Abstract
BackgroundMalaria due to Plasmodium falciparum is the leading cause of morbidity and mortality in Tanzania. According to health statistics, malaria accounts for about 30% and 15% of hospital admissions and deaths, respectively. The risk of P. falciparum infection varies across the country. This study describes the spatial variation and socio-economic determinants of P. falciparum infection in northeastern Tanzania.MethodsThe study was conducted in 14 villages located in highland, lowland and urban areas of Korogwe district. Four cross-sectional malaria surveys involving individuals aged 0-19 years were conducted during short (Nov-Dec) and long (May-Jun) rainy seasons from November 2005 to June 2007. Household socio-economic status (SES) data were collected between Jan-April 2006 and household's geographical positions were collected using hand-held geographical positioning system (GPS) unit. The effects of risk factors were determined using generalized estimating equation and spatial risk of P. falciparum infection was modelled using a kernel (non-parametric) method.ResultsThere was a significant spatial variation of P. falciparum infection, and urban areas were at lower risk. Adjusting for covariates, high risk of P. falciparum infection was identified in rural areas of lowland and highland. Bed net coverage levels were independently associated with reduced risk of P. falciparum by 19.1% (95%CI: 8.9-28.2, p < 0.001) and by 39.3% (95%CI: 28.9-48.2, p < 0.001) in households with low and high coverage, respectively, compared to those without bed nets. Households with moderate and lower SES had risk of infection higher than 60% compared to those with higher SES; while inhabitants of houses built of mud walls were at 15.5% (95%CI: 0.1 - 33.3, p < 0.048) higher risk compared to those living in houses built by bricks. Individuals in houses with thatched roof had an excess risk of 17.3% (95%CI: 4.1 - 32.2, p < 0.009) compared to those living in houses roofed with iron sheet.ConclusionsThere was high spatial variation of risk of P. falciparum infection and urban area was at the lowest risk. High bed net coverage, better SES and good housing were among the important risk factors associated with low risk of P. falciparum infection.
Highlights
Malaria due to Plasmodium falciparum is the leading cause of morbidity and mortality in Tanzania
Malaria transmission intensity varies with season and decreases with altitude due to its dependence on temperature which affects the development of vectors and parasites [3]
High level of urbanization is associated with less malaria and this is attributable to high pollution levels which affects mosquito larvae development, good housing [4], better access to health facilities and high bed nets coverage [5,6]
Summary
Malaria due to Plasmodium falciparum is the leading cause of morbidity and mortality in Tanzania. This study describes the spatial variation and socio-economic determinants of P. falciparum infection in northeastern Tanzania. Malaria due to Plasmodium falciparum is a major public health problem in Sub-Saharan Africa and accounts for about 90% of malaria disease burden in the world. Other factors which affects transmission of malaria include rainfall, topography, land use and socio-economic status (SES) [7]. Application of geographical information system (GIS) and spatial statistical methods are regarded as important tools in epidemiology to identify areas with increased risk of diseases and determine spatial association between disease and risk factors [8,9,10,11]. The use of maps and spatial statistical methods makes it easy to identify and display the unmeasured effect as a spatial effect and show areas with unusual high rates of the disease. Disease-specific maps play an important role in disease control activities including monitoring the changes of the disease epidemiology, guiding resource allocation as well as identifying areas for further investigation [11,12]
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