Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa: A systematic review and meta-analysis

Abraham Degarege, Kristopher Fennie, Dawit Degarege, Shasank Chennupati, Purnima Madhivanan

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background A clear understanding of the effects of housing structure, education, occupation, income, and wealth on malaria can help to better design socioeconomic interventions to control the disease. This literature review summarizes the relationship of housing structure, educational level, occupation, income, and wealth with the epidemiology of malaria in sub-Saharan Africa (SSA). Methods A systematic review and meta-analysis was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. The protocol for this study is registered in PROSPERO (ID=CRD42017056070), an international database of prospectively registered systematic reviews. On January 16, 2016, available literature was searched in PubMed, Embase, CINAHL, and Cochrane Library. All but case studies, which reported prevalence or incidence of Plasmodium infection stratified by socioeconomic status among individuals living in SSA, were included without any limits. Odds Ratio (OR) and Relative Risk (RR), together with 95% CI and p-values were used as effect measures. Heterogeneity was assessed using chi-square, Moran’s I 2 , and tau 2 tests. Fixed (I 2 <30%), random (I 2 30%) or log-linear dose-response model was used to estimate the summary OR or RR. Results After removing duplicates and screening of titles, abstracts, and full text, 84 articles were found eligible for systematic review, and 75 of them were included in the meta-analyses. Fifty-seven studies were cross-sectional, 12 were prospective cohort, 10 were case-control, and five were randomized control trials. The odds of Plasmodium infection increased among individuals who were living in poor quality houses (OR 2.13, 95% CI 1.56–3.23, I 2 = 27.7), were uneducated (OR 1.36, 95% CI 1.19–1.54, I 2 = 72.4.0%), and were farmers by occupation (OR 1.48, 95% CI 1.11–1.85, I 2 = 0.0%) [p<0.01 for all]. The odds of Plasmodium infection also increased with a decrease in the income (OR 1.02, 95% CI 1.01–1.03, tau 2 <0.001), and wealth index of individuals (OR 1.25, 95% CI 1.18–1.35, tau 2 = 0.028) [p<0.001 for both]. Longitudinal studies also showed an increased risk of Plasmodium infection among individuals who were living in poor quality houses (RR 1.86, 95% CI 1.47–2.25, I 2 = 0.0%), were uneducated (OR 1.27, 1.03–1.50, I 2 = 0.0%), and were farmers (OR 1.36, 1.18–1.58) [p<0.01 for all]. Conclusions Lack of education, low income, low wealth, living in poorly constructed houses, and having an occupation in farming may increase risk of Plasmodium infection among people in SSA. Public policy measures that can reduce inequity in health coverage, as well as improve economic and educational opportunities for the poor, will help in reducing the burden of malaria in SSA.

Original languageEnglish (US)
Article numbere0211205
JournalPloS one
Volume14
Issue number1
DOIs
StatePublished - Jan 2019

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Africa South of the Sahara
systematic review
socioeconomic status
Sub-Saharan Africa
meta-analysis
Social Class
odds ratio
malaria
Malaria
Meta-Analysis
Odds Ratio
Plasmodium
Occupations
income and wealth
relative risk
Education
infection
Epidemiology
education
income

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa : A systematic review and meta-analysis. / Degarege, Abraham; Fennie, Kristopher; Degarege, Dawit; Chennupati, Shasank; Madhivanan, Purnima.

In: PloS one, Vol. 14, No. 1, e0211205, 01.2019.

