Does socio-economic status explain the differentials in malaria parasite prevalence? Evidence from The Gambia

Malaria Journal, Nov 2014

Background Malaria is commonly associated with poverty. Macro-level estimates show strong links between malaria and poverty, and increasing evidence suggests that the causal link between malaria and poverty runs in both directions. However, micro-level (household and population) analyses on the linkages between malaria and poverty have often produced mixed results. Methods The Gambia Malaria Indicator Survey (MIS) 2010/11 was carried out between November 2010 and January 2011. Laboratory-confirmed malaria and wealth quintiles were used to assess the association of socio-economic status and malaria infection in children and the general population. Simple and multiple logistic regressions and survey data analysis procedures, including linearized standard errors to account for cluster sampling and unequal selection probabilities were applied. Results Children (six to 59 months) from the second, third, fourth and richest quintiles were significantly less likely to have malaria compared to children from the poorest quintiles. Children (five to 14 years) from the fourth and richest quintiles were also significantly less likely to have malaria compared to those from the poorest quintiles. The malaria burden has shifted from the under-five children (six to 59 months) to children aged five to 14 years. Malaria prevalence was significantly higher in the Central River Region compared to the Upper River Region; and males bear the malaria brunt more than females. Children (six to 59 months) and children (five to 14 years) living in houses with poor walls, floors, roofs and windows were significant associated with higher prevalence of malaria. However, in the general population, only poor wall housing materials were associated with higher prevalence of malaria. Conclusions Investments in strategies that address socio-economic disparities and improvements in the quality of housing could, in the long term, significantly reduce the malaria burden in the poorest communities.

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Does socio-economic status explain the differentials in malaria parasite prevalence? Evidence from The Gambia

Sheriff T Sonko 1 Malanding Jaiteh 3 James Jafali 2 Lamin BS Jarju 1 Umberto D'Alessandro 2 Abu Camara 5 Musu Komma-Bah 4 Alieu Saho 4 0 17 , Kanifing , The Gambia 1 National Malaria Control Programme , Kanifing Institutional Layout, Plot 2 Medical Research Council Laboratories , Fajara, Banjul , The Gambia 3 Center for International Earth Science Information Network (CIESIN), Columbia University , New York , USA 4 Gambia Bureau of Statistics, Kanifing Institutional Layout , Kanifing , The Gambia 5 Islamic Development Bank , Jeddah, Kingdom of Saudi Arabia Background: Malaria is commonly associated with poverty. Macro-level estimates show strong links between malaria and poverty, and increasing evidence suggests that the causal link between malaria and poverty runs in both directions. However, micro-level (household and population) analyses on the linkages between malaria and poverty have often produced mixed results. Methods: The Gambia Malaria Indicator Survey (MIS) 2010/11 was carried out between November 2010 and January 2011. Laboratory-confirmed malaria and wealth quintiles were used to assess the association of socio-economic status and malaria infection in children and the general population. Simple and multiple logistic regressions and survey data analysis procedures, including linearized standard errors to account for cluster sampling and unequal selection probabilities were applied. Results: Children (six to 59 months) from the second, third, fourth and richest quintiles were significantly less likely to have malaria compared to children from the poorest quintiles. Children (five to 14 years) from the fourth and richest quintiles were also significantly less likely to have malaria compared to those from the poorest quintiles. The malaria burden has shifted from the under-five children (six to 59 months) to children aged five to 14 years. Malaria prevalence was significantly higher in the Central River Region compared to the Upper River Region; and males bear the malaria brunt more than females. Children (six to 59 months) and children (five to 14 years) living in houses with poor walls, floors, roofs and windows were significant associated with higher prevalence of malaria. However, in the general population, only poor wall housing materials were associated with higher prevalence of malaria. Conclusions: Investments in strategies that address socio-economic disparities and improvements in the quality of housing could, in the long term, significantly reduce the malaria burden in the poorest communities. - Background The worldwide malaria burden is currently estimated at about 207 million cases and 627,000 deaths. Sub-Saharan Africa bears the heaviest brunt, with 90% of all deaths, 77% among children under-five. Nevertheless, between 2000 and 2012, malaria mortality rates have decreased by 42% worldwide (by 48% in children under-five) and by 49% in the African Region (by 54% in children under-five) [1]. Malaria is commonly associated with poverty [2-10]. Macro-level estimates show strong links between malaria and poverty. For instance, the malaria burden is highest in the poorest countries, particularly in sub-Saharan Africa, where poverty is widespread and with little economic growth over the past quarter century [5,6]. The gross national product (GNP) in malaria endemic countries is more than half lower than in non-endemic countries [6]. The poorest 20% of the worlds population contribute to 58% of all malaria deaths [11]. Increasing evidence at macro-level suggests that the causal link between malaria and poverty runs in both directions [3-6]. A review of micro-level (household and population) analyses on the link between malaria and poverty has produced mixed results [12]. Out of nine studies, only two reported a significant association between malaria and poverty [12]. Data from 29 demographic and health surveys (DHS) in 22 countries were used for an aggregatelevel regional data analysis for West and Central Africa, and East and Southern Africa, including individual child and country-by-country analysis. No differences were found at the household level in the incidence of fever between the poor and the less poor, though significant differences were found at more aggregate-levels, i.e., country-by-country as opposed to regional-level analysis [13]. In Ghana, social class was not associated with risk of malaria infection [14]. In Tanzania, there was no association between self-reported malaria and socioeconomic status (SES) but malaria prevalence was significantly higher among the lower SES individuals [15]. In Nigeria, self-reported malaria or fever was more frequent among the better-off SES and urban dwellers [16] though an earlier study showed a heavier malaria burden among the poor (<US $1/day) compared to the rich [17]. Contrasting results are function of the methodology used to measure malaria and poverty. Studies based on self-reported fever are likely to overestimate the malaria (...truncated)


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Sheriff T Sonko, Malanding Jaiteh, James Jafali, Lamin BS Jarju, Umberto D’Alessandro, Abu Camara, Musu Komma-Bah, Alieu Saho. Does socio-economic status explain the differentials in malaria parasite prevalence? Evidence from The Gambia, Malaria Journal, 2014, pp. 449, 13, DOI: 10.1186/1475-2875-13-449