Malaria and Migrant Workers in Ethiopia
One data collector shades a fellow data collector from the bright sun while he interviews a migrant farm worker using a tablet.
Malaria is a difficult disease to control for many reasons. It involves addressing environmental conditions, such as stagnant water and climate change; buying and distributing prevention tools, such as bed nets and insecticide-residual sprays; and finding new tools as parasites develop resistance to insecticides. In the Amhara region of Ethiopia, migrant farm workers present additional challenges to malaria-control efforts.
Since 2006 The Carter Center’s Malaria Control Program has worked with health officials in Ethiopia to control the disease in hopes of eventual elimination. Ethiopia’s prevalence of malaria varies by region due to the country’s changing altitude and landscape. Low-lying, fertile agricultural areas pose ideal habitats for mosquitoes, and these areas often experience the most intense malaria transmission. Malaria also follows seasonal transmission patterns, with peaks occurring in October and November following the main rainy season—months that correspond to peak agricultural activities. There is particular concern that migrants carry malaria infections back to their home areas at the end of each farming season. With 85 percent of the Ethiopian workforce employed in agriculture, understanding the impact of malaria on migrants and their role in the epidemiology of malaria in Ethiopia is crucial to national productivity and malaria control efforts. “Ethiopia has achieved great success in the scale up of interventions against malaria in recent years. However, there is increasing recognition that migrant populations may not be fully covered by the standard package of malaria prevention measures, which are largely targeted to stationary household populations,” says Greg Noland, senior epidemiologist for the Malaria Control Program at The Carter Center.
Data collectors, farm workers, a donkey and Schicker all hitch a ride through the farm areas on the bed of a tractor.
This past summer, MSN/MPH student Rebekah Stewart Schicker had the opportunity to study migrant populations in Amhara. Working with Greg Noland, Schicker surveyed migrant farm workers in two districts of North Gondar zone to determine their access to, and use of, malaria-prevention methods; to measure prevalence of malaria and anemia; and to understand migrants’ health-care-seeking behavior while working on farms.
For Schicker, working with underserved populations is nothing new—she worked as a nurse in hospital emergency departments for eight years, often witnessing the struggles of populations that faced barriers to accessing healthcare. In addition to her nursing, she has volunteered with refugees and migrant communities. So when Schicker’s original Global Field Experience (GFE) project fell through in spring 2013, she was surprised to find this unique opportunity that combined her passions. Schicker explained how the opportunity was rather serendipitous, saying, “My initial GFE project fell through, and so I asked Professor Deb McFarland for advice. She noted that Greg Noland was looking for someone who had taken the Complex Humanitarian Emergency Certificate course to help with research on migrant populations in Ethiopia. I had my certificate, and I realized it was a perfect match—health care access and migrant populations.”
After designing and revising the survey in the course of several months with her colleagues from The Carter Center in Atlanta and Ethiopia, Ethiopian health ministry officials, and Rollins faculty member Rob Stephenson, Schicker and the team decided to use a venue-based survey. The latter are typically chosen when conducting research within hard-to-reach populations, such as drug users, those involved in prostitution, and men having sex with men. Instead of focusing on households, as most malaria-related surveys do, this survey—aided by a completely electronic survey platform using hand-held tablet computers—brought the team to places where the migrant workers gathered and worked.
Migrant farm workers walk in groups along the dirt road looking for work.
While Schicker is still analyzing the data, preliminary results suggest that, contrary to anecdotal reports, the vast majority of the migrants originate from other districts within North Gondar zone. Only 12 percent of those surveyed had bed nets. Most migrants slept in temporary shelters which are typically overcrowded, making it difficult to accommodate bed nets. In addition, most migrants are paid by land owners on a contract basis according to how much they produce, not how long they work. As a result, the workers are inclined to work long hours, even after dusk, which is when malaria-carrying mosquitoes bite. Overall, the migrant population in the region contributes significantly to Ethiopia as agriculture makes up 50 percent of the country’s GDP. Yet according to Schicker, these workers do not have a voice or proper access to health care to treat malaria or other illnesses. From these results, Schicker and the team—including Noland and Carter Center Ethiopia staff—are looking for appropriate interventions to combat malaria in this population as well as lay the groundwork for how land owners and health workers might also have a hand in improving the health and overall living conditions for the population.
All these efforts continue in collaboration with the Ethiopian ministry of health. “This project was definitely a collaborative effort. We benefited greatly from our partners at Emory and in Ethiopia, support from IDN, and especially Rebekah’s enthusiasm for the project and people of Ethiopia,” said Noland.
As with most experiences working in a different context and culture, Schicker’s time in Ethiopia was not without challenges. However, “the experience,” she said, “was wonderful for defining my interests and future work.” She would like to continue her work with migrant workers and other immigrant populations and looks forward to further collaboration on this project as she continues her studies at Emory.