Research output: Contribution to journalArticle

Degarege, Abraham ; Fennie, Kristopher ; Degarege, Dawit ; Chennupati, Shasank ; Madhivanan, Purnima. / Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa : A systematic review and meta-analysis. In: PloS one. 2019 ; Vol. 14, No. 1.
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title = "Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa: A systematic review and meta-analysis",
abstract = "Background A clear understanding of the effects of housing structure, education, occupation, income, and wealth on malaria can help to better design socioeconomic interventions to control the disease. This literature review summarizes the relationship of housing structure, educational level, occupation, income, and wealth with the epidemiology of malaria in sub-Saharan Africa (SSA). Methods A systematic review and meta-analysis was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. The protocol for this study is registered in PROSPERO (ID=CRD42017056070), an international database of prospectively registered systematic reviews. On January 16, 2016, available literature was searched in PubMed, Embase, CINAHL, and Cochrane Library. All but case studies, which reported prevalence or incidence of Plasmodium infection stratified by socioeconomic status among individuals living in SSA, were included without any limits. Odds Ratio (OR) and Relative Risk (RR), together with 95{\%} CI and p-values were used as effect measures. Heterogeneity was assessed using chi-square, Moran’s I 2 , and tau 2 tests. Fixed (I 2 <30{\%}), random (I 2 30{\%}) or log-linear dose-response model was used to estimate the summary OR or RR. Results After removing duplicates and screening of titles, abstracts, and full text, 84 articles were found eligible for systematic review, and 75 of them were included in the meta-analyses. Fifty-seven studies were cross-sectional, 12 were prospective cohort, 10 were case-control, and five were randomized control trials. The odds of Plasmodium infection increased among individuals who were living in poor quality houses (OR 2.13, 95{\%} CI 1.56–3.23, I 2 = 27.7), were uneducated (OR 1.36, 95{\%} CI 1.19–1.54, I 2 = 72.4.0{\%}), and were farmers by occupation (OR 1.48, 95{\%} CI 1.11–1.85, I 2 = 0.0{\%}) [p<0.01 for all]. The odds of Plasmodium infection also increased with a decrease in the income (OR 1.02, 95{\%} CI 1.01–1.03, tau 2 <0.001), and wealth index of individuals (OR 1.25, 95{\%} CI 1.18–1.35, tau 2 = 0.028) [p<0.001 for both]. Longitudinal studies also showed an increased risk of Plasmodium infection among individuals who were living in poor quality houses (RR 1.86, 95{\%} CI 1.47–2.25, I 2 = 0.0{\%}), were uneducated (OR 1.27, 1.03–1.50, I 2 = 0.0{\%}), and were farmers (OR 1.36, 1.18–1.58) [p<0.01 for all]. Conclusions Lack of education, low income, low wealth, living in poorly constructed houses, and having an occupation in farming may increase risk of Plasmodium infection among people in SSA. Public policy measures that can reduce inequity in health coverage, as well as improve economic and educational opportunities for the poor, will help in reducing the burden of malaria in SSA.",
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T1 - Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa

T2 - A systematic review and meta-analysis

AU - Degarege, Abraham

AU - Fennie, Kristopher

AU - Degarege, Dawit

AU - Chennupati, Shasank

AU - Madhivanan, Purnima

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N2 - Background A clear understanding of the effects of housing structure, education, occupation, income, and wealth on malaria can help to better design socioeconomic interventions to control the disease. This literature review summarizes the relationship of housing structure, educational level, occupation, income, and wealth with the epidemiology of malaria in sub-Saharan Africa (SSA). Methods A systematic review and meta-analysis was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. The protocol for this study is registered in PROSPERO (ID=CRD42017056070), an international database of prospectively registered systematic reviews. On January 16, 2016, available literature was searched in PubMed, Embase, CINAHL, and Cochrane Library. All but case studies, which reported prevalence or incidence of Plasmodium infection stratified by socioeconomic status among individuals living in SSA, were included without any limits. Odds Ratio (OR) and Relative Risk (RR), together with 95% CI and p-values were used as effect measures. Heterogeneity was assessed using chi-square, Moran’s I 2 , and tau 2 tests. Fixed (I 2 <30%), random (I 2 30%) or log-linear dose-response model was used to estimate the summary OR or RR. Results After removing duplicates and screening of titles, abstracts, and full text, 84 articles were found eligible for systematic review, and 75 of them were included in the meta-analyses. Fifty-seven studies were cross-sectional, 12 were prospective cohort, 10 were case-control, and five were randomized control trials. The odds of Plasmodium infection increased among individuals who were living in poor quality houses (OR 2.13, 95% CI 1.56–3.23, I 2 = 27.7), were uneducated (OR 1.36, 95% CI 1.19–1.54, I 2 = 72.4.0%), and were farmers by occupation (OR 1.48, 95% CI 1.11–1.85, I 2 = 0.0%) [p<0.01 for all]. The odds of Plasmodium infection also increased with a decrease in the income (OR 1.02, 95% CI 1.01–1.03, tau 2 <0.001), and wealth index of individuals (OR 1.25, 95% CI 1.18–1.35, tau 2 = 0.028) [p<0.001 for both]. Longitudinal studies also showed an increased risk of Plasmodium infection among individuals who were living in poor quality houses (RR 1.86, 95% CI 1.47–2.25, I 2 = 0.0%), were uneducated (OR 1.27, 1.03–1.50, I 2 = 0.0%), and were farmers (OR 1.36, 1.18–1.58) [p<0.01 for all]. Conclusions Lack of education, low income, low wealth, living in poorly constructed houses, and having an occupation in farming may increase risk of Plasmodium infection among people in SSA. Public policy measures that can reduce inequity in health coverage, as well as improve economic and educational opportunities for the poor, will help in reducing the burden of malaria in SSA.

AB - Background A clear understanding of the effects of housing structure, education, occupation, income, and wealth on malaria can help to better design socioeconomic interventions to control the disease. This literature review summarizes the relationship of housing structure, educational level, occupation, income, and wealth with the epidemiology of malaria in sub-Saharan Africa (SSA). Methods A systematic review and meta-analysis was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. The protocol for this study is registered in PROSPERO (ID=CRD42017056070), an international database of prospectively registered systematic reviews. On January 16, 2016, available literature was searched in PubMed, Embase, CINAHL, and Cochrane Library. All but case studies, which reported prevalence or incidence of Plasmodium infection stratified by socioeconomic status among individuals living in SSA, were included without any limits. Odds Ratio (OR) and Relative Risk (RR), together with 95% CI and p-values were used as effect measures. Heterogeneity was assessed using chi-square, Moran’s I 2 , and tau 2 tests. Fixed (I 2 <30%), random (I 2 30%) or log-linear dose-response model was used to estimate the summary OR or RR. Results After removing duplicates and screening of titles, abstracts, and full text, 84 articles were found eligible for systematic review, and 75 of them were included in the meta-analyses. Fifty-seven studies were cross-sectional, 12 were prospective cohort, 10 were case-control, and five were randomized control trials. The odds of Plasmodium infection increased among individuals who were living in poor quality houses (OR 2.13, 95% CI 1.56–3.23, I 2 = 27.7), were uneducated (OR 1.36, 95% CI 1.19–1.54, I 2 = 72.4.0%), and were farmers by occupation (OR 1.48, 95% CI 1.11–1.85, I 2 = 0.0%) [p<0.01 for all]. The odds of Plasmodium infection also increased with a decrease in the income (OR 1.02, 95% CI 1.01–1.03, tau 2 <0.001), and wealth index of individuals (OR 1.25, 95% CI 1.18–1.35, tau 2 = 0.028) [p<0.001 for both]. Longitudinal studies also showed an increased risk of Plasmodium infection among individuals who were living in poor quality houses (RR 1.86, 95% CI 1.47–2.25, I 2 = 0.0%), were uneducated (OR 1.27, 1.03–1.50, I 2 = 0.0%), and were farmers (OR 1.36, 1.18–1.58) [p<0.01 for all]. Conclusions Lack of education, low income, low wealth, living in poorly constructed houses, and having an occupation in farming may increase risk of Plasmodium infection among people in SSA. Public policy measures that can reduce inequity in health coverage, as well as improve economic and educational opportunities for the poor, will help in reducing the burden of malaria in SSA.

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