Rowland Mark, Rab Mohammad Abdur, Freeman Tim, Durrani Naeem, Rehman Naveeda
HealthNet International, University Town, Peshawar, Pakistan.
Soc Sci Med. 2002 Dec;55(11):2061-72. doi: 10.1016/s0277-9536(01)00341-0.
Influx of refugees and establishment of camps or settlements in malaria endemic areas can affect the distribution and burden of malaria in the host country. Within a decade of the Soviet invasion of Afghanistan and the arrival of 2.3 million Afghan refugees in Pakistan's North West Frontier Province, the annual burden of malaria among refugees had risen ten fold from 11,200 cases in 1981 to 118,000 cases in 1991, a burden greater than the one reported by the Pakistan Ministry of Health for the entire Pakistani population. Political developments in the 1990s led to over half the refugee population repatriating to Afghanistan, and the Afghan Refugee Health Programme (ARHP) was scaled down proportionately. Districts in which the ARHP recorded a reduced incidence of malaria began to show an increased incidence in the statistics of the Pakistan government health programme. This and other evidence pointed to a change in health seeking practices of the refugees who remained in Pakistan, with many turning from ARHP to Pakistani health services as aid declined. Comparison of the two sources of data produced no evidence for the spatial distribution of malaria in NWFP having changed during the 1990s. Nor was there any evidence for the presence of refugees having increased the malaria burden in the Pakistani population, as is sometimes alleged. This highlights the risk of misinterpreting health trends when parallel health services are operating. Over the decade incidence in the refugee camps decreased by 25% as a result of control activities, and by 1997 the burden among remaining refugees had fallen to 26,856 cases per annum. These trends indicate that the burden would continue to fall if political conditions in Afghanistan were to improve and more refugees returned to their homeland.
难民涌入以及在疟疾流行地区建立营地或定居点会影响东道国疟疾的分布和负担。在苏联入侵阿富汗后的十年内，230万阿富汗难民抵达巴基斯坦西北边境省，难民中疟疾的年负担增加了十倍，从1981年的11200例增至1991年的118000例，这一负担超过了巴基斯坦卫生部报告的整个巴基斯坦人口的疟疾负担。20世纪90年代的政治局势变化导致一半以上的难民返回阿富汗，阿富汗难民健康项目（ARHP）也相应缩减规模。ARHP记录显示疟疾发病率降低的地区，在巴基斯坦政府卫生项目的统计中发病率开始上升。这一情况及其他证据表明，留在巴基斯坦的难民就医习惯发生了变化，随着援助减少，许多人从ARHP转向巴基斯坦的医疗服务。对这两个数据来源的比较没有发现证据表明20世纪90年代西北边境省疟疾的空间分布发生了变化。也没有证据表明难民的存在增加了巴基斯坦人口的疟疾负担，尽管有时有人这样声称。这凸显了在并行的医疗服务运作时误解健康趋势的风险。在这十年间，由于防控措施，难民营中的发病率下降了25%，到1997年，剩余难民中的疟疾负担降至每年26856例。这些趋势表明，如果阿富汗的政治状况得到改善，更多难民返回家园，疟疾负担将继续下降。
