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Individual- and Household-Level Risk Factors Associated with Malaria in Mutasa District, Zimbabwe: A Serial Cross-Sectional Study

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  • 1 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
  • | 2 Biomedical Research and Training Institute, Harare, Zimbabwe.
  • | 3 Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
  • | 4 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
  • | 5 National Institute of Health Research, Harare, Zimbabwe.
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Malaria constitutes a major public health problem in Zimbabwe, particularly in the north and east bordering Zambia and Mozambique. In Manicaland Province in eastern Zimbabwe, malaria transmission is seasonal and unstable. Over the past decade, Manicaland Province has reported increased malaria transmission due to limited funding, drug resistance and insecticide resistance. The aim of this study was to identify risk factors at the individual and household levels to better understand the epidemiology of malaria and guide malaria control strategies in eastern Zimbabwe. Between October 2012 and September 2014, individual demographic data and household characteristics were collected from cross-sectional surveys of 1,116 individuals residing in 316 households in Mutasa District, one of the worst affected districts. Factors associated with malaria, measured by rapid diagnostic test (RDT), were identified through multilevel logistic regression models. A total of 74 participants were RDT positive. Sleeping under a bed net had a protective effect against malaria despite pyrethroid resistance in the mosquito vector. Multivariate analysis showed that malaria risk was higher among individuals younger than 25 years, residing in households located at a lower household density and in closer proximity to the Mozambique border. The risk factors identified need to be considered in targeting malaria control interventions to reduce host–vector interactions.

Author Notes

* Address correspondence to Mufaro Kanyangarara, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205. E-mail: mkanyan1@jhu.edu

Financial support: This work was supported by the Division of Microbiology and Infectious Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health as part of the International Centers of Excellence for Malaria Research (U19 AI089680).

Authors' addresses: Mufaro Kanyangarara and Luke C. Mullany, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mails: mkanyan1@jhu.edu and lmullany@jhu.edu. Edmore Mamini, Sungano Mharakurwa, Shungu Munyati, and Peter R. Mason, Biomedical Research and Training Institute, Harare, Zimbabwe, E-mails: edmoremamini@gmail.com, smharak1@jhu.edu, smunyati@brti.co.zw, and pmason@brti.co.zw. Lovemore Gwanzura, Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe, E-mail: gwanzura@mweb.co.zw. Tamaki Kobayashi, Timothy Shields, Frank C. Curriero, and William J. Moss, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mails: tkobaya2@jhu.edu, tshield2@jhu.edu, fcurriero@jhu.edu, and wmoss1@jhu.edu. Susan Mutambu, National Institute of Health Research, Harare, Zimbabwe, E-mail: mutambusl@gmail.com.

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