Environmental and sociodemographic factors associated with household malaria burden in the Congo

Ngatu, Nlandu Roger; Kanbara, Sakiko; Renzaho, Andre Μ Ν; Wumba, Roger; Mbelambela, Etongola Papy; Muchanga, Sifa Marie Joelle; Muzembo, Basilua Andre; Leon-Kabamba, Ngombe; Choomplang, Nattadech; Numbi, Oscar Luboya; Wada, Koji; Ikeda, Mitsunori; Nojima, Sayumi; Sugishita, Tomohiko; Ikeda, Shunya

doi:10.1186/s12936-019-2679-0

Cited by 31 publications

(35 citation statements)

References 25 publications

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“…This allows us to make inferences regarding the country as a whole. Other recent malaria risk factor studies have fewer individuals or are conducted in a smaller geographic area 11,12 . Second, we determined malaria infection using high-throughput real-time PCR, the most sensitive method for diagnosing infection 28 .…”

Section: Discussionmentioning

confidence: 99%

“…A small number of studies performed in the DRC have identified important risk factors for infection 4,9,10 . These studies showed that increasing age, wealth, and individual bed-net use are protective, as are increasing community level bed-net use, lower average temperature and higher altitude [9][10][11][12] . However, these studies included only children under the age of five 9,10 , or were small and geographically limited 11,12 .…”

Section: Introductionmentioning

confidence: 99%

“…These studies showed that increasing age, wealth, and individual bed-net use are protective, as are increasing community level bed-net use, lower average temperature and higher altitude [9][10][11][12] . However, these studies included only children under the age of five 9,10 , or were small and geographically limited 11,12 . A study of adults in the DRC conducted using data from the 2007 DHS identified several risk factors, such as younger age, male sex, and lower individual and community level wealth 13 ; however, no nationally representative risk factor studies of adults have been conducted since.…”

Section: Introductionmentioning

confidence: 99%

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Spatial and epidemiological drivers of P. falciparum malaria among adults in the Democratic Republic of the Congo

Deutsch-Feldman¹,

Brazeau²,

Parr

et al. 2020

Preprint

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Background: Malaria remains a significant public health problem in sub-Saharan Africa. Adults are frequently infected and may serve as a reservoir for further transmission, yet we know relatively little about risk factors for adult infections. In this study, we assessed malaria risk factors amongst adults using samples from the nationally representative, cross-sectional 2013-2014 Demographic and Health Survey (DHS) conducted in the Democratic Republic of Congo (DRC). We further explored differences in risk factors by urbanicity. Methods: Plasmodium falciparum infection was determined by polymerase chain reaction (PCR). Covariates were drawn from the DHS to model individual, community, and environmental level risk factors for infection. Additionally, we used deep sequencing data to estimate the community-level proportions of drug resistant infections and included these estimates as potential risk factors. All identified factors were assessed for differences in associations by urbanicity. Results: A total of 16,126 adults were included. Overall prevalence of malaria was 30.3% (SE = 1.1) by PCR; province-level prevalence ranged from 6.7-58.3%. Only 17% of individuals lived in households with at least one bednet for every two people, as recommended by the World Health Organization. Protective factors included increasing within-household bednet coverage (PR = 0.85, 95% CI = 0.76 - 0.95) and modern housing (PR = 0.58, 95% CI = 0.49 - 0.69). Community level protective factors included: increased average education and wealth (PR = 0.77, 95% CI = 0.65-0.91; PR - 0.84, 95% CI = 0.80 - 0.89). Education, wealth, and modern housing showed protective associations in cities but not in rural areas. Conclusions: The DRC continues to suffer from a high burden of malaria; interventions that target high-risk groups and sustained investment in malaria control are sorely needed. Differences in risk factors by urbanicity may be due to differences in transmission intensity or access to resources.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spatial and epidemiological drivers of P. falciparum malaria among adults in the Democratic Republic of the Congo

Deutsch-Feldman¹,

Brazeau²,

Parr

et al. 2020

Preprint

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“…[6][7][8][9][10] The environmental and socio-demographic factors predominantly affect the burden of malaria at household level. 11 Ethiopia has made notable progress in decreasing the prevalence and burden of malaria through public health measures taken during the millennium development goals (MDGs) era. 12 However, malaria remains one of the public health problems with a high level of mortality and disability adjusted life years (DALYs).…”

Section: Introductionmentioning

confidence: 99%

<p>Economic Burden of Malaria and Associated Factors Among Rural Households in Chewaka District, Western Ethiopia</p>

