Socio-economic & household risk factors of malaria in tribal areas of Madhya Pradesh, central India

Toward Malaria Elimination: Understanding Awareness, Prevention, and Health-Seeking Patterns in Odisha, India

Given India's goal of eliminating malaria by 2030, this study aimed to investigate community perspectives on malaria in highly endemic areas of Odisha, a region historically prone to malaria. The research explores self-reported malaria events, community knowledge, attitudes, practices, health-seeking behaviors, and access to healthcare services. A community-based cross-sectional survey conducted among 387 households between November 2022 and May 2023 served as an extension of our recent project, monitoring malaria elimination efforts in remote and challenging-to-reach communities in Odisha. The participants, who had a mean (SD) age of 41.7 (13.17) years, were predominantly male (88.4%). Self-reported malaria in the last 12 months prior to the survey was 6.2%, with half of the patients opting for primary health centers for treatment, averaging a 5-day recovery per episode. The median cost per malaria treatment episode was U.S. dollars 20.17. A significant majority (79.8%) demonstrated a strong awareness of malaria symptoms and transmission, with 83.3% expressing a favorable attitude toward disease prevention. Notably, 65.1% reported consistent use of long-lasting insecticidal nets. However, nearly half of the participants reported inadequate larval source management and indoor residual spraying services. Although there were slight variations in knowledge, attitude, and practice scores among demographic groups, the overall understanding of and approach to malaria were consistent in the study population, with no statistically significant differences (P >0.05). The study findings offer hope, suggesting that with sustained dedication and focused surveillance, malaria could become a thing of the past.

Demographic and socioeconomic obstacles to access to malaria services for Myanmar migrants in Thailand

BACKGROUND

Typically mobile and vulnerable, migrants face significant barriers to access to routine malaria prevention, diagnostics and treatment, which leads to unchecked malaria transmission, particularly in border regions with a high population displacement. This study aimed to investigate the demographic and socioeconomic obstacles to access to malaria services among Myanmar migrants residing in the Thailand-Myanmar border areas.

METHODS

A cross-sectional study was conducted in early 2024 across three districts near the Thailand-Myanmar border. Quantitative data were collected from Myanmar migrants using standardized questionnaires through structured surveys. Data analysis included descriptive statistics and simple and multiple logistic regression models.

RESULTS

Out of 300 participants, approximately a quarter (27.3%) reported adequate access to comprehensive malaria services, including prevention, diagnostics, treatment and malaria-related health information. In multiple logistic regression models, factors associated with inadequate access included Myanmar migrants aged over 60 years (aOR: 7.63, 95% CI 1.74-20.58), accompanied by one to three family members (aOR: 3.33, 95% CI 1.06-8.45), earning monthly incomes below 3000 THB (aOR: 5.13, 95% CI 1.38-19.09) and 3000 to 6000 THB (aOR: 3.64, 95% CI 1.06-12.51), belonging to the Karen ethnicity (aOR: 2.13, 95% CI 1.02-3.84), with poor perception toward malaria (aOR: 2.03, 95% CI 1.03-4.01) and with poor preventive and health-seeking practices (aOR: 5.83, 95% CI 2.71-9.55).

CONCLUSIONS

A significant proportion of Myanmar migrants encounter demographic and socioeconomic barriers to access to routine malaria services in Thailand. Tailored interventions are required to expand such access, including the recruitment of worksite health volunteers, strengthening the role of ethnic health organizations across the border and collaboration with private sector stakeholders (e.g. farm/company owners) to distribute preventive tools and ensure timely referral of suspected malaria cases to health facilities.

Traditional Beliefs, Practices, and Migration: A Risk to Malaria Transmission in Rural Nepal

The study aimed to explore sociocultural factors influencing the risk of malaria and practices and beliefs towards malaria prevention, transmission and treatment in a remote village in Khatyad Rural Municipality (KRM) of Nepal. A sequential exploratory mixed methods approach was used. Qualitative data were collected through 25 one-on-one, in-depth interviews followed by a face-to-face household survey (n = 218) among people from a village in KRM believed to have a high risk of malaria. Traditional practices such as Chhaupadi requiring the seclusion of women during menstruation and post-partum, transhumance, and reliance on traditional healers for the management of malaria were common practices in the village. The household survey found 98.1% of women faced menstrual exile either inside the house or in a separate hut, with 64.2% not having access to Long-lasting Insecticidal Nets (LLINs). Hardships and economic constraints compelled villagers to migrate seasonally for work to malaria-endemic areas in India, thereby exposing themselves to the risk of malaria. Persistent traditional beliefs and seasonal migration could threaten the elimination goals set by the national malaria program.

