Length of maternal schooling and children's risk of malaria infection: evidence from a natural experiment in Uganda

Spatial distribution of malaria among under-five children and associated factors in Tanzania: a spatial and multilevel analysis

BACKGROUND

Malaria is a major public health problem in Tanzania, accounting for 3.1% of the global cases, with under-five children being particularly vulnerable. Over half of malaria deaths in Tanzania occurred among under-five children. Identifying the spatial determinants of malaria is crucial for optimizing targeted interventions to reduce morbidity and mortality in this vulnerable population. Therefore, this study aimed to assess the spatial determinants of malaria and factors associated with malaria infection among under-five children in Tanzania.

METHODS

A secondary data analysis was carried out using the Tanzanian Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2022 data. A total weighted sample of 4971 under-five children was included in the analysis. Spatial determinants of malaria were identified by ordinary least square and geographically weighted regression analysis. A multilevel binary logistic regression model was fitted to identify factors associated with malaria infection among under-five children.

RESULTS

Malaria among under-five children was spatially clustered in Tanzania (Moran's Index = 0.14, p-value < 0.0001). Significant primary clusters of malaria were identified in the Northwestern part of the country (western and Lake zones) (log-likelihood ratio (LLR = 80.22, p < 0.0001) and secondary clusters in the Mtwara region (LLR = 16.04, p < 0.0001). Wealth index and access to health care were significant determinants of spatial clustering of malaria among under-five children. In the multilevel analysis, maternal education [primary level (AOR = 0.71, 95% CI 0.52-0.97)], child age of 48-59 months (AOR = 3.17, 95% CI: 1.80-5.62), family size of 5 to 10 (AOR = 1.69, 95%CI 1.12, 2.54), being in poor wealth index (AOR = 2.56, 95% CI 1.18-5.57), and unimproved roof (AOR = 1.49, 95% CI 1.04-2.16) were significantly associated with malaria infection among under-five children.

CONCLUSION AND RECOMMENDATION

Malaria among under-five children in Tanzania shows significant spatial clustering, particularly in the Northwestern and Southern parts of the country. This spatial clustering of malaria was attributed to poor socioeconomic status and lack of access to health care. Improving access to health care and enhancing malaria prevention measures for the economically disadvantaged group could have a better impact on reducing the burden of malaria.

What do women in the highest malaria burden country know about ways to prevent malaria? A multi-level analysis of the 2021 Nigeria Malaria Indicator Survey data

BACKGROUND

With Nigeria accounting for 31% of the estimated 608,000 deaths due to malaria globally, good knowledge of malaria prevention is essential for effective malaria control. The objective of this study was to examine the knowledge of malaria prevention and its associated factors among Nigerian women.

METHODS

This study analysed secondary data from the 2021 Nigeria Malaria Indicator Survey. The sample included 14,476 women of reproductive age (15-49 years). A multilevel multivariable logistic regression was used to examine individual, household, and community-level factors associated with having good knowledge of malaria prevention.

RESULTS

The weighted prevalence of having good knowledge of malaria prevention was 43.5% (95%CI: 41.7-45.2%). Women with secondary/higher education had 2.35 higher odds of good knowledge of malaria prevention, when compared with those with no formal/primary education (aOR = 2.35; 95% CI: 2.00-2.75). Those exposed to malaria messages had 2.62 higher odds of good knowledge of malaria prevention, when compared with no exposure to malaria messages (aOR = 2.62; 95% CI: 2.31-2.97). Women from non-poor households had 1.42 higher odds of good knowledge of malaria prevention, when compared with those from poor households (aOR = 1.42; 95% CI: 1.17-1.71). Rural dwellers had 39.0% reduction in the odds of good knowledge of malaria prevention, when compared with their urban counterparts (aOR = 0.61; 95% CI: 0.46-0.80). In addition, women from communities with high level of education (aOR = 2.24; 95%CI: 1.38-3.64), moderately exposed to malaria messages (aOR = 1.43; 95%CI: 1.08-1.88) and highly exposed to malaria messages (aOR = 1.71; 95%CI: 1.27-2.30), had higher odds of good knowledge of malaria prevention, when compared with women from communities with low education and low exposure to malaria messages, respectively.

CONCLUSION

The knowledge of malaria prevention was found to be low. The study identified education, religion, exposure to malaria messages, wealth, region, place of residence, community-level poverty, education and exposure to malaria messages as factors associated with the knowledge of malaria prevention. Addressing these factors through targeted interventions, such as improving educational opportunities for women and enhancing media-driven public health campaigns are essential to enhancing malaria knowledge among this critical demographic group.

