Abstract
The importance of household socio-economic position (SEP) in shaping individual infectious disease risk is increasingly recognised, particularly in low income settings. However, few studies have measured the extent to which this association is consistent for the range of pathogens that are typically endemic among the rural poor in the tropics. This cross-sectional study assessed the relationship between SEP and human infection within a single community in western Kenya using a set of pathogens with diverse transmission routes. The relationships between household SEP and individual infection with Plasmodium falciparum, hookworm (Ancylostoma duodenale and/or Necator americanus), Entamoeba histolytica/dispar, Mycobacterium tuberculosis, and HIV, and co-infections between hookworm, P. falciparum and E. histolytica/dispar, were assessed using multivariable logistic and multinomial regression. Individuals in households with the lowest SEP were at greatest risk of infection with P. falciparum, hookworm and E. histolytica/dispar, as well as co-infection with each pathogen. Infection with M. tuberculosis, by contrast, was most likely in individuals living in households with the highest SEP. There was no evidence of a relationship between individual HIV infection and household SEP. We demonstrate the existence of a household socio-economic gradient within a rural farming community in Kenya which impacts upon individual infectious disease risk. Structural adjustments that seek to reduce poverty, and therefore the socio-economic inequalities that exist in this community, would be expected to substantially reduce overall infectious disease burden. However, policy makers and researchers should be aware that heterogeneous relationships can exist between household SEP and infection risk for different pathogens in low income settings.
Highlights
More than one billion people live on less than 1.25 US dollars per day[1]
On the basis of a multivariable logistic regression model with adjustment for a range of demographic and environmental variables operating at the individual and household level, there was evidence that the probability of individual infection with hookworm, P. falciparum and E. histolytica/dispar decreased as the socio-economic position (SEP) of the household to which individuals belong increased
The reverse trend was observed for HIV and M. tuberculosis, with the probability of individual infection increasing as SEP increased, there was little evidence to support this relationship for HIV (Table 1)
Summary
More than one billion people live on less than 1.25 US dollars per day[1] People in these circumstances typically live in communities where inadequate sanitation, limited access to health care and under-nutrition are widespread[2]. This structural poverty promotes the transmission and persistence of a wide range of infectious diseases[3]. Few studies have explored the importance of household SEP as a shared risk factor for the wide range of infectious agents that are typically endemic in low income settings in the tropics[21]. The study was conducted in a rural area of Kenya known to be heavily burdened with a number of endemic infectious diseases[21], and which is characterised by high levels of household poverty
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