{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T04:23:46Z","timestamp":1782707026337,"version":"3.54.5"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100011780","name":"Johns Hopkins Malaria Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011780","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015283","name":"Bloomberg Philanthropies","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015283","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Southern and Central Africa International Centers of Excellence for Malaria Research","award":["U19AI089680"],"award-info":[{"award-number":["U19AI089680"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23AI139343"],"award-info":[{"award-number":["K23AI139343"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007880","name":"Johns Hopkins University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007880","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Burroughs Wellcome Fund-American Society"},{"name":"Tropical Medicine and Hygiene Postdoctoral Fellowship"},{"name":"Tropical Diseases Research Centre"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Malaria is a leading cause of morbidity and mortality in refugee children in high-transmission parts of Africa. Characterizing the clinical features of malaria in refugees can inform approaches to reduce its burden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study was conducted in a high-transmission region of northern Zambia hosting Congolese refugees. We analyzed surveillance data and hospital records of children with severe malaria from refugee and local sites using multivariable regression models and geospatial visualization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Malaria prevalence in the refugee settlement was similar to the highest burden areas in the district, consistent with the local ecology and leading to frequent rapid diagnostic test stockouts. We identified 2197 children hospitalized for severe malaria during the refugee crisis in 2017 and 2018. Refugee children referred from a refugee transit center (n = 63) experienced similar in-hospital mortality to local children and presented with less advanced infection. However, refugee children from a permanent refugee settlement (n = 110) had more than double the mortality of local children (P &amp;lt; .001), had lower referral rates, and presented more frequently with advanced infection and malnutrition. Distance from the hospital was an important mediator of the association between refugee status and mortality but did not account for all of the increased risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Malaria outcomes were more favorable in refugee children referred from a highly outfitted refugee transit center than those referred later from a permanent refugee settlement. Refugee children experienced higher in-hospital malaria mortality due in part to delayed presentation and higher rates of malnutrition. Interventions tailored to the refugee context are required to ensure capacity for rapid diagnosis and referral to reduce malaria mortality.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciac417","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T23:18:12Z","timestamp":1654039092000},"page":"e1104-e1113","source":"Crossref","is-referenced-by-count":12,"title":["Malaria in Refugee Children Resettled to a Holoendemic Area of Sub-Saharan Africa"],"prefix":"10.1093","volume":"76","author":[{"given":"Manuela","family":"Hauser","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Basel , Basel , Switzerland"},{"name":"Children\u2019s Research Center, University Children\u2019s Hospital Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Bertin B","family":"Kabuya","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Tropical Diseases Research Centre , Ndola , Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Mantus","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc K","family":"Kamavu","sequence":"additional","affiliation":[{"name":"Office of Hospital Administration, Saint Paul\u2019s General Hospital , Nchelenge , Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L","family":"Sichivula","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Tropical Diseases Research Centre , Ndola , Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wycliffe M","family":"Matende","sequence":"additional","affiliation":[{"name":"United Nations High Commissioner for Refugees, Country Representation Office , Lusaka , Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Fritschi","sequence":"additional","affiliation":[{"name":"Mycobacterial and Migrant Health Research Group, University of Basel Children\u2019s Hospital , Basel , Switzerland"},{"name":"Department of Clinical Research, University of Basel , Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Shields","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Curriero","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Kvit","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gershom","family":"Chongwe","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J","family":"Moss","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA"},{"name":"Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Ritz","sequence":"additional","affiliation":[{"name":"Mycobacterial and Migrant Health Research Group, University of Basel Children\u2019s Hospital , Basel , Switzerland"},{"name":"Infectious Disease and Vaccinology Unit, University Children\u2019s Hospital Basel, University of Basel , Basel , Switzerland"},{"name":"Department of Pediatrics, The Royal Children\u2019s Hospital Melbourne, The University of Melbourne , Melbourne , Australia"},{"name":"Department of Paediatrics and Paediatric Infectious Diseases, Children\u2019s Hospital, Lucerne Cantonal Hospital , Lucerne , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew M","family":"Ippolito","sequence":"additional","affiliation":[{"name":"Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA"},{"name":"Division of Clinical Pharmacology and Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"2023053118481036700_ciac417-B1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1752-1505-5-24","article-title":"Incidence and risk factors for malaria, pneumonia and diarrhea in children under 5 in UNHCR refugee camps: a retrospective study","volume":"5","author":"Hershey","year":"2011","journal-title":"Confl Health"},{"key":"2023053118481036700_ciac417-B2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1752-1505-5-17","article-title":"The burden of malaria in post-emergency refugee sites: a retrospective study","volume":"5","author":"Anderson","year":"2011","journal-title":"Confl Health"},{"key":"2023053118481036700_ciac417-B3","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/S0140-6736(04)17481-3","article-title":"Communicable diseases in complex emergencies: impact and challenges","volume":"364","author":"Connolly","year":"2004","journal-title":"Lancet"},{"key":"2023053118481036700_ciac417-B4","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1752-1505-4-2","article-title":"Conflict-affected displaced persons need to benefit more from HIV and malaria national strategic plans and Global Fund grants","volume":"4","author":"Spiegel","year":"2010","journal-title":"Confl Health"},{"key":"2023053118481036700_ciac417-B5","doi-asserted-by":"crossref","first-page":"3296","DOI":"10.1001\/jama.1990.03440240086021","article-title":"Prevention of excess mortality in refugee and displaced populations in developing countries","volume":"263","author":"Toole","year":"1990","journal-title":"JAMA"},{"key":"2023053118481036700_ciac417-B6","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1080\/00034983.2001.11813694","article-title":"Malaria epidemiology and control in refugee camps and complex emergencies","volume":"95","author":"Rowland","year":"2001","journal-title":"Ann Trop Med Parasitol"},{"key":"2023053118481036700_ciac417-B7","volume-title":"UNHCR\u2019s strategic plan for malaria control 2008\u20132012","author":"United Nations High Commissioner for Refugees (UNHCR)","year":"2008"},{"key":"2023053118481036700_ciac417-B8","first-page":"869","article-title":"Prevention. Malaria in refugees from Tanzania: King County, Washington, 2007","volume":"57","author":"Centers for Disease C","year":"2008","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023053118481036700_ciac417-B9","first-page":"129","article-title":"Infectious diseases among refugee children","volume":"6","author":"Shetty","year":"2019","journal-title":"Children (Basel)"},{"key":"2023053118481036700_ciac417-B10","first-page":"271","article-title":"Demographics and disease prevalence of two new refugee groups in San Francisco. The Ethiopian and Afghan refugees","volume":"143","author":"McCaw","year":"1985","journal-title":"West J Med"},{"key":"2023053118481036700_ciac417-B11","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/1475-2875-10-149","article-title":"Malaria in Kakuma refugee camp, Turkana, Kenya: facilitation of Anopheles arabiensis vector populations by installed water distribution and catchment systems","volume":"10","author":"Bayoh","year":"2011","journal-title":"Malar J"},{"key":"2023053118481036700_ciac417-B12","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/jrs\/14.4.412","article-title":"An investigation of increasing mortality among Congolese refugees in Lugufu camp, Tanzania, May-June 1999","volume":"14","author":"Talley","year":"2001","journal-title":"J Refug Stud"},{"key":"2023053118481036700_ciac417-B13","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1186\/s12936-016-1479-z","article-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","volume":"15","author":"Charchuk","year":"2016","journal-title":"Malar