RESUMO
Introduction: Mozambique has the fourth highest malaria cases and malaria mortality globally. Locally, malaria incidence increases from low in the southern region to high in the central and northern regions. Manica Province in central Mozambique has the fourth highest prevalence of malaria out of the 11 provinces, and the highest in the central region of the country. In this area where coverage of interventions has been limited, household level risk factors can be important for understanding the natural history of infection, as well as the implementation of current and future interventions. There has been indication that the relationship between household structure and malaria risk is actually a mediating one between the true relationship between household income and education and Plasmodium falciparum infection. The objective of this study was to determine and quantify these complex relationships. Methods: We conducted a community-based cross-sectional study in Sussundenga village. Sussundenga is a rural village, located in Sussundenga District, Manica Province, Mozambique. We enrolled 303 participants from 83 randomly selected households. We collected information on demographics, household construction, and administered a P. falciparum rapid diagnostic test (RDT). We constructed several generalized estimating equations logistic regression models to determine the independent effects of housing construction on malaria risk. We also constructed models separate from generalized estimating equations logistic mediation models to determine the proportion of effects mediated by household construction material in the relationship between head of household occupation and education and malaria risk. Results: The overall malaria prevalence among the study population by RDT was 30.8%. In the multivariable model adjusting for all individual and household factors as potential confounders, rudimentary roof structure was the only household structural variable that was statistically significantly associated with increased malaria risk [OR 2.41 (1.03-5.63)]. We found no evidence that household structure mediated the relationship between head of household education or employment and malaria risk in our study population. Discussion: Household structure was a significant risk factor for malaria infection in our study population. These findings are consistent with malaria being a disease of poverty and an area that could be targeted for future interventions that could have long-term impacts.
RESUMO
Background: Mozambique has the 4 th highest malaria incidence and mortality globally. Despite the existing malaria control strategies, malaria prevalence remains stagnant. These challenges have increased calls for innovative strategies in areas with the highest disease burden. Community mass treatment with anthelmintic agents have been used as an effective tool for the control of major helminth infections and has emerged as a potential tool for vector control in the fight against malaria. Methods: This was an analysis of data from a cross-sectional community-based survey designed to study malaria risk, prevention, and health seeking behaviors in Sussundenga, Mozambique. Using logistic regression models, we quantified the association between ever receiving anthelmintic treatment and P. falciparum infection. We also fit models to determine the association between recent anthelmintic treatment and malaria infection. Results: Two-hundred, seventy-seven (277) participants from 83 households were included in this analysis. The prevalence of P. falciparum infection measured by rapid diagnostic test (RDT) was 30%. 77% of participants reported having ever received anthelmintics. The prevalence of malaria was slightly higher among participants who reported ever taking anthelmintics. There was no statistically significant association between prior receipt of anthelmintic and P. falciparum malaria infection after adjusting for age, ITN use and head of household full-time employment (OR = 1.37, 95% CI, 0.70-2.70, p = 0.36). However, recent intake of anthelmintics was associated with lower odds of testing positive for in the adjusted models (OR = 0.35, 95% CI, 0.07-1.80, p = 0.21), but this was not statistically significant. Conclusions: Our findings show that the benefit of anthelmintics treatment as a control tool for P. falciparum malaria infection is likely tied to when it is administered rather than if it was ever administered. These findings offer evidence for making decisions in planning mass community deworming in sub-Saharan Africa.