Determinants of Malaria Morbidity Among School-Aged Children Living in East Hararghe Zone, Oromia, Ethiopia: A Community-Based Case–Control Study

Background

Understanding the determinants of malaria morbidity offers helpful insights toward the changing malaria situation, which might lead to the adjustment of malaria program activities. Even though the determinants of malaria morbidity remain unknown, school-aged children were the highest malaria morbidity contributors in the East Hararghe Zone. Therefore, this study aimed to assess the determinants of malaria morbidity among school-aged children in the study area from February 1 to May 31, 2020.

Methods

A case-control study was conducted among school-aged children living in ten randomly selected low, moderate, and high malaria transmission kebeles. Cases were confirmed as positive for malaria, while controls were confirmed as negative for malaria among randomly selected school-aged children. Rapid diagnostic testing (RDT) and blood film (BF) malaria testing methods were used. Multivariable logistic regression was used to identify association between malaria and its determinants.

Results

The determinants of malaria infection were having no formal education (adjusted odds ratio (AOR)=4.91, 95% CI: 1.20–20.17), low family wealth index (AOR=2.50, 95% CI: 1.22–5.12), being from rural residence (AOR=2.34, 95% CI: 1.87–4.12), living near to stagnant water (AOR=2.01, 95% CI: 1.14–3.54), having a maximum of three family members (AOR=0.37, 95% CI: 0.18–0.78), using indoor residual spraying (IRS) (AOR=0.15, 95% CI: 0.08–0.29) and long-lasting insecticide-treated net (LLITN) over the last night (AOR=0.19, 95% CI: 0.10–0.35), and living in the house surrounded by cultivated land(AOR=0.24, 95%CI: 0.10-0.60) compared with their counterparts.

Conclusion

This study revealed that residence, family size, education, wealth index, stagnant water existence, and using LLITN and IRS had significant association with malaria morbidity. Thus, all concerned bodies, including the community should strengthen working on stagnant water elimination around their house to cut the breeding site of the malaria vector mosquito. Moreover, the findings have an important implication for improving interventions targeting the economic status and literacy of the society that may help in the reduction of the risk of malaria in the school-aged children.

Socio-economic and household determinants of malaria in adults aged 45 and above: analysis of longitudinal ageing survey in India, 2017-2018

Background

Even though malaria cases have drastically come down in the last decade, malaria remains a serious public health concern in many parts of India. National Framework for Malaria Elimination in India (2016–2030) has been launched with the goal to eliminate malaria by 2030. Understanding the socio-economic and household determinants of malaria at the national level will greatly aid India’s malaria elimination efforts.

Methods

The data from Longitudinal Ageing Survey of India (LASI) Wave 1 (2017–2018) survey comprising 70,671 respondents ≥ 45 years across all the States and Union Territories were used for the analysis. Simple and multiple logistic regressions were used to obtain the unadjusted and adjusted odds ratio respectively of the socio-economic and household variables.

Results

The major socio-economic variables that increase the likelihood of malaria are caste (‘scheduled tribes’), low education levels and rural residence. The scheduled tribes have 1.8 times higher odds of malaria than the scheduled castes (AOR: 1.8; 95% CI: 1.5–2.1). Respondents with high school education (6–12 grade) (AOR: 0.7; 95% CI: 0.6–0.8) and college education (AOR: 0.5; 95% CI: 0.4–0.6) had a very low risk of malaria than those with no school years. Rural residence and occupation (agriculture and allied jobs) also increases the odds of malaria. The major housing determinants are household size (≥ 6), housing type (kutcha), use of unclean fuel, outside water source, improper sanitation (toilet facilities) and damp wall/ceiling.

Conclusions

The study has identified the major socio-economic and housing factors associated with malaria in adults aged 45 and above. In addition to vector and parasite control strategies in the tribal dominated regions of India, improving literacy and housing conditions may help India’s malaria elimination efforts.

Socio-economic determinants of malaria in tribal dominated Mandla district enrolled in Malaria Elimination Demonstration Project in Madhya Pradesh

Background

Malaria is known as a disease of poverty because of its dominance in poverty-stricken areas. Madhya Pradesh state in central India is one of the most vulnerable states for malaria morbidity and mortality. Socio-economic, environmental and demographic factors present challenges in malaria control and elimination. As part of the Malaria Elimination Demonstration Project in the tribal district of Mandla in Madhya Pradesh, this study was undertaken to assess the role of different social-economic factors contributing to malaria incidence.

Methods

The study was conducted in the 1233 villages of district Mandla, where 87% population resides in rural areas. The data was collected using the android based mobile application—SOCH for a period of 2 years (September 2017 to August 2019). A wealth index was computed along with analysis of the socio-economic characteristics of houses with malaria cases. Variables with significant variation in malaria cases were used in logistic regression.

