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Am. J. Trop. Med. Hyg., 80(1), 2009, pp. 103-111
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Individual and Household Level Factors Associated with Malaria Incidence in a Highland Region of Ethiopia: A Multilevel Analysis

Ingrid Peterson*, Luisa N. Borrell, Wafaa El-Sadr, AND Awash Teklehaimanot
Medical Research Council Laboratories, Fajara, The Gambia; Department of Health Sciences, Lehman College, City University of New York, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, New York

Multilevel analysis was used to identify individual and household level factors associated with malaria risk in 1,367 individuals in a peri-urban area of highland Ethiopia. Living within 450 m of a major vector-breeding site accounted for 38.78% and 78.49% of between-household variance in malaria incidence in adults and children, respectively. In adults, other individual level factors associated with malaria risk were regular or recent travel to rural areas (incidence rate ratio [IRR] = 12.96; 95% confidence interval [CI] = 4.05, 41.48) and having an indoor job (IRR = 0.37; 95% CI = 0.16, 0.87). Household level factors associated with adult malaria risk were low vegetation level in compound (IRR = 0.27; 95% CI = 0.10, 0.78), tidy compound (IRR = 0.29; 95% CI = 0.12, 0.71), household use of preventive measures (IRR = 0.31; 95% CI = 0.13, 0.74), and the number of 5- to 9-year-old children in the household (IRR = 1.66; 95% CI = 1.08, 2.53). Aside from distance to the vector-breeding site, few other malaria risk factors were identified in children. Malaria interventions in highland African communities should address household level factors associated with malaria clustering.

Received January 29, 2008. Accepted for publication August 26, 2008.

Acknowledgments: The authors thank all the community members and patients who participated in the study, as well as the laboratory staff, vector control technicians and data collectors whose diligence made this study possible.

* Address correspondence to Ingrid Peterson, MRC Laboratories, Fajara, Atlantic Rd., P.O. Box 273, Banjul, The Gambia. E-mail: idpet2{at}gmail.com

Authors’ addresses: Ingrid Peterson, MRC Laboratories, Fajara, Atlantic Rd., P.O. Box 273, Banjul, The Gambia. Luisa N. Borrell, Department of Health Sciences, Lehman College, City University of New York, 250 Bedford Park Blvd. West, Gillet 336, Bronx, NY 10468. Wafaa El-Sadr, International Center for AIDS Care & Treatment Programs, Columbia University, Mailman School of Public Heath, 722 West 168th St., Room #709, New York, NY 10032. Awash Teklehaimanot, Earth Institute Center for Global Health & Econ Dev, Columbia University, Hogan Hall, 100 Level, Mail Code: 3277, New York, NY 10027.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.