Abstract
BackgroundHealth inequality is a recognized barrier to achieving health-related development goals. Health-equality data are essential for evidence-based planning and assessing the effectiveness of initiatives to promote equity. Such data have been captured but have not always been analysed or used to manage programming. Health data were examined for microeconomic differences in malaria indices and associated malaria control initiatives in western Kenya.MethodsData was analysed from a malaria cross-sectional survey conducted in July 2012 among 2719 people in 1063 households in Siaya County, Kenya. Demographic factors, history of fever, malaria parasitaemia, malaria medication usage, insecticide-treated net (ITN) use and expenditure on malaria medications were collected. A composite socioeconomic status score was created using multiple correspondence analyses (MCA) of household assets; households were classified into wealth quintiles and dichotomized into poorest (lowest 3 quintiles; 60%) or less-poor (highest 2 quintiles; 40%). Prevalence rates were calculated using generalized linear modelling.ResultsOverall prevalence of malaria infection was 34.1%, with significantly higher prevalence in the poorest compared to less-poor households (37.5% versus 29.2%, adjusted prevalence ratio [aPR] 1.23; 95% CI = 1.08–1.41, p = 0.002). Care seeking (aPR = 0.95; 95% CI 0.87–1.04, p = 0.229), medication use (aPR = 0.94; 95% CI 0.87–1.00, p = 0.087) and ITN use (aPR = 0.96; 95% CI = 0.87–1.05, p = 0.397) were similar between households. Among all persons surveyed, 36.4% reported taking malaria medicines in the prior 2 weeks; 92% took artemether-lumefantrine, the recommended first-line malaria medication. In the poorest households, 4.9% used non-recommended medicines compared to 3.5% in less-poor (p = 0.332). Mean and standard deviation [SD] for expenditure on all malaria medications per person was US$0.38 [US$0.50]; the mean was US$0.35 [US$0.52] amongst the poorest households and US$0.40 [US$0.55] in less-poor households (p = 0.076). Expenditure on non-recommended malaria medicine was significantly higher in the poorest (mean US$1.36 [US$0.91]) compared to less-poor households (mean US$0.98 [US$0.80]; p = 0.039).ConclusionsInequalities in malaria infection and expenditures on potentially ineffective malaria medication between the poorest and less-poor households were evident in rural western Kenya. Findings highlight the benefits of using MCA to assess and monitor the health-equity impact of malaria prevention and control efforts at the microeconomic level.
Highlights
Health inequality is a recognized barrier to achieving health-related development goals
The aim of this study was to establish the relationship between household socioeconomic status (SES) and inequalities in malaria-related health indicators including morbidity, use of insecticide-treated nets (ITNs), care seeking, and expenditure on malaria medications in a malariaendemic area of rural western Kenya
The survey was conducted within the Kenya Medical Research Institute (KEMRI) and Centers for Disease Control and Prevention (CDC) health and demographic surveillance system (HDSS) in Siaya County, western Kenya
Summary
Health inequality is a recognized barrier to achieving health-related development goals. Health-equal‐ ity data are essential for evidence-based planning and assessing the effectiveness of initiatives to promote equity. Such data have been captured but have not always been analysed or used to manage programming. Health data were examined for microeconomic differences in malaria indices and associated malaria control initiatives in western Kenya. Malaria is one of the most important diseases in many low- and middle-income countries, primarily affecting children and pregnant women in sub-Saharan Africa. In sub-Saharan Africa, 3.1% of all disabilityadjusted life-years (DALYs) were lost to malaria in 2002 [2]. In Kenya, despite remarkable achievements in malaria prevention and control over the last 10 years, malaria remains a leading cause of morbidity and mortality [4]. In 2015, while the prevalence of microscopically-confirmed malaria was 8% amongst children less than 15 years (13% by malaria rapid diagnostic test [RDT]) nationally, it was 27% (43% by malaria RDT) in the lake-endemic region of western Kenya [5]
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