Results

More than 70% of houses in Mandla are Kuccha (made of thatched roof or mud), 20% do not have any toilet facilities, and only 11% had an annual income of more than 50,000 INR, which converts to about $700 per year. Households with younger heads, male heads, more number of family members were more likely to have malaria cases. Kuccha construction, improper water supply, low household income houses were also more likely to have a malaria case and the odds doubled in houses with no toilet facilities.

Conclusion

Based on the results of the study, it has been found that there is an association between the odds of having malaria cases and different household variables such as age, gender, number of members, number of rooms, caste, type of house, toilet facilities, water supply, cattle sheds, agricultural land, income, and vector control interventions. Therefore, a better understanding of the association of various risk factors that influence the incidence of malaria is required to design and/or deploy effective policies and strategies for malaria elimination. The results of this study suggest that appropriate economic and environmental interventions even in low-income and poverty-stricken tribal areas could have huge impact on the success of the national malaria elimination goals.

Reproductive-Age Women's Knowledge and Care Seeking for Malaria Prevention and Control in Ghana: Analysis of the 2016 Malaria Indicator Survey

INTRODUCTION

Malaria is a major cause of morbidity and mortality worldwide, requiring individual and environmental level controls to prevent its adverse morbidity effects. This study examined reproductive-aged women's knowledge and care-seeking practices for malaria prevention and control in Ghana.

METHODS

The 2016 Ghana Malaria Indicator Survey data for reproductive-age women was analysed (n=5,150). Multilevel mixed-effects logistic regression model was used to determine factors associated with reproductive-aged women's knowledge and care-seeking practices for malaria.

RESULTS

62.3%, 81.3%, and 64.6% knowledge levels on causes, signs/symptoms, and prevention of malaria were found, respectively, among respondents. Age, wealth and educational status, religion, region, and place of residence (rural) were found to significantly influence respondents' knowledge of causes, signs/symptoms, and care-seeking practices for malaria. A 15% differential among Insecticide Treated Nets (ITNs) awareness and use was found. Increasing age (≥35 years) was associated with increasing knowledge of malaria. Regional variations were observed to significantly influence knowledge of malaria treatment.

CONCLUSION

Though ownership of ITNs and knowledge of malaria prevention were high, it did not necessarily translate into use of ITNs. Thus, there is a need to intensify education on the importance and the role of ITNs use in the prevention of malaria.

Detecting local risk factors for residual malaria in northern Ghana using Bayesian model averaging

Background

There is a need for comprehensive evaluations of the underlying local factors that contribute to residual malaria in sub-Saharan Africa. However, it is difficult to compare the wide array of demographic, socio-economic, and environmental variables associated with malaria transmission using standard statistical approaches while accounting for seasonal differences and nonlinear relationships. This article uses a Bayesian model averaging (BMA) approach for identifying and comparing potential risk and protective factors associated with residual malaria.

Results

The relative influence of a comprehensive set of demographic, socio-economic, environmental, and malaria intervention variables on malaria prevalence were modelled using BMA for variable selection. Data were collected in Bunkpurugu-Yunyoo, a rural district in northeast Ghana that experiences holoendemic seasonal malaria transmission, over six biannual surveys from 2010 to 2013. A total of 10,022 children between the ages 6 to 59 months were used in the analysis. Multiple models were developed to identify important risk and protective factors, accounting for seasonal patterns and nonlinear relationships. These models revealed pronounced nonlinear associations between malaria risk and distance from the nearest urban centre and health facility. Furthermore, the association between malaria risk and age and some ethnic groups was significantly different in the rainy and dry seasons. BMA outperformed other commonly used regression approaches in out-of-sample predictive ability using a season-to-season validation approach.

Conclusions

This modelling framework offers an alternative approach to disease risk factor analysis that generates interpretable models, can reveal complex, nonlinear relationships, incorporates uncertainty in model selection, and produces accurate predictions. Certain modelling applications, such as designing targeted local interventions, require more sophisticated statistical methods which are capable of handling a wide range of relevant data while maintaining interpretability and predictive performance, and directly characterize uncertainty. To this end, BMA represents a valuable tool for constructing more informative models for understanding risk factors for malaria, as well as other vector-borne and environmentally mediated diseases.

Electronic supplementary material

The online version of this article (10.1186/s12936-018-2491-2) contains supplementary material, which is available to authorized users.

Socio-demographic and household attributes may not necessarily influence malaria: evidence from a cross sectional study of households in an urban slum setting of Chennai, India

Background

Household and environmental factors are reported to influence the malaria endemicity of a place. Hence, a careful assessment of these factors would, potentially help in locating the possible areas under risk to plan and adopt the most suitable and appropriate malaria control strategies.

