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Measuring Socioeconomic Inequalities in Relation to Malaria Risk: A Comparison of Metrics in Rural Uganda

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  • Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; Infectious Disease Research Collaboration, Mulago Hospital Complex, Kampala, Uganda; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Economics, School of Oriental and African Studies, London, United Kingdom; Department of Medicine, University of California at San Francisco, San Francisco, California; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom

Socioeconomic position (SEP) is an important risk factor for malaria, but there is no consensus on how to measure SEP in malaria studies. We evaluated the relative strength of four indicators of SEP in predicting malaria risk in Nagongera, Uganda. A total of 318 children resident in 100 households were followed for 36 months to measure parasite prevalence routinely every 3 months and malaria incidence by passive case detection. Household SEP was determined using: 1) two wealth indices, 2) income, 3) occupation, and 4) education. Wealth Index I (reference) included only asset ownership variables. Wealth Index II additionally included food security and house construction variables, which may directly affect malaria. In multivariate analysis, only Wealth Index II and income were associated with the human biting rate, only Wealth Indices I and II were associated with parasite prevalence, and only caregiver's education was associated with malaria incidence. This is the first evaluation of metrics beyond wealth and consumption indices for measuring the association between SEP and malaria. The wealth index still predicted malaria risk after excluding variables directly associated with malaria, but the strength of association was lower. In this setting, wealth indices, income, and education were stronger predictors of socioeconomic differences in malaria risk than occupation.

Author Notes

* Address correspondence to Lucy S. Tusting, Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. E-mail: lucy.tusting@lshtm.ac.uk

Financial support: This work was supported by NIH/NIAID (U19AI089674); the Leverhulme Centre for Integrative Research in Agriculture and Health; Research and Policy for Infectious Disease Dynamics (RAPIDD) programme of the Science and Technology Directorate, U.S. Department of Homeland Security, the Fogarty International Center (U.S. National Institutes of Health) and the Bill & Melinda Gates Foundation (OPP1053338).

Authors' addresses: Lucy S. Tusting and Jo Lines, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mails: lucy.tusting@lshtm.ac.uk and jo.lines@lshtm.ac.uk. John C. Rek and Emmanuel Arinaitwe, Infectious Disease Research Collaboration, Mulago Hospital Complex, Kampala, Uganda, E-mails: jrek@idrc-uganda.org and earinaitwe@idrc-uganda.org. Sarah G. Staedke, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: sarah.staedke@lshtm.ac.uk. Moses R. Kamya, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: mkamya@idrc-uganda.org. Christian Bottomley, MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: christian.bottomley@lshtm.ac.uk. Deborah Johnston, Department of Economics, School of Oriental and African Studies, London, United Kingdom, E-mail: dj3@soas.ac.uk. Grant Dorsey, Department of Medicine, University of California at San Francisco, San Francisco, CA, E-mail: grant.dorsey@ucsf.edu. Steve W. Lindsay, School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom, E-mail: s.w.lindsay@durham.ac.uk.

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