Tefera

Ololo

Daka

2020

CEOR

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Background: There has been a remarkable decline in the burden of malaria in the past few decades in Ethiopia. However, malaria remains a major impediment to both health and economic development in Ethiopia, with 60% of the population at risk of contracting malaria. Hence, this study aimed to estimate the economic burden of malaria among rural households in Chewaka district, Buno Bedele zone, Oromia regional state, Western Ethiopia. Methods: Community-based cross-sectional study design was employed to estimate the economic burden of malaria at the household level from August 13 to September 2, 2018. A retrospective costing approach was employed, and cost was estimated from the perspective of households. The study included malaria expenditure of households during a one-year period (July 9, 2017 to July 9, 2018). Data were collected from 765 randomly selected households and analyzed using SPSS version 20. Multivariate logistic regression analysis was performed to identify predictors of the economic burden of malaria among rural households and all variables with P-value <0.05 were considered as statistically significant at 95% CI. Results: On average, each household comprised 2 malaria cases (SD 1.1) in the past oneyear period and the prevalence of malaria in the study setting was 32% (95% CI, 30.5-33.2). The average annual income of households was US$626.7 (95% CI, 590.4-663.0). The mean annual cost of malaria illness to households was US$16 (95% CI, 14.8-17.2), and most of this cost (78%) was contributed by the indirect costs. In every household, on average, patients and companions or caregivers lost 3.4 productive workdays due to malaria illness, respectively. Fourteen households out of 100 spent more than 5% of their annual income on malaria treatment and hence, they were prone to high economic burden or catastrophic costs. Household level economic burden of malaria was determined by the sex and educational status of household head, means of transportation to treatment center, the episodes of malaria, the number of malaria "ill days" and type of malaria diagnosis. Conclusion: Malaria continues to significantly impose an economic burden on the rural households of Ethiopia. Hence, the national malaria program needs to recognize and address the catastrophic costs associated with malaria illness. Efforts should be made to ensure universal access to and utilization of malaria prevention, diagnosis, and treatment services.

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“…Our pilot survey conducted in Congolese rural and urban counties showed that poor WASH and low income were associated with malaria [13]. Furthermore, other previous works showed evidence on the effects of malaria on workers' absenteeism, productivity, medical costs [14,15], population growth, as well as children developmental retardation and premature death [16,17].…”

Section: Introductionmentioning

confidence: 99%

Malaria Rapid Diagnostic Test (HRP2/pLDH) Positivity, Incidence, Care Accessibility and Impact of Community WASH Action in DR Congo: Mixed Method Study involving 625 Households

Ngatu¹,

Muzembo

Kanbara³

et al. 2020

Preprint

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Background Malaria is one of the most prevalent and deadliest illnesses in sub Saharan Africa (SSA). Despite recent gains made towards its control or elimination in past decades, many African countries still have endemic malaria transmission. Thus, the search for disease control strategies is indispensable. This study aimed to assess malaria burden at household level in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory water, sanitation and hygiene (WASH) action.Methods Mixed method research was conducted in two semi-rural towns, Mbanza-Ngungu (WASH action site) and Kasangulu (WASH control site) between July 2017 to March 2018, involving 625 households (3,712 individuals). Baseline and post-intervention malaria surveys were conducted in 2017 and 2018, respectively, using the World Bank/WHO Malaria Indicator Questionnaire. In addition, an action research consisting of a six-month (September 2017 - February 2018) prospective study was carried out which comprised two interventions: (1) a community participatory WASH action aiming at eliminating mosquito breeding sites in the residential environment and a (2) community anti-malaria education campaign. The latter was implemented at both study sites. In addition, baseline and post-intervention rapid diagnostic test (RDT) for malaria was performed among respondents. Furthermore, a six-month prospective hospital-based epidemiological study was simultaneously conducted using records of patients admitted at health settings located at both study sites.Results Prevalence of positive malaria RDT among respondents decreased significantly at WASH-action site (38% vs. 20%; p < 0.05), but no significant change was observed at the WASH control site. There were 96% of respondents (heads of households) who reported at least one malaria event occurring in the previous six-month period, only 66.5% of them received malaria care at a health setting. At household level, long-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%), followed by mosquito repellent (15%), indoor residual spraying (IRS) (2%), LLIN-IRS combination (2%); however, 24% of households did not use any measures. Mean household malaria incidence decreased at the WASH action site; 2.3 ± 2.2 cases vs. 1.2 ± 0.7 cases (p < 0.05), whereas no significant change was noted in control site. Moreover, malaria incidence rate was highest (60.9%) among households living in proximity to grassy and/or stagnant water spots. Low household monthly income (ORa = 2.37; 95%CI: 1.05–3.12; p < 0.05), Proximity to high risk area (grassy/stagnant water spots) for malaria (ORa = 5.13; 95%CI: 2-29-8.07; p < 0.001), poor general WASH status in residential area (ORa = 4.10; 95%CI: 2.11–7.08; p < 0.001) were determinants of household malaria. Furthermore, data collected from referral health settings showed high malaria frequency, 67.4% (1,108/1,645) occurring during the first semester of 2017, including 772 (70%) of pediatric malaria cases and 336 (30%) of cases from Internal medicine departments.Conclusion Findings from this research suggest the necessity for DRC government to scale up the fight against malaria by integrating efficient indoor and outdoor preventive measures, including WASH intervention in residential environment, and improve malaria care accessibility to reduce malaria burden. This would be a step towards achieving universal health coverage (UHC) in the Congo.

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Environmental and sociodemographic factors associated with household malaria burden in the Congo

Cited by 31 publications

References 25 publications

Spatial and epidemiological drivers of P. falciparum malaria among adults in the Democratic Republic of the Congo

Spatial and epidemiological drivers of P. falciparum malaria among adults in the Democratic Republic of the Congo

<p>Economic Burden of Malaria and Associated Factors Among Rural Households in Chewaka District, Western Ethiopia</p>

Malaria Rapid Diagnostic Test (HRP2/pLDH) Positivity, Incidence, Care Accessibility and Impact of Community WASH Action in DR Congo: Mixed Method Study involving 625 Households

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