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      Profiling malaria infection among under-five children in the Democratic Republic of Congo

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      1 , 2 , * , 3 , 4
      PLoS ONE
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          Abstract

          Introduction

          In 2018, Malaria accounted for 38% of the overall morbidity and 36% of the overall mortality in the Democratic Republic of Congo (DRC). This study aimed to identify malaria socioeconomic predictors among children aged 6–59 months in DRC and to describe a socioeconomic profile of the most-at-risk children aged 6–59 months for malaria infection.

          Materials and methods

          This study used data from the 2013 DRC Demographic and Health Survey. The sample included 8,547 children aged 6–59 months who were tested for malaria by microscopy. Malaria infection status, the dependent variable, is a dummy variable characterized as a positive or negative test. The independent variables were child’s sex, age, and living arrangement; mother’s education; household’s socioeconomic variables; province of residence; and type of place of residence. Statistical analyses used the chi-square automatic interaction detector (CHAID) model and logistic regression.

          Results

          Of the 8,547 children included in the sample, 25% had malaria infection. Four variables—child’s age, mother’s education, province, and wealth index—were statistically associated with the prevalence of malaria infection in bivariate analysis and multivariate analysis (CHAID and logistic regression). The prevalence of malaria infection increases with child’s age and decreases significantly with mother’s education and the household wealth index. These findings suggest that the prevalence of malaria infection is driven by interactions among environmental factors, socioeconomic characteristics, and probably differences in the implementation of malaria programs across the country. The effect of mother’s education on malaria infection was only significant among under-five children living in Ituri, Kasaï-Central, Haut-Uele, Lomami, Nord-Ubangi, and Maniema provinces, and the effect of wealth index was significant in Mai-Ndombe, Tshopo, and Haut-Katanga provinces.

          Conclusion

          Findings from this study could be used for targeting malaria interventions in DRC. Although malaria infection is common across the country, the prevalence of children at high risk for malaria infection varies by province and other background characteristics, including age, mother’s education, wealth index, and place of residence. In light of these findings, designing provincial and multisectoral interventions could be an effective strategy to achieve zero malaria infection in DRC.

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          Most cited references42

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          An Exploratory Technique for Investigating Large Quantities of Categorical Data

          G. Kass (1980)
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            The burden of malaria mortality among African children in the year 2000.

            Although malaria is a leading cause of child deaths, few well-documented estimates of its direct and indirect burden exist. Our objective was to estimate the number of deaths directly attributable to malaria among children <5 years old in sub-Saharan Africa for the year 2000. We divided the population into six sub-populations and, using results of studies identified in a literature review, estimated a malaria mortality rate for each sub-population. Malaria deaths were estimated by multiplying each sub-population by its corresponding rate. Sensitivity analyses were performed to assess the impact of varying key assumptions. The literature review identified 31 studies from 14 countries in middle Africa and 17 studies and reports from four countries in southern Africa. In 2000, we estimated that approximately 100 million children lived in areas where malaria transmission occurs and that 803 620 (precision estimate: 705 821-901 418) children died from the direct effects of malaria. For all of sub-Saharan Africa, including populations not exposed to malaria, malaria accounted for 18.0% (precision estimate: 15.8-20.2%) of child deaths. These estimates were sensitive to extreme assumptions about the causes of deaths with no known cause. These estimates, based on the best available data and methods, clearly demonstrate malaria's enormous mortality burden. We emphasize that these estimates are an approximation with many limitations and that the estimates do not account for malaria's large indirect burden. We describe information needs that, if filled, might improve the validity of future estimates.
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              Assessment of insecticide-treated bednet use among children and pregnant women across 15 countries using standardized national surveys.

              Impact of insecticide-treated bednets (ITNs) on preventing malaria may be minimized if they are not used by vulnerable populations. Among ITN-owning households from 15 standardized national surveys from 2003 to 2006, we identify factors associated with ITN use among children younger than 5 years of age and make comparisons of ITN use among children and pregnant women across countries. Within ITN-owning households, many children and pregnant women are still not using them. Between-country analysis with linear regression showed child ITN use increases as intra-household access to ITNs increases (P = 0.020, R2 = 0.404), after controlling for season and survey year. Results from within-country logistic regression analyses were consistent with between-country analysis showing intra-household access to ITNs is the strongest and most consistent determinant of use among children. The gaps in ITN use and possession will likely persist in the absence of achieving a ratio of no more than two people per ITN.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                6 May 2021
                2021
                : 16
                : 5
                : e0250550
                Affiliations
                [1 ] Population and Health Research Institute, Kinshasa, Democratic Republic of Congo
                [2 ] Department of Population and Development Study, University of Kinshasa, Kinshasa, Democratic Republic of Congo
                [3 ] World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
                [4 ] ICF, United States of America
                Swiss Tropical & Public Health Institute, SWITZERLAND
                Author notes

                Competing Interests: Yazoumé Yé is an employee of M&E Infectious Disease, ICF International. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0003-3709-1121
                Article
                PONE-D-20-10152
                10.1371/journal.pone.0250550
                8101767
                33956848
                9677a93d-b8a8-49b7-8c0a-49eb02c17dbc
                © 2021 Emina et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 April 2020
                : 12 April 2021
                Page count
                Figures: 4, Tables: 8, Pages: 21
                Funding
                This research did not receive any specific funding. Yazoumé Yé (YY) is Vice President Malaria Surveillance and Research at ICF, USA, but was involved as a researcher. His institution did not have any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.
                Categories
                Research Article
                Medicine and Health Sciences
                Medical Conditions
                Parasitic Diseases
                Malaria
                Medicine and Health Sciences
                Medical Conditions
                Tropical Diseases
                Malaria
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                People and Places
                Population Groupings
                Families
                Mothers
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Pediatric Infections
                Medicine and Health Sciences
                Pediatrics
                Pediatric Infections
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                Earth Sciences
                Geography
                Geographic Areas
                Rural Areas
                Earth Sciences
                Geography
                Human Geography
                Urban Geography
                Cities
                Social Sciences
                Human Geography
                Urban Geography
                Cities
                Custom metadata
                This study is based on the Democratic Republic of Congo 2013 Demographic and Health Survey. These data are available at https://www.dhsprogram.com. Access to the file required authorization from The Demographic and Health Surveys Program ( https://www.dhsprogram.com). The website depicts the process.

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