Socio-economic determinants of malaria in tribal dominated Mandla district enrolled in Malaria Elimination Demonstration Project in Madhya Pradesh

Abstract

Background Malaria is known as a disease of poverty because of its dominance in poverty-stricken areas. Madhya Pradesh state in central India is one of the most vulnerable states for malaria morbidity and mortality. Socio-economic, environmental and demographic factors present challenges in malaria control and elimination. As part of the Malaria Elimination Demonstration Project in the tribal district of Mandla in Madhya Pradesh, this study was undertaken to assess the role of different social-economic factors contributing to malaria incidence. Methods The study was conducted in the 1233 villages of district Mandla, where 87% population resides in rural areas. The data was collected using the android based mobile application—SOCH for a period of 2 years (September 2017 to August 2019). A wealth index was computed along with analysis of the socio-economic characteristics of houses with malaria cases. Variables with significant variation in malaria cases were used in logistic regression. Results More than 70% of houses in Mandla are Kuccha (made of thatched roof or mud), 20% do not have any toilet facilities, and only 11% had an annual income of more than 50,000 INR, which converts to about $700 per year. Households with younger heads, male heads, more number of family members were more likely to have malaria cases. Kuccha construction, improper water supply, low household income houses were also more likely to have a malaria case and the odds doubled in houses with no toilet facilities. Conclusion Based on the results of the study, it has been found that there is an association between the odds of having malaria cases and different household variables such as age, gender, number of members, number of rooms, caste, type of house, toilet facilities, water supply, cattle sheds, agricultural land, income, and vector control interventions. Therefore, a better understanding of the association of various risk factors that influence the incidence of malaria is required to design and/or deploy effective policies and strategies for malaria elimination. The results of this study suggest that appropriate economic and environmental interventions even in low-income and poverty-stricken tribal areas could have huge impact on the success of the national malaria elimination goals.

Socio-economic and household determinants of malaria in adults aged 45 and above: analysis of longitudinal ageing survey in India, 2017–2018

“…Residents in kutcha houses have higher odds of malaria; kutcha houses may have holes and gaps that allow easy entry of mosquitoes. This is in line with earlier Indian studies where kutcha houses/walls made of dung and earth have shown to be a risk factor for malaria [ 14 , 17 ]. Positive association between mosquito bites/day and bamboo houses has been reported in Assam, India [ 18 ].…”

“…Agricultural activities require significant time to be spent outdoors, and these individuals are at higher risk of mosquito bites. A recent study from Mandla district in Madhya Pradesh shows households having own farmlands to have a significant association with malaria [ 17 ].…”

“…Family size/number of people in the house/number of people per room is an important risk factor for malaria [ 14 , 17 , 32 – 35 ], as crowding attracts more mosquitoes due to strong olfactory signals [ 36 ]. As observed in studies carried out in India [ 14 , 17 ], Ethiopia [ 37 ], Indonesia [ 38 ], and sub-Saharan Africa [ 39 ], access to outside water-source is a major malaria risk factor, as dependence on outside source for water, especially in dusk and dawn increases the chances of mosquito bite. Furthermore, households using tube-wells as outside water-source have risk of malaria [ 17 ], as tube-wells are suggested to have more stagnant water around them due to improperly maintained drainage facilities [ 40 ].…”

“…As observed in studies carried out in India [ 14 , 17 ], Ethiopia [ 37 ], Indonesia [ 38 ], and sub-Saharan Africa [ 39 ], access to outside water-source is a major malaria risk factor, as dependence on outside source for water, especially in dusk and dawn increases the chances of mosquito bite. Furthermore, households using tube-wells as outside water-source have risk of malaria [ 17 ], as tube-wells are suggested to have more stagnant water around them due to improperly maintained drainage facilities [ 40 ]. Poor toilet facility (sanitation) is another important household risk factor of malaria, and is in-line with earlier studies carried out in India [ 17 ] and elsewhere [ 37 – 39 , 41 ].…”

“…In addition, housing factors have also been shown to play an important role in malaria transmission [ 15 , 16 ]. In India, studies on socio-economic and household determinants of malaria are very limited, and are focused on selected districts [ 14 , 17 – 19 ]. Type of house, toilet facility and water-source were the major housing risk factors [ 17 ], while, social groups, family size [ 14 ], monthly income [ 18 ] were some of the key socio-economic determinants reported in these Indian studies.…”