Spatial and Epidemiological Drivers of Plasmodium Falciparum Malaria among Adults in the Democratic Republic of the Congo

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Deutsch-Feldman, Molly; Brazeau, Nicholas F.; Parr, Jonathan B.; Thwai, Kyaw L.; Muwonga, Jeremie; Kashamuka, Melchior; Tshefu, Antoinette K.; Aydemir, Ozkan; Bailey, Jeffrey A.; & Edwards, Jessie K., et al. (2020). Spatial and Epidemiological Drivers of Plasmodium Falciparum Malaria among Adults in the Democratic Republic of the Congo. BMJ Global Health, 5(6), e002316. PMCID: PMC7326263

Abstract

BACKGROUND: Adults are frequently infected with malaria and may serve as a reservoir for further transmission, yet we know relatively little about risk factors for adult infections. In this study, we assessed malaria risk factors among adults using samples from the nationally representative, cross-sectional 2013-2014 Demographic and Health Survey (DHS) conducted in the Democratic Republic of the Congo (DRC). We further explored differences in risk factors by urbanicity.
METHODS: Plasmodium falciparum infection was determined by PCR. Covariates were drawn from the DHS to model individual, community and environmental-level risk factors for infection. Additionally, we used deep sequencing data to estimate the community-level proportions of drug-resistant infections and included these estimates as potential risk factors. All identified factors were assessed for differences in associations by urbanicity.
RESULTS: A total of 16 126 adults were included. Overall prevalence of malaria was 30.3% (SE=1.1) by PCR; province-level prevalence ranged from 6.7% to 58.3%. Only 17% of individuals lived in households with at least one bed-net for every two people, as recommended by the WHO. Protective factors included increasing within-household bed-net coverage (Prevalence Ratio=0.85, 95% CI=0.76-0.95) and modern housing (PR=0.58, 95% CI=0.49-0.69). Community-level protective factors included increased median wealth (PR=0.87, 95% CI=0.83-0.92). Education, wealth, and modern housing showed protective associations in cities but not in rural areas.
CONCLUSIONS: The DRC continues to suffer from a high burden of malaria; interventions that target high-risk groups and sustained investment in malaria control are sorely needed. Areas of high prevalence should be prioritised for interventions to target the largest reservoirs for further transmission.

URL

http://dx.doi.org/10.1136/bmjgh-2020-002316

Reference Type

Journal Article

Year Published

2020

Journal Title

BMJ Global Health

Author(s)

Deutsch-Feldman, Molly
Brazeau, Nicholas F.
Parr, Jonathan B.
Thwai, Kyaw L.
Muwonga, Jeremie
Kashamuka, Melchior
Tshefu, Antoinette K.
Aydemir, Ozkan
Bailey, Jeffrey A.
Edwards, Jessie K.
Verity, Robert J.
Emch, Michael E.
Gower, Emily W.
Juliano, Jonathan J.
Meshnick, Steven R.

Article Type

Regular

PMCID

PMC7326263

Data Set/Study

Demographic and Health Surveys (DHS)

Continent/Country

Congo

ORCiD

Emch - 0000-0003-2642-965X
Edwards, J -0000-0002-1741-335X