Epidemiological Surveillance Among Mozambican Refugees in Malawi, 1987–89

In early 1987 the Malawian Ministry of Health the UN High Commissioner for Refugees and the private medical organization called Medicins Sans Frontieres established a routine health surveillance system of the Mozambican refugee population living in 11 camps or villages in Malawi along the border with Mozambique. Between 1987 and 1989 the Mozambican refugee population rose from 70000 to 750000 for a mean increase of 8.3%/month which in turn caused a 10% increase in the total population of Malawi. 22% of the refugee population was 5 years old (35.7/1000 vs. 6.3/1000). 70% of deaths among the 5 years old were preventable or treatable infectious diseases (e.g. diarrhea malaria acute lower respiratory infections and measles). 11.5% of all measle cases died. Most of the measle cases (67.5%) were 12 months in Mankhokwe camp. The incidence of measles fell as vaccine coverage increased. 7 cholera outbreaks occurred between 1988 and 1989. Mankhokwe had the highest attack rate (March-May 1988; 2.6%) while Mkwayi had the lowest (February 1989; 0.8%). Yet Mkwayi had the highest case fatality ratio (10.8%). Malnutrition prevalence rates differed based on times and camps (1.2-18%). <5 year old mortality rates were strongly correlated with malnutrition prevalence rates. The food ration in the Mankhokwe camp (40000 refugees) was lower than the recommended 1800 kcal/person/day for 20 months. Beginning in June 1989 the daily mean of niacin available per refugee was <5 mg/day which resulted in an outbreak of pellagra. This surveillance system allowed for relatively timely public health interventions to keep mortality and morbidity rates low. Mortality rates among the Mozambican refugees were 3-5 times lower than mortality rates of refugees in Thailand Somalia Uganda and the Sudan.