title: Burden of malaria is higher among children in an internal displacement camp compared to a neighbouring village in the Democratic Republic of the Congo.
abstract: BACKGROUND
  In the Democratic Republic of the Congo (DRC), violent conflict has caused the displacement of millions of people into camps where they are exposed to poor living conditions and high rates of infectious diseases. Malaria, in particular, is a major cause of mortality in children under five; however, the burden of disease in displacement camps has not previously been described.
  
  
  METHODS
  Two cross-sectional surveys were performed. First, prevalence of Plasmodium falciparum antigenemia was measured in a random sample of 200 children living in a displacement camp and 200 children from a nearby village (control group). Second, the proportion of febrile illness attributable to malaria was measured in a study of 100 children from the displacement camp and 100 children from the control village presenting to the same health clinic with fever. All participants were tested for P. falciparum with a rapid diagnostic test and additional demographic data, clinical characteristics, and malaria risk factors were determined using a parental questionnaire.
  
  
  RESULTS
  In the community survey, children living in the displacement camp had a higher prevalence of P. falciparum infection (17 %) than controls (7.5 %) (OR 2.6; 95 % CI 1.3-4.1; P = 0.0095). In the clinic-based survey, the proportion of febrile illness attributable to malaria was higher among children from the displacement camp (78 %) than controls (39 %) (OR 5.5; 95 % CI 3.0-10.3; P < 0.001). Household bed net ownership and use was significantly lower in the displacement camp than control village in both surveys. Statistically significant differences in household wealth, maternal education, and exposure to community violence were also found.
  
  
  CONCLUSIONS
  Population displacement due to violent conflict appears to be a risk factor for malaria, a major cause of child mortality. Children living in displacement camps are a relatively understudied population, but have a high burden of malaria, despite control programmes focused on bed net distribution.
authors: School of Public Health, University of Alberta, Edmonton, Canada.
authors: Rhianna
authors: R
authors: Charchuk
authors: École de Santé Publique, Université de Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
authors: Makelele Katsuva Jean
authors: MK
authors: Paul
authors: Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
authors: Kasereka Masumbuko
authors: KM
authors: Claude
authors: School of Public Health, University of Alberta, Edmonton, Canada.|Department of Medicine, University of Alberta, Edmonton, Canada.
authors: Stan
authors: S
authors: Houston
authors: School of Public Health, University of Alberta, Edmonton, Canada. mthawkes@ualberta.ca.|Department of Pediatrics, University of Alberta, Edmonton, Canada. mthawkes@ualberta.ca.
authors: Michael T
authors: MT
authors: Hawkes
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000453:epidemiology*; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D015995:Prevalence; D012036:Refugees; D012307:Risk Factors
keywords: Children; Cross sectional study; Democratic Republic of the Congo; Internally displaced persons