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Discourse on malaria elimination: where do forcibly displaced persons fit in these discussions?

ABSTRACT: BACKGROUND: Individuals forcibly displaced are some of the poorest people in the world, living in areas where infrastructure and services are at a bare minimum. Out of a total of 10,549,686 refugees protected and assisted by the United Nations High Commissioner for Refugees globally, 6,917,496 (65.6%) live in areas where malaria is transmitted. Historically, national malaria control programmes have excluded displaced populations. RESULTS: The current discourse on malaria elimination rarely includes discussion of forcibly displaced persons who reside within malaria-eliminating countries. Of the 100 malaria-endemic countries, 64 are controlling malaria and 36 are in some stage of elimination. Of these, 30 malaria-controlling countries and 13 countries in some phase of elimination host displaced populations of ?50,000, even though 13 of the 36 (36.1%) malaria-elimination countries host displaced populations of ?50,000 people. DISCUSSION: Now is the time for the malaria community to incorporate forcibly displaced populations residing within malarious areas into malaria control activities. Beneficiaries, whether they are internally displaced persons or refugees, should be viewed as partners in the delivery of malaria interventions and not simply as recipients. CONCLUSION: Until equitable and sustainable malaria control includes everyone residing in an endemic area, the goal of malaria elimination will not be met.

SUBMITTER: Williams HA

PROVIDER: S-EPMC3626721 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Discourse on malaria elimination: where do forcibly displaced persons fit in these discussions?

Williams Holly A HA Hering Heiko H Spiegel Paul P

Malaria journal 20130410

<h4>Background</h4>Individuals forcibly displaced are some of the poorest people in the world, living in areas where infrastructure and services are at a bare minimum. Out of a total of 10,549,686 refugees protected and assisted by the United Nations High Commissioner for Refugees globally, 6,917,496 (65.6%) live in areas where malaria is transmitted. Historically, national malaria control programmes have excluded displaced populations.<h4>Results</h4>The current discourse on malaria elimination ...[more]

PMID: 23575209

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Project description:BACKGROUND:The post-partum consumption of the placenta by the mother (placentophagy) has been practiced since the 1970s in the global North and is seemingly increasing in popularity. Maternal placentophagy is not known to have been practiced in any other time period or culture, despite being near-ubiquitous in other placental mammals. An in-depth qualitative exploration as to the reasons for the practice, its increasing popularity and how it is narratively incorporated into discourses surrounding "ideal" natural and medical births are given in this paper. METHODS:1752 posts from 956 users across 85 threads from the parenting forums Mumsnet and Netmums were identified for inclusion. A thematic discourse analysis was performed using NVivo. RESULTS:Three main themes were identified: women recounted predominantly positive attitudes towards their own experiences of placentophagy, and they were respectful of others' views and experiences; some had negative views, particularly around the concept of disgust, but again, they were respectful of others' experiences. By far the most common method of consumption of the placenta was encapsulation. CONCLUSIONS:This paper identifies the motivation for placentophagy to almost universally be for medical benefits, most commonly the prevention or treatment of post-natal depression (PND). Whilst disgust is a common reaction, discussion of risks is rare, and positive experiences outweigh negative ones. The increasing popularity of the practice is ascribed in part to the comparative palatability of encapsulation and the use of the internet to share resources and remove barriers. Parenting forums are important spaces to negotiate normative birth practices, including placentophagy, and act to build communities of women who value personal experience over medical evidence and highly value personal choice and bodily autonomy. Placentophagy is discussed in terms of its relation to natural and medical births with arguments being made using both discourses for and against the practice. This paper argues that placentophagy is practiced as a resistance to medicalisation as an assertion of control by the mother, whilst simultaneously being a medicalised phenomenon itself.

Project description:BackgroundThe Malaria Elimination Demonstration Project (MEDP) maintained a workforce of 235 Village Malaria Workers (VMWs) and 25 Malaria Field Coordinators (MFCs) to conduct disease surveillance, case management, IEC/BCC activities, capacity building, and monitoring of vector control activities in 1233 villages of Mandla, a high malaria endemic district of Madhya Pradesh in central India.MethodsThe induction training was conducted for 3 days on malaria diagnosis, treatment, prevention, and ethics. All trainings were assessed using a pre and post-training assessment questionnaire, with 70% marks as qualifying threshold. The questionnaire was divided into three thematic areas viz. general knowledge related to malaria (KAP), diagnosis and treatment (DXRX), and vector control (PVC).ResultsIn 2017, the project trained 330 candidates, followed by 243 and 247 candidates in 2018 and 2019, respectively. 94.3% candidates passed after a single training session. Almost all (95%) candidates showed improvement in knowledge after the training with 4% showing no effect and 1% showing deterioration. Progressive improvement in scores of 2017 cohort was seen along with significant improvement in performance of candidates in 2019 after the introduction of systematic monitoring and 'shadowing' training exercises.ConclusionThe project has successfully demonstrated the value of recruitment of workers from the study area, outcome of training, and performance evaluation of field staff in malaria elimination programme. This careful strategy of recruitment and training resulted in a work-force that was capable of independently conducting surveillance, case management, vector control, and Information Education Communication/Behaviour Change Communication (IEC/BCC). The learnings of this study, including the training modules and monitoring processes, can be used to train the health delivery staff for achieving national goal for malaria elimination by 2030. Similar training and monitoring programmes could also be used for other public health delivery programmes.

Project description:BackgroundMalaria Elimination Demonstration Project (MEDP) was started as a Public-Private-Partnership between the Indian Council of Medical Research through National Institute of Research in Tribal Health, Govt. of Madhya Pradesh and Foundation of Disease Elimination and Control of India, which is a Corporate Social Responsibility (CSR) initiative of the Sun Pharmaceutical Industries Limited. The project's goal was to demonstrate that malaria can be eliminated from a high malaria endemic district along with prevention of re-establishment of malaria and to develop a model for malaria elimination using the lessons learned and knowledge acquired from the demonstration project.MethodsThe project employed tested protocols of robust surveillance, case management, vector control, and capacity building through continuous evaluation and training. The model was developed using the learnings from the operational plan, surveillance and case management, monitoring and feedback, entomological investigations and vector control, IEC and capacity building, supply chain management, mobile application (SOCH), and independent reviews of MEDP.ResultsThe MEDP has been operational since April 2017 with field operations from August 2017, and has observed: (1) reduction in indigenous cases of malaria by about 91 %; (2) need for training and capacity building of field staff for diagnosis and treatment of malaria; (3) need for improvement insecticide spraying and for distribution and usage of bed-nets; (4) need for robust surveillance system that captures and documents information on febrile cases, RDT positive individuals, and treatments provided; (5) need for effective supervision of field staff based on advance tour plan; (6) accountability and controls from the highest level to field workers; and (7) need for context-specific IEC.ConclusionsMalaria elimination is a high-priority public health goal of the Indian Government with a committed deadline of 2030. In order to achieve this goal, built-in systems of accountability, ownership, effective management, operational, technical, and financial controls will be crucial components for malaria elimination in India. This manuscript presents a model for malaria elimination with district as an operational unit, which may be considered for malaria elimination in India and other countries with similar geography, topography, climate, endemicity, health infrastructure, and socio-economic characteristics.

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Discourse on malaria elimination: where do forcibly displaced persons fit in these discussions?

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Discourse on malaria elimination: where do forcibly displaced persons fit in these discussions?

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