Household and microeconomic factors associated with malaria in Mpumalanga, South Africa

A household matched case-control study design was used to explore associations between household characteristics and malaria risk in seven study towns in the hypoendemic area of Mpumalanga Province, South Africa. Controls were identified from neighboring households of each case. Principle component analysis was used to calculate a wealth index for households to allow comparison across socioeconomic groups. Conditional univariate and multiple logistic regression analyses were used to assess associations between household malaria risk and potential risk factors. Univariate analysis demonstrated an increased household malaria risk for people living in mud-walled houses compared with those in brick dwellings (OR = 5.10, 95% CI 2.03-12.80, P = 0.001). Multivariate analysis confirmed the association between malaria risk and mud-wall construction (OR = 6.12, 95% CI 2.26-16.59, P = 0.001) and demonstrated an association with opening windows after retiring to sleep (OR = 4.01, 95% CI 1.32-12.18, P = 0.014). An inverse association between household wealth, third (OR = 0.24, 95% CI 0.09-0.65, P = 0.005) and fourth quartiles (OR = 0.27, 95% CI 0.10-0.79, P = 0.016), and malaria risk was observed. Associations found here include increased household malaria risk and mud-wall construction, the practice of opening of windows at night and relative household poverty. Education campaigns targeting risk behavior may reduce malaria risk, but economic development is a more important intervention.