 3. Natural Disasters. 4. Relief Work. WC 765 B652m 2003] I. Williams, Holly A. II. Roundtable on the Demography of Forced Migration. III. Joseph L. Mailman School of Public Health. Program on Forced Migration and Health. IV. Title.
RA644.M2 B566 2003
614.5’32—dc21
2002151428
Suggested citation: National Research Council. (2003). Malaria Control During Mass Population Movements and Natural Disasters. Peter B. Bloland and Holly A. Williams. Roundtable on the Demography of Forced Migration. Committee on Population, Division of Behavioral and Social Sciences and Education and Program on Forced Migration and Health at the Mailman School of Public Health of Columbia University, Washington, DC: The National Academies Press.
Additional copies of this report are available from the
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ROUNDTABLE ON THE DEMOGRAPHY OF FORCED MIGRATION 2002
CHARLES B. KEELY (Chair),
Walsh School of Foreign Service, Georgetown University
LINDA BARTLETT,
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta
RICHARD BLACK,
Center for Development and Environment, University of Sussex
STEPHEN CASTLES,
Refugee Studies Centre, University of Oxford
WILLIAM GARVELINK,
Bureau of Humanitarian Response, U.S. Agency for International Development, Washington, DC
ANDRE GRIEKSPOOR,
Emergency and Humanitarian Action Department, World Health Organization, Geneva
JOHN HAMMOCK,
Fletcher School of Law and Diplomacy, Tufts University
BELA HOVY,
Program Coordination Section, United Nations High Commissioner for Refugees, Geneva
JENNIFER LEANING,
School of Public Health, Harvard University
DOMINIQUE LEGROS,
Epi Centre, Médecins Sans Frontières, Paris
NANCY LINDBORG,
Mercy Corps, Washington, DC
PAULA REED LYNCH,
Bureau of Population, Refugees, and Migration, U.S. Department of State, Washington, DC
CAROLYN MAKINSON,
The Andrew W. Mellon Foundation, New York
SUSAN F. MARTIN,
Institute for the Study of International Migration, Georgetown University
W. COURTLAND ROBINSON,
Center for Refugee and Disaster Studies, Johns Hopkins University
SHARON STANTON RUSSELL,
Center for International Studies, Massachusetts Institute of Technology
WILLIAM SELTZER,
Department of Sociology and Anthropology, Fordham University
PAUL SPIEGEL,
International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta
RONALD WALDMAN,
Mailman School of Public Health, Columbia University
ANTHONY ZWI,
School of Public Health and Community Medicine, University of New South Wales
HOLLY REED, Program Officer
COMMITTEE ON POPULATION 2002
JANE MENKEN (Chair),
Institute of Behavioral Sciences, University of Colorado, Boulder
ELLEN BRENNAN-GALVIN,
Woodrow Wilson International Center for Scholars, Washington, DC
JANET CURRIE,
Department of Economics, University of California, Los Angeles
JOHN N. HOBCRAFT,
Population Investigation Committee, London School of Economics
CHARLES B. KEELY,
Walsh School of Foreign Service, Georgetown University
DAVID I. KERTZER,
Department of Anthropology, Brown University
DAVID A. LAM,
Population Studies Center, University of Michigan, Ann Arbor
CYNTHIA LLOYD,
The Population Council, New York
W. HENRY MOSLEY,
Department of Population and Family Health Sciences, Johns Hopkins University
ALBERTO PALLONI,
Center for Demography and Ecology, University of Wisconsin, Madison
JAMES W. VAUPEL,
Max Planck Institute for Demographic Research, Rostock, Germany
KENNETH W. WACHTER,
Department of Demography, University of California, Berkeley
LINDA J. WAITE,
Population Research Center, University of Chicago
BARNEY COHEN, Director
Preface
In response to the need for more research on displaced persons, the Committee on Population developed the Roundtable on the Demography of Forced Migration in 1999. This activity, which is supported by the Andrew W. Mellon Foundation, provides a forum in which a diverse group of experts can discuss the state of knowledge about demographic structures and processes among people who are displaced by war and political violence, famine, natural disasters, or government projects or programs that destroy their homes and communities. The roundtable includes representatives from operational agencies, with long-standing field and administrative experience. It includes researchers and scientists with both applied and scholarly expertise in medicine, demography, and epidemiology. The group also includes representatives from government, international organizations, donors, universities, and nongovernmental organizations.
The roundtable is organized to be as inclusive as possible of relevant expertise and to provide occasions for substantive sharing to increase knowledge for all participants with a view toward developing cumulative facts to inform policy and programs in complex humanitarian emergencies. To this aim, the roundtable has held annual workshops on a variety of topics, including mortality patterns in complex emergencies, demographic assessment techniques in emergency settings, and research ethics among conflict-affected and displaced populations.
