House Structure Is Associated with Malaria among Febrile Patients in a High-Transmission Region of Zambia

Abstract

Since the late nineteenth century, the importance of house structure as a determinant of malaria risk has been recognized. Few studies to date have examined the association of housing and malaria in clinical populations. We conducted a cross-sectional study of febrile patients (n = 282) at two rural health clinics in a high malaria-transmission area of northern Zambia. Participants underwent testing for Plasmodium falciparum infection by PCR. Demographic and other risk factors including house structure, indoor residual spraying (IRS), bed net use, education level, and household income were collected. Data were fitted to logistic regression models for relational and mediation analyses. Residing in a house with a thatch roof was associated with higher odds of malaria than residing in a house with corrugated metal (odds ratio: 2.6; 95% CI: 1.0–6.3, P = 0.04). Lower income and educational attainment were also associated with greater odds of malaria. Living under a thatch roof accounted for 24% (95% CI: 14–82) of the effect of household income on malaria risk, and income accounted for 11% (95% CI: 8–19) of the effect of education. Neither IRS nor bed net use was associated with malaria risk despite large, local investments in these vector control interventions. The findings testify to malaria as a disease of rural poverty and contribute further evidence to the utility of housing improvements in vector control programs.

Prevalence and risk factors associated with malaria infections at a micro-geographic level in three villages of Muheza district, north-eastern Tanzania

“…However, adopting this strategy to reduce and control malaria mainly depends on the government’s and global partners’ strategies to enhance economic growth and ultimately improve the SES of the families. Previous studies showed that apart from their inability to afford better or improved houses, poor families also fail to adopt and effectively use other malaria interventions (such as access to better health care services, and ownership and use of bed nets) leaving them at increased risk of the disease as well as perpetuating the transmission in the community [73–75]. Therefore, specific interventions are urgently needed to target poor families in the fight against malaria.…”

“…However, adopting this strategy to reduce and control malaria mainly depends on the government's and global partners' strategies to enhance economic growth and ultimately improve the SES of the families. Previous studies showed that apart from their inability to afford better or improved houses, poor families also fail to adopt and effectively use other malaria interventions (such as access to better health care services, and ownership and use of bed nets) leaving them at increased risk of the disease as well as perpetuating the transmission in the community [73][74][75] In the study areas, most of the participants (over 96%) reported owning and using bed nets and the prevalence and risk of malaria infections were similar in those with as well as without/not using bed nets. Studies have shown that with high bed net coverage, even non-users and the entire community may be protected against malaria because high coverage of ITN/LLINs in the community and their use lead to a reduction of the number of mosquitoes, their length of survival and eventually their ability to transmit malaria [76,77].…”

Scientific Findings of the Southern and Central Africa International Center of Excellence for Malaria Research: Ten Years of Malaria Control Impact Assessments in Hypo-, Meso-, and Holoendemic Transmission Zones in Zambia and Zimbabwe

“… 54 Other risk factors were less context-specific: younger age, male sex, low-quality housing, living at lower elevation, higher rainfall, warmer weather, and lower educational attainment of the head of household were associated with higher malaria risk. 53 – 55 Using a mosquito net and living in a household with more nets per occupant were protective against malaria. 53 – 55 In hospitalized children with malaria, blood stockouts and referral from a village or health center further from the hospital were associated with higher inpatient mortality.…”

“… 53 – 55 Using a mosquito net and living in a household with more nets per occupant were protective against malaria. 53 – 55 In hospitalized children with malaria, blood stockouts and referral from a village or health center further from the hospital were associated with higher inpatient mortality. 56 Whole blood transfusion was associated with improved survival in children with severe malarial anemia, and transfusion using whole blood stored > 28 days was no better than no transfusion.…”

Household structure is independently associated with malaria risk in rural Sussundenga, Mozambique

“…There has been indication that the relationship between household structure and malaria risk is actually a mediating one between the true relationship between household income and education and P. falciparum infection ( 20 ). The underlying hypothesis in this relationship is that the head of household education level and income level are associated with household structure, which is then associated with P. falciparum infection.…”