Institute for Justice and Democracy in Haiti

Peacekeepers Should Learn from Cholera to Prevent Malaria

When United Nations peacekeepers brought cholera to Haiti in 2010, many were shocked that the UN didn’t screen the troops before they were deployed, particularly when Nepal is known to have endemic cholera and Haiti is known to have poor infrastructure. Now, many of those same people are hoping that the UN will use Haiti as a lesson for peacekeeping in sub-Saharan Africa: As Southeast Asia has a particularly challenging type of malaria, troops sent from there to sub-Saharan Africa should be screened and treated before being deployed.

Part of the paper is below. Click HERE for the full text and summary points.

Screening and Treating UN Peacekeepers to Prevent the Introduction of Artemisinin-Resistant Malaria into Africa

Stan Houston & Adam Houston, PLOS Medicine
May 5, 2015

Introduction: The Precedent of Cholera in Haiti
In the aftermath of the massive earthquake that devastated Haiti in 2010, an ongoing epidemic of cholera introduced by United Nations peacekeepers has resulted in over 730,000 cases and over 8,700 deaths—the largest single-country cholera epidemic in nearly a century [1,2]. This disaster should serve as an urgent warning about the potential for introduction by UN troops of other serious infectious diseases into the vulnerable populations they were sent to protect. Indeed, the UN has recently agreed to avoid rotation of African troops to Haiti because of concern about the introduction of Ebola [3]. But the tragedy in Haiti pales in comparison to the scale of long-term impact on malaria morbidity, mortality, and control programs that would result from the introduction of artemisinin-resistance into sub-Saharan Africa, where 85% of the world’s falciparum malaria cases and over 90% of all malaria deaths now occur [4]. This threat demands urgent action, in particular on the part of the UN.

The Importance of Artemisinins and the Threat of Resistance
Artemisinin derivatives are currently the mainstay of antimalarial treatment throughout the world. Their implementation, along with expanded use of insecticide-treated bed nets, accounts for a large part of the reduction in malaria deaths in Africa over the past decade [5]. Consequently, the emergence of decreasing responsiveness to artemisinin derivatives over the past few years is deeply concerning. Initially observed in Cambodia, resistant strains now appear to be spreading rapidly within the region and have been observed in Myanmar, Laos, Thailand, Vietnam, and, most recently, at the Indian border [6–8]. This pattern of rapid dissemination evokes the history of chloroquine resistance, which first appeared in the same area of Southeast Asia over 50 years ago. Chloroquine resistance soon reached Africa, where its inexorable spread across the continent over a few years resulted in the loss of a safe, inexpensive treatment and a 2-to-3-fold increase in malaria deaths and admissions for severe malaria [9,10]. With no comparably effective treatment alternative available, the establishment of artemisinin-resistant malaria in sub-Saharan Africa would be expected to result in a substantial reversal of the recent progress in malaria control and a major increase in malaria illness and death.

New WHO initiatives to prevent the emergence of artemisinin resistance by ensuring the drug is only available coformulated with other antimalarials represent an important positive step, to the degree that they are effectively implemented. Any positive impact of these policies, however, would be rapidly overwhelmed if resistant parasites were introduced directly into the fertile soil of a highly malaria-endemic population.

Click HERE for the full text and summary points.

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