Another role for the roundtable is to serve as a promoter of the best research in the field. The field is rich in practitioners but is lacking a
coherent body of research. In recent years a number of attempts to codify health policies and practices for the benefit of the humanitarian assistance community have been launched. The SPHERE Project—a collaboration of a large group of nongovernmental organizations—has produced a set of guidelines for public health interventions in emergency settings. The nongovernmental organization Médecins Sans Frontières has published a book entitled Refugee Health: An Approach to Emergency Situations (1997). In addition, a number of short-term training courses have been developed, including the Health Emergencies in Large Populations (HELP) course sanctioned by the International Committee of the Red Cross and the Public Health in Complex Emergencies course, which is partially funded by the U.S. Agency for International Development. All of these are intended to convey the “state of the art” to health care practitioners who serve refugees.
Yet the scientific basis for these currently recommended “best practices” is rarely presented along with the guidelines. And many of the current recommendations are based on older, perhaps even outdated, analyses and summaries of the literature. Furthermore, even when data are available, they are frequently inconsistent, unreliable, and spotty. Few of the currently recommended practices are based on scientifically valid epidemiological or clinical studies conducted among the refugee populations they are intended to benefit. Recognition of the need for a more evidence-based body of knowledge to guide the public health work practiced by the relief community has led to a widespread call for more epidemiological research. This was acted on by the World Health Organization, which formed an Advisory Group for Research in Emergency Settings.
In some sense the current wave of recommendations represents the end of a cycle of learning that began with the publication of a series of papers in the medical literature in the late 1980s. The data contained in those papers were originally generated during the period 1978-1986. But the world and the nature of forced migration have changed a great deal since then, and the relevance of those data can now be called into question. Therefore, the roundtable and the Program on Forced Migration and Health at the Mailman School of Public Health of Columbia University have commissioned a series of epidemiological reviews on priority public health problems for forced migrants that will update the state of knowledge. These occasional monographs will be individually authored documents presented to the roundtable and any recommendations or conclusions will be solely attributable to the authors. It is hoped these reviews will result in the
formulation of newer and more scientifically sound public health practices and policies and will identify areas where new research is needed to guide the development of health care policy. Many of the monographs may represent newer areas of concern for which no summary information is available in the published literature.
The present monograph—on malaria control—is the first in this series. It provides a basic overview of the state of knowledge about the epidemiology of malaria and public health interventions and practices for controlling the disease in situations involving forced displacement and conflict. Other topics under consideration include reviews of current knowledge on diarrheal diseases, malnutrition (particularly micronutrient disorders), psychosocial issues, and reproductive health.
This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review was to provide candid and critical comments that would assist the institution in making the published monograph as accurate and as sound as possible. The review comments and draft manuscript remain confidential.
Ronald J. Waldman of Columbia University served as review coordinator for this report. We wish to thank the following individuals for their participation in the review of this report: Mary Ettling of the Office of Sustainable Development, Bureau for Africa, United States Agency for International Development, and Dominique Legros of Epi Centre, Médecins Sans Frontières, Paris.
Although the individuals listed above provided constructive comments and suggestions, it must be emphasized that responsibility for this monograph rests entirely with the authors.
We are also grateful to the staff and associates of the National Research Council. Ana-Maria Ignat assisted with the proofreading and formatting of the manuscript. Barbara Bodling O’Hare edited the volume. Christine McShane skillfully assisted with the editing and Yvonne Wise guided the manuscript through the publication process. Development and execution of this project occurred under the general guidance of Barney Cohen, director of the Committee on Population.
The authors, Peter B. Bloland and Holly A. Williams, work with the Malaria Epidemiology Branch in the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention in Atlanta, Georgia.
The authors also thank John Sexton, Ray Beach, Eric Noji, Brent Burkholder, Gail Stennies, and Paul Spiegel for their comments on a draft version of this report.
This series of monographs is being made possible by a special collaboration between the Roundtable on the Demography of Forced Migration of the National Academy of Sciences and the Program on Forced Migration and Health at the Mailman School of Public Health of Columbia University. We thank the Andrew W. Mellon Foundation for its continued support of the work of the roundtable and the program at Columbia. A special thanks is due Carolyn Makinson of the Mellon Foundation for her enthusiasm and significant expertise in the field of forced migration, which she has shared with the roundtable, and for her help in facilitating partnerships such as this.
Most of all, we are grateful to the authors of this report. We hope that this publication contributes to both better policy and better practice in the field.
Charles B. Keely
Chair, Roundtable on the Demography of Forced Migration
Ronald J. Waldman
Member, Roundtable on the Demography of Forced Migration
Holly E. Reed
Program Officer, Roundtable on the Demography of Forced Migration