Individual,household and neighborhood risk factors for malaria in the Democratic Republic of the Congo support new approaches to programmatic intervention |
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| Affiliation: | 1. Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan;2. Department of International Health and Medical Anthropology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan;3. Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo;4. Division of Molecular Parasitology, Proteo-Science Centre, Ehime University, Ehime, Japan;5. Department of Protozoology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan;6. Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, Tokyo, Japan;1. Department of Statistics, College of Science, Bahir Dar University, Ethiopia;2. School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa;3. Department of public health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar- Ethiopia |
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| Abstract: | BackgroundThe Democratic Republic of the Congo (DRC) remains one of the countries most impacted by malaria despite decades of control efforts, including multiple mass insecticide treated net (ITN) distribution campaigns. The multi-scalar and complex nature of malaria necessitates an understanding of malaria risk factors over time and at multiple levels (e.g., individual, household, community). Surveillance of households in both rural and urban settings over time, coupled with detailed behavioral and geographic data, enables the detection of seasonal trends in malaria prevalence and malaria-associated behaviors as well as the assessment of how the local environments within and surrounding an individual's household impact malaria outcomes.MethodsParticipants from seven sites in Kinshasa Province, DRC were followed for over two years. Demographic, behavioral, and spatial information was gathered from enrolled households. Malaria was assessed using both rapid diagnostic tests (RDT) and polymerase chain reaction (PCR) and seasonal trends were assessed. Hierarchical regression modeling tested associations between behavioral and environmental factors and positive RDT and PCR outcomes at individual, household and neighborhood scales.ResultsAmong 1591 enrolled participants, malaria prevalence did not consistently vary seasonally across the sites but did vary by age and ITN usage. Malaria was highest and ITN usage lowest in children ages 6–15 years across study visits and seasons. Having another member of the household test positive for malaria significantly increased the risk of an individual having malaria [RDT: OR = 4.158 (2.86–6.05); PCR: OR = 3.37 (2.41–4.71)], as did higher malaria prevalence in the 250 m neighborhood around the household [RDT: OR = 2.711 (1.42–5.17); PCR: OR = 4.056 (2.3–7.16)]. Presence of water within close proximity to the household was also associated with malaria outcomes.ConclusionsTaken together, these findings suggest that targeting non-traditional age groups, children >5 years old and teenagers, and deploying household- and neighborhood-focused interventions may be effective strategies for improving malaria outcomes in high-burden countries like the DRC. |
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| Keywords: | Malaria Longitudinal Democratic Republic of the Congo Rural Geographic Seasonal Household |
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