Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa: A systematic review and meta-analysis

Abstract

BackgroundA clear understanding of the effects of housing structure, education, occupation, income, and wealth on malaria can help to better design socioeconomic interventions to control the disease. This literature review summarizes the relationship of housing structure, educational level, occupation, income, and wealth with the epidemiology of malaria in sub-Saharan Africa (SSA).MethodsA systematic review and meta-analysis was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. The protocol for this study is registered in PROSPERO (ID=CRD42017056070), an international database of prospectively registered systematic reviews. On January 16, 2016, available literature was searched in PubMed, Embase, CINAHL, and Cochrane Library. All but case studies, which reported prevalence or incidence of Plasmodium infection stratified by socioeconomic status among individuals living in SSA, were included without any limits. Odds Ratio (OR) and Relative Risk (RR), together with 95% CI and p-values were used as effect measures. Heterogeneity was assessed using chi-square, Moran’s I2, and tau2 tests. Fixed (I2<30%), random (I2≥30%) or log-linear dose-response model was used to estimate the summary OR or RR.ResultsAfter removing duplicates and screening of titles, abstracts, and full text, 84 articles were found eligible for systematic review, and 75 of them were included in the meta-analyses. Fifty-seven studies were cross-sectional, 12 were prospective cohort, 10 were case-control, and five were randomized control trials. The odds of Plasmodium infection increased among individuals who were living in poor quality houses (OR 2.13, 95% CI 1.56–3.23, I2 = 27.7), were uneducated (OR 1.36, 95% CI 1.19–1.54, I2 = 72.4.0%), and were farmers by occupation (OR 1.48, 95% CI 1.11–1.85, I2 = 0.0%) [p<0.01 for all]. The odds of Plasmodium infection also increased with a decrease in the income (OR 1.02, 95% CI 1.01–1.03, tau2<0.001), and wealth index of individuals (OR 1.25, 95% CI 1.18–1.35, tau2 = 0.028) [p<0.001 for both]. Longitudinal studies also showed an increased risk of Plasmodium infection among individuals who were living in poor quality houses (RR 1.86, 95% CI 1.47–2.25, I2 = 0.0%), were uneducated (OR 1.27, 1.03–1.50, I2 = 0.0%), and were farmers (OR 1.36, 1.18–1.58) [p<0.01 for all].ConclusionsLack of education, low income, low wealth, living in poorly constructed houses, and having an occupation in farming may increase risk of Plasmodium infection among people in SSA. Public policy measures that can reduce inequity in health coverage, as well as improve economic and educational opportunities for the poor, will help in reducing the burden of malaria in SSA.

Multilevel modelling of the risk of malaria among children aged under five years in Nigeria

“…Furthermore, our data suggest that children with educated mothers had less odds of malaria. As mother's education is often used as a proxy for household wealth (23), previous studies have found a reduced risk of malaria in wealthier households (24). There is the consistent trend in association between the household wealth index, an indicator related to other household determinants that impact on malaria incidence, with the poor suffering the brunt of malaria cases and perhaps mortality.…”

“…Malaria is a major public health problem in developing economies, especially in sub-Sahara Africa (SSA) where it is responsible for substantial morbidity and mortality (1) as well as other socioeconomic losses (2). The disease is caused by Plasmodium parasite, and transmitted through the bite of infected female Anopheles mosquitoes (3).…”

Malaria and tuberculosis as diseases of neglected populations: state of the art in chemotherapy and advances in the search for new drugs

“…Continuous interest must be maintained, as they affect mainly poor, or neglected, people in the world, and are responsible for a high level of mortality in these populations and put at risk many countries, including developed ones. (1,6,175,176) The intensification and the ease of people's migration are modifying the spread of many diseases, including those ones. Even considering the higher financial support for malaria and tuberculosis than for other diseases that are considered neglected, the amount invested is still lower than the estimated need.…”

Antiprotozoal dimeric naphthylisoquinolines, mbandakamines B3 and B4, and related 5,8′-coupled monomeric alkaloids, ikelacongolines A–D, from a Congolese Ancistrocladus liana

“…The dramatic increase of parasite resistance to routinely used chemotherapeutics and the absence of vaccines aggravate the situation dramatically. [35][36][37] For this reason, several research groups from medicinal chemistry, pharmacy, and infection biology focus on the search of new effective agents for the treatment of tropical infectious diseases. In the recent years, intense phytochemical studies on African plants have led to the discovery of terpenoids, alkaloids, avonoids, quinones, lignans, coumarins, and many other natural products displaying excellent antiprotozoal activities, [38][39][40][41][42][43][44][45] thus providing templates and new scaffolds for the development of a new generation of more potent drugs.…”