Malaria drug and diagnostic resistance in refugee children in Uganda
Stephen Tukwasibwe, PhD
BACKGROUND: Resistance to antimalarial drugs, especially artemisinins, and deletions in HRP-2 based rapid diagnostic tests that result in false negative tests are seen at varied and increasing prevalence in Africa, including countries where refugees to Uganda originate. Malaria testing at reception centers, which process refugees when they enter Uganda, is only done when refugees present with clinical signs suggesting malaria, posing a risk of importation of malaria parasites, with genetic polymorphisms mediating drug and diagnostic resistance, especially in refugees with asymptomatic malaria parasitemia, which is common in Africa. GAP: We do not know the prevalence of malaria parasitemia in refugee children entering Uganda or, for those who are parasitemic, the prevalences of key drug and diagnostic resistance mediating genetic polymorphisms. HYPOTHESIS: We hypothesize that the prevalence of malaria parasitemia is high in newly arriving refugee children and that the prevalence of key markers of drug and diagnostic resistance will differ between refugee and non-refugee populations. METHODS: This will be a cross-sectional surveillance study of refugee and non-refugee populations. We will study newly arrived refugee children and children in nearby non-refugee populations in Uganda. RESULTS: Pending. IMPACT: Our results will be shared with policy makers and be of value in the prioritization of malaria control efforts in Uganda. Specifically, our data may suggest introduction of testing for malaria parasitemia and resistance markers in refugee screening. This project may be followed by a larger refugee surveillance program and/or clinical trials to test improved control policies in refugee populations.