Community Knowledge, Attitudes and Practices About Malaria: Insights from a Northwestern Colombian Endemic Locality

Malaria prevention and control programs are mainly oriented to vector control, timely diagnosis and adequate treatment. Malaria transmission is influenced by several factors, including biological and social aspects. Thus, it is relevant to consider community beliefs and practices to ensure sustainable prevention and control strategies. This study aimed to determine knowledge, attitudes and practices (KAP) towards malaria in an endemic locality in northwestern Colombia. Preliminary data were collected through a focus group discussion. Subsequently, a KAP survey was administered to the community. KAP scores were associated with both sociodemographic characteristics and with previous malaria infection. Focus group data revealed knowledge gaps and the absence of or having worn-out nets. Survey results showed that participants recognized a mosquito bite as the transmission mode (72.09%), followed by dirty water (44.19%), high fever (86.05%) and headache (79.07%) as the main symptoms. Regarding attitudes, 44.19% of the people would go to the hospital in the case of having symptoms. The most recognized practices for disease prevention were the use of mosquito nets (65.12%) and fans (23.26%). The results showed that some people had misconceptions about the disease transmission mode. The analysis showed significant associations of either female gender and homemaker occupation with a good knowledge [OR = 3.74, (p = 0.04), OR = 3.55, (p = 0.04), respectively] or female with a positive attitude towards malaria control and prevention [OR = 4.80, (p = 0.04)]. These results showed that the identified gaps in KAP require increasing education among the community in addition to applying public health prevention efforts. The data may be useful in designing malaria control strategies that involve community participation.

Age-specific malaria vulnerability and transmission reservoir among children

Purpose

The pediatric population, especially under-five children, is highly susceptible to malaria and accounts for 76 % of global malaria deaths according to the World Malaria Report 2022. The purpose of this manuscript is to discuss the various factors involved in the susceptibility of the pediatric population to Malaria and the importance of this age group for malaria elimination.

Methodology

Data on pediatric malaria epidemiology that includes prevalence, risk factors, immune factors, socioeconomic factors, control methods, etc. were extracted from published literature using PubMed and Google Scholar. This data was further correlated with malaria incidence data from the World Health Organization (WHO) and the National Center for Vector Borne Diseases Control (NCVBDC).

Results

The younger age group is vulnerable to severe malaria due to an immature immune system. The risk of infection and clinical disease increases after the waning of maternal immunity. In the initial years of life, the developing brain is more susceptible to malaria infection and its after-effects. The pediatric population may act as a malaria transmission reservoir due to parasite density and asymptomatic infections. WHO recommended RTS,S/AS01 has limitations and may not be applicable in all settings to propel malaria elimination.

Conclusion

The diagnosis of malaria is based on clinical suspicion and confirmed with microscopy and/or rapid diagnostic testing. The school-age pediatric population serves as a transmission reservoir in the form of asymptomatic malaria since they have acquired some immunity due to exposure in early childhood. Targeting the hidden reservoir in the pediatric population and protecting this vulnerable group will be essential for malaria elimination from the countries targeting elimination.

Exploring agricultural land-use and childhood malaria associations in sub-Saharan Africa

Agriculture in Africa is rapidly expanding but with this comes potential disbenefits for the environment and human health. Here, we retrospectively assess whether childhood malaria in sub-Saharan Africa varies across differing agricultural land uses after controlling for socio-economic and environmental confounders. Using a multi-model inference hierarchical modelling framework, we found that rainfed cropland was associated with increased malaria in rural (OR 1.10, CI 1.03-1.18) but not urban areas, while irrigated or post flooding cropland was associated with malaria in urban (OR 1.09, CI 1.00-1.18) but not rural areas. In contrast, although malaria was associated with complete forest cover (OR 1.35, CI 1.24-1.47), the presence of natural vegetation in agricultural lands potentially reduces the odds of malaria depending on rural-urban context. In contrast, no associations with malaria were observed for natural vegetation interspersed with cropland (veg-dominant mosaic). Agricultural expansion through rainfed or irrigated cropland may increase childhood malaria in rural or urban contexts in sub-Saharan Africa but retaining some natural vegetation within croplands could help mitigate this risk and provide environmental co-benefits.