Methods

A cross-sectional household survey was carried out in the study site, Besant Nagar, Chennai, through random sampling method from February 2014 to February 2015. A structured interviewer-administered questionnaire was used to assess selected variables of demography, structural particulars of a household, usage of repellents, animals on site, presence of breeding habitats and any mosquito/vector breeding in the household, malaria/vector control measures undertaken by government in each houses. The data was collected through one to one personal interview method, statistically analysed overall and compared between the households/people infected with malaria within a period of 1 year and their non-infected counterparts of the same area.

Results

Presence of malaria was found to be significantly associated with the occupation, number of inhabitants, presence of a separate kitchen, availability of overhead tanks and cisterns, immatures of vector mosquitoes, presence of mosquito breeding and type of roof structures (p < 0.05). However, age, gender, usage of repellents, animals on site, number of breeding habitats or detection of vector breeding did not significantly associate with the malaria incidence/prevalence.

Conclusions

The survey revealed various demographic, household and environmental factors likely to associate with the malaria incidence/prevalence in an urban slum of Chennai. The socio-demographic and household variables have revealed disparities in malaria infection from the present cross sectional study. The absence of significant association with many parameters indicates the probable role of other confounding factors which influence the malaria prevalence.

Active v. passive surveillance for malaria in remote tribal belt of Central India: Implications for malaria elimination

Balaghat district in Central India is characterized by perennial malaria transmission. In this study, we have estimated malaria parasite rates by microscopic examination of blood smears by conducting active (ACD) and passive surveillance (PCD) in the villages of Baihar community health center (CHC) during January 2012-December 2012. Comparison of the results of two methods revealed that ACD (active case detection) in villages provides relatively large numbers of malaria positive cases (1408/3601) as compared to PCD (passive case detection) at CHC (139/2743) (OR 12.03, 95% CI, 9.97-14.57, p < 0.0001). Similarly, large numbers of Plasmodium falciparum cases (1194) were found (SFR, 33.2%) in villages, while only 98 P. falciparum cases (SFR, 3.6%) were found at CHC (OR 13.39, 95% CI, 10.80-16.73, p < 0.0001). Likewise, Plasmodium vivax were 211 (SVR, 5.9%) in villages by ACD (OR 4.1, 95% CI, 2.91-5.9, p < 0.0001), while only 41 P. vivax (SVR, 1.5%) were found at CHC. In this cross-sectional study, we discussed the potential role of ACD in strengthening of surveillance for high coverage. For malaria elimination initiative, a surveillance system must be more sensitive than PCD along with effective tools for vector control to target high-risk population who are not visiting the health facility and seed transmission to the surrounding population. The study highlights the substantial difference in the malaria positivity rate by two methods in difficult and hard-to-reach areas and recommendations are made to understand how best to deploy ACD methods in the pursuit of malaria elimination.

A systematic review of knowledge, attitudes and beliefs about malaria among the South Asian population

BACKGROUND

Malaria is one of the deadliest mosquito-borne diseases in the world. More than 80% of the total populations are at risk of malaria in the 22 countries in Asia and the Pacific. South Asia alone is home to an estimated 1.4 billion people at risk of contracting malaria. Despite the remarkable progress in reducing the burden of malaria, evidence of the disease based on knowledge of the social and cultural contexts from a South Asian perspective is limited. Our objective was to understand the knowledge, attitudes and beliefs about malaria in South Asian communities.

METHODOLOGY

We conducted a systematic literature review, searching six databases, between 1990 and 2015, focusing on knowledge, attitudes and beliefs about malaria in South Asia. Databases were searched using both 'free terms' and 'index terms' funnelled using Boolean operators and truncations. Inclusion and exclusion criteria were set, and included papers were scrutinised, employing a critical appraisal tool to find the best available evidences to support the study purpose.

RESULTS AND DISCUSSION

Evidence from 32 articles (26 quantitative, four qualitative and two mixed methods). General knowledge and awareness of the disease, its transmission, and control and preventative measures were generally found to be lacking amongst both the general public and healthcare professionals. In addition, the study shows that poor socio-economic factors - including limited access to services due to poor/limited availability - and issues of affordability are considered as major risk factors.

CONCLUSION

This review suggests the importance of increasing health awareness, mobilising the local or community healthcare professionals, for prevention as well as early detection and effective treatment of malaria among people who are at risk. Malaria is also a disease associated with poverty and socio-cultural factors; therefore, strong political will, wider partnerships between health and non-health sectors, and strengthening health systems' technical and managerial capabilities at all level of primary healthcare systems, is inevitable.