Abstract
Despite reductions in malaria incidence and mortality across Sub-Saharan (SSA) countries, malaria control and elimination efforts are currently facing multiple global challenges such as climate and land use change, invasive vectors, and disruptions in healthcare delivery. Although relationships between malaria risks and socioeconomic factors have been widely demonstrated, the strengths and variability of these associations have not been quantified across SSA. In this study, we used data from population-based malaria indicator surveys in SSA countries to assess spatial trends in relative and absolute socioeconomic inequalities, analyzed as social (mothers’ highest educational level—MHEL) and economic (wealth index—WI) inequalities in malaria prevalence. To capture spatial variations in socioeconomic (represented by both WI and MHEL) inequalities in malaria, we calculated both the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) in each administrative region. We also conducted cluster analyses based on Local Indicator of Spatial Association (LISA) to consider the spatial auto-correlation in SII and RII across regions and countries. A total of 47,404 participants in 1874 Primary Sampling Units (PSU) were analyzed across the 13 SSA countries. Our multi-country assessment provides estimations of strong socioeconomic inequalities between and within SSA countries. Such within- and between- countries inequalities varied greatly according to the socioeconomic metric and the scale used. Countries located in Eastern Africa showed a higher median Slope Index of Inequality (SII) and Relative Index of Inequality (RII) in malaria prevalence relative to WI in comparison to countries in other locations across SSA. Pockets of high SII in malaria prevalence in relation to WI and MHEL were observed in the East part of Africa. This study was able to map this wide range of malaria inequality metrics at a very local scale and highlighted the spatial clustering patterns of pockets of high and low malaria inequality values.
Highlights
Despite reductions in malaria incidence and mortality across Sub-Saharan (SSA) countries, malaria control and elimination efforts are currently facing multiple global challenges such as climate and land use change, invasive vectors, and disruptions in healthcare delivery
A total of 47,404 participants in 1,874 (MHEL subset: 1,603) Primary Sampling Units (PSU) were analyzed across the 13 Sub-Saharan African (SSA) countries
Greater variability in Slope Index of Inequality (SII) for WI was observed in Togo followed by Malawi (Supplementary Fig. 2) and Liberia, and for MHEL in Sierra Leone followed by Angola and Malawi (Supplementary Fig. 4)
Summary
Despite reductions in malaria incidence and mortality across Sub-Saharan (SSA) countries, malaria control and elimination efforts are currently facing multiple global challenges such as climate and land use change, invasive vectors, and disruptions in healthcare delivery. Important evidence about the socioeconomic inequalities on the malaria risk was reported in previous studies done in SSA countries such as in Uganda22, Kenya23,29, Tanzania[30], and Nigeria[24] These studies highlighted the substantial heterogeneity between socioeconomic metrics at a subnational and local level and the utility of their identification to target malaria control interventions. The Demographic and Health Surveys (DHS) and in particular the Malaria Indicator Survey (MIS) provides information about malaria screening and sociodemographic variables in multiple countries, when multi-country assessments in the SSA region are scant This dataset represents a unique opportunity to capitalize on to identify such malaria heterogeneities across the socioeconomic gradient. Previous studies highlighted the role of the maternal education on the child’s health in developing c ountries[35,36,37]; few studies have examined independently the wealth and socioeconomic status inequalities in m alaria[38,39]
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