J"},{"key":"2023053118481036700_ciac417-B14","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1136\/bmj.295.6593.314","article-title":"Epidemiological assessment of the health and nutrition of Ethiopian refugees in emergency camps in Sudan, 1985","volume":"295","author":"Shears","year":"1987","journal-title":"Br Med J (Clin Res Ed)"},{"key":"2023053118481036700_ciac417-B15","first-page":"237","article-title":"An analysis of mortality trends among refugee populations in Somalia, Sudan, and Thailand","volume":"66","author":"Toole","year":"1988","journal-title":"Bull World Health Organ"},{"key":"2023053118481036700_ciac417-B16","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1080\/00034983.1990.11812460","article-title":"Malaria in refugee camps in eastern Sudan: a sero-epidemiological approach","volume":"84","author":"Lienhardt","year":"1990","journal-title":"Ann Trop Med Parasitol"},{"key":"2023053118481036700_ciac417-B17","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4269\/ajtmh.15-0006","article-title":"Malaria epidemiology and control within the international centers of excellence for malaria research","volume":"93","author":"Moss","year":"2015","journal-title":"Am J Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B18","doi-asserted-by":"crossref","first-page":"e0156717","DOI":"10.1371\/journal.pone.0156717","article-title":"Individual and household level risk factors associated with malaria in Nchelenge District, a region with perennial transmission: a serial cross-sectional study from 2012 to 2015","volume":"11","author":"Pinchoff","year":"2016","journal-title":"PLoS One"},{"key":"2023053118481036700_ciac417-B19","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.4269\/ajtmh.20-0852","article-title":"Therapeutic efficacy of Artemether-Lumefantrine for uncomplicated falciparum malaria in Northern Zambia","volume":"103","author":"Ippolito","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B20","doi-asserted-by":"crossref","DOI":"10.18356\/9789211066012","volume-title":"Global trends forced displacement in 2019","author":"United Nations High Commissioner for Refugees (UNHCR)","year":"2020"},{"key":"2023053118481036700_ciac417-B21","volume-title":"Operational update - Zambia","author":"United Nations High Commissioner for Refugees (UNHCR)","year":"2020"},{"key":"2023053118481036700_ciac417-B22","volume-title":"Settlement profile: Mantapala","author":"United Nations High Commissioner for Refugees (UNHCR)","year":"2021"},{"key":"2023053118481036700_ciac417-B23","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1093\/infdis\/jiy223","article-title":"Drug-resistance and population structure of Plasmodium falciparum across the Democratic Republic of Congo using high-throughput molecular inversion probes","volume":"218","author":"Aydemir","year":"2018","journal-title":"J Infect Dis"},{"key":"2023053118481036700_ciac417-B24","volume-title":"Mantapala refugee settlement profile","author":"United Nations High Commissioner for Refugees (UNHCR)","year":"2018"},{"key":"2023053118481036700_ciac417-B25","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.4269\/ajtmh.17-1017","article-title":"Risk factors for mortality in children hospitalized with severe malaria in northern Zambia: a retrospective case-control study","volume":"98","author":"Ippolito","year":"2018","journal-title":"Am J Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B26","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.4269\/ajtmh.15-0283","article-title":"Predictive malaria risk and uncertainty mapping in Nchelenge District, Zambia: evidence of widespread, persistent risk and implications for targeted interventions","volume":"93","author":"Pinchoff","year":"2015","journal-title":"Am J Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B27","doi-asserted-by":"crossref","first-page":"126","DOI":"10.4269\/ajtmh.18-0875","article-title":"Risk factors for household vector abundance using indoor CDC light traps in a high malaria transmission area of northern Zambia","volume":"101","author":"Hast","year":"2019","journal-title":"Am J Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B28","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0020-2452(98)80024-9","article-title":"Control of infectious diseases in refugee and displaced populations in developing countries","volume":"96","author":"Paquet","year":"1998","journal-title":"Bulletin de l\u2019Institut Pasteur"},{"key":"2023053118481036700_ciac417-B29","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s12916-018-1153-0","article-title":"Healthcare service delivery to refugee children from the Democratic Republic of Congo living in Durban, South Africa: a caregivers\u2019 perspective","volume":"16","author":"Meyer-Weitz","year":"2018","journal-title":"BMC