title: Lack of household clustering of malaria in a complex humanitarian emergency: implications for active case detection.
abstract: BACKGROUND
  Malaria contributes to elevated morbidity and mortality in populations displaced by conflict in tropical zones. In an attempt to reduce malaria transmission in an internally displaced persons (IDP) camp in eastern Democratic Republic of Congo (DRC), we tested a strategy of active case detection of household contacts of malaria cases.
  
  
  METHODS
  Prospective community-based survey.
  
  
  RESULTS
  From a convenience sample of 100 febrile patients under 5 years of age from the IDP camp presenting to a nearby clinic for management of a fever episode, 19 cases of uncomplicated malaria and 81 controls with non-malarial febrile illness (NFMI) were diagnosed. We engaged community health workers in the IDP camp to screen their household contacts for malaria using rapid diagnostic tests. We detected 29 cases of malaria through this active case-finding procedure. Household contacts of children with uncomplicated malaria were no more likely to have positive Plasmodium falciparum antigenemia than controls with NFMI (OR 0.89, 95% CI 0.33 to 2.4, p = 1.0), suggesting that malaria cases did not cluster at the household level. However, household contacts reporting mild symptoms at the time of community survey (headache, myalgia) had a higher odds of malaria than asymptomatic individuals (OR 14 (95% CI 4.2-48), p ≤ 0.001 and 18 (95% CI 5.9-54), p ≤ 0.001, respectively).
  
  
  CONCLUSIONS
  Screening household contacts of malaria cases was not an efficient case-finding strategy in a Congolese IDP camp. Symptom-based screening may be a simpler and cost-effective method to identify individuals at increased risk of malaria for targeted screening and treatment in an IDP camp.
authors: a School of Public Health , University of Alberta , Edmonton , Canada.
authors: Hasan
authors: H
authors: Hamze
authors: a School of Public Health , University of Alberta , Edmonton , Canada.
authors: Rhianna
authors: R
authors: Charchuk
authors: b École de Santé Publique , Université de Lubumbashi , Lubumbashi , Democratic Republic of the Congo.
authors: Makelele Katsuva
authors: MK
authors: Jean Paul
authors: c Department of Surgery , Université Catholique du Graben , Butembo , Democratic Republic of the Congo.
authors: Kasereka Masumbuko
authors: KM
authors: Claude
authors: d Médecins d'Afrique , Goma , Democratic Republic of the Congo.
authors: Mashukano
authors: M
authors: Léon
authors: a School of Public Health , University of Alberta , Edmonton , Canada.|e Department of Pediatrics , University of Alberta , Edmonton , Canada.|f Department of Medical Microbiology and Immunology , University of Alberta , Edmonton , Canada.
authors: Michael T
authors: MT
authors: Hawkes
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use; D002675:Child, Preschool; D016000:Cluster Analysis; D016358:Contact Tracing / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission; D008297:Male; D008403:Mass Screening / Q000379:methods; D011446:Prospective Studies; D012036:Refugees; D012959:Socioeconomic Factors
chemical_list: D000962:Antimalarials
keywords: Cost-effectiveness; Febrile illness; Internally displaced persons; Malaria; Screening