1Tropical Diseases Research Centre, Ndola, Zambia.
2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Trop Med Hyg. 2021 Apr 12;104(6):2131-2138. doi: 10.4269/ajtmh.20-1378.
Since the late nineteenth century, the importance of house structure as a determinant of malaria risk has been recognized. Few studies to date have examined the association of housing and malaria in clinical populations. We conducted a cross-sectional study of febrile patients (n = 282) at two rural health clinics in a high malaria-transmission area of northern Zambia. Participants underwent testing for Plasmodium falciparum infection by PCR. Demographic and other risk factors including house structure, indoor residual spraying (IRS), bed net use, education level, and household income were collected. Data were fitted to logistic regression models for relational and mediation analyses. Residing in a house with a thatch roof was associated with higher odds of malaria than residing in a house with corrugated metal (odds ratio: 2.6; 95% CI: 1.0-6.3, P = 0.04). Lower income and educational attainment were also associated with greater odds of malaria. Living under a thatch roof accounted for 24% (95% CI: 14-82) of the effect of household income on malaria risk, and income accounted for 11% (95% CI: 8-19) of the effect of education. Neither IRS nor bed net use was associated with malaria risk despite large, local investments in these vector control interventions. The findings testify to malaria as a disease of rural poverty and contribute further evidence to the utility of housing improvements in vector control programs.
自 19 世纪末以来，房屋结构作为疟疾风险的决定因素的重要性已得到认可。迄今为止，很少有研究检查过住房与临床人群中疟疾的关联。我们对赞比亚北部一个高疟疾传播地区的两个农村诊所的发热患者（n = 282）进行了横断面研究。参与者接受了聚合酶链反应（PCR）检测疟原虫感染。收集了人口统计学和其他风险因素，包括房屋结构、室内滞留喷洒（IRS）、蚊帐使用、教育水平和家庭收入。数据拟合到逻辑回归模型中进行关系和中介分析。与居住在波纹金属屋顶的房屋相比，居住在茅草屋顶的房屋感染疟疾的几率更高（优势比：2.6；95%置信区间：1.0-6.3，P = 0.04）。较低的收入和教育程度也与疟疾发病几率较高有关。茅草屋顶的生活方式占家庭收入对疟疾风险影响的 24%（95%置信区间：14-82），而收入占教育对疟疾风险影响的 11%（95%置信区间：8-19）。尽管在这些病媒控制干预措施方面进行了大量的地方投资，但 IRS 和蚊帐使用均与疟疾风险无关。这些发现证明了疟疾是农村贫困的一种疾病，并进一步证明了住房改善在病媒控制计划中的实用性。