Med"},{"key":"2023053118481036700_ciac417-B30","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s12936-015-0724-1","article-title":"The evidence for improving housing to reduce malaria: a systematic review and meta-analysis","volume":"14","author":"Tusting","year":"2015","journal-title":"Malar J"},{"key":"2023053118481036700_ciac417-B31","first-page":"279","article-title":"L\u2019Immunit\u00e9, la Pr\u00e9munition et la R\u00e9sistance Inn\u00e9e","volume":"TXIII","author":"Sergent","year":"1935","journal-title":"Archives de l\u2019Institut Pasteur d\u2019Alg\u00e9rie"},{"key":"2023053118481036700_ciac417-B32","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1086\/315906","article-title":"Nutritional modulation of malaria morbidity and mortality","volume":"182","author":"Shankar","year":"2000","journal-title":"J Infect Dis"},{"key":"2023053118481036700_ciac417-B33","doi-asserted-by":"crossref","first-page":"903","DOI":"10.4269\/ajtmh.14-0312","article-title":"Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control","volume":"92","author":"Kamya","year":"2015","journal-title":"Am J Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B34","doi-asserted-by":"crossref","first-page":"686","DOI":"10.4269\/ajtmh.2002.66.686","article-title":"Prognostic value of thrombocytopenia in African children with falciparum malaria","volume":"66","author":"Gerardin","year":"2002","journal-title":"Am J Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B35","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1093\/infdis\/jiu487","article-title":"Severe malarial thrombocytopenia: a risk factor for mortality in Papua, Indonesia","volume":"211","author":"Lampah","year":"2015","journal-title":"J Infect Dis"},{"key":"2023053118481036700_ciac417-B36","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1016\/S0140-6736(02)11915-5","article-title":"Health programmes and policies associated with decreased mortality in displaced people in postemergency phase camps: a retrospective study","volume":"360","author":"Spiegel","year":"2002","journal-title":"Lancet"},{"key":"2023053118481036700_ciac417-B37","first-page":"7","article-title":"Severe malaria","volume":"19(Suppl 1)","author":"World Health Organization","year":"2014","journal-title":"Trop Med Int Health"},{"key":"2023053118481036700_ciac417-B38","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1001\/jama.293.12.1461","article-title":"Association of transmission intensity and age with clinical manifestations and case fatality of severe Plasmodium falciparum malaria","volume":"293","author":"Reyburn","year":"2005","journal-title":"JAMA"},{"key":"2023053118481036700_ciac417-B39","doi-asserted-by":"crossref","first-page":"539","DOI":"10.4269\/ajtmh.1998.59.539","article-title":"Severe malaria in Burkina Faso: influence of age and transmission level on clinical presentation","volume":"59","author":"Modiano","year":"1998","journal-title":"Am J Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B40","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1093\/cid\/ciac304","article-title":"Whole blood transfusion for severe malarial anemia in a high Plasmodium falciparum transmission setting","volume":"75","author":"Ippolito","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2023053118481036700_ciac417-B41","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S0035-9203(99)90024-X","article-title":"Bacteraemia complicating severe malaria in children","volume":"93","author":"Berkley","year":"1999","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B42","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S0035-9203(01)90152-X","article-title":"Leucocytosis in severe malaria","volume":"95","author":"Modiano","year":"2001","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2023053118481036700_ciac417-B43","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/trstmh\/trt086","article-title":"Malaria and soil-transmitted intestinal helminth co-infection and its effect on anemia: a meta-analysis","volume":"107","author":"Naing","year":"2013","journal-title":"Trans R Soc Trop Med Hyg"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciac417\/44553967\/ciac417.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/76\/3\/e1104\/50496743\/ciac417.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/76\/3\/e1104\/50496743\/ciac417.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T05:55:00Z","timestamp":1727330100000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/76\/3\/e1104\/6595698"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,31]]},"references-count":43,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,5,31]]},"published-print":{"date-parts":[[2023,2,8]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciac417","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,2,1]]},"published":{"date-parts":[[2022,5,31]]}}}