Socio-economic and environmental protective/risk factors for severe malaria in Thailand.
We conducted a cross-sectional study to identify the socio-economic and environmental protective/risk factors for severe malaria in Thailand. Forty-six cases of severe malaria, 72 cases of non-severe malaria with high parasite biomass and 40 mild malaria cases were included. When comparing severe malaria and non-severe malaria with high parasite biomass, specific logistic regression models showed a significant protective effect for helminths, adjusted odds ratio 0.24 (0.07-0.78) for low body mass index (BMI), adjusted odds ratio 0.11 (0.02-0.58). When comparing severe and mild malaria, a longer residence duration, adjusted odds ratio 0.36 (0.09-0.83) and the use of antimalarial self-medication, adjusted odds ratio 0.08 (0.009-0.84) were associated with protection from severe malaria. Using stepwise logistic regression with all the variables inserted in the model yielded similar results. These findings suggest specific immunity and self-medication control parasite multiplication whereas helminths and malnutrition more specifically affect the pathogenesis of severe malaria.
Unité INSERM 511: Immunobiologie Cellulaire et Moléculaire des Infections Parasitaires, Faculté de médecine Pitié-Salpétrière, 91 boulevard de l'Hôpital, 75634 Cedex 13, Paris, France. m_nacher@mailcity.com
M
M
Nacher
P
P
Singhasivanon
S
S
Vannaphan
S
S
Treeprasertsuk
M
M
Phanumaphorn
B
B
Traore
S
S
Looareesuwan
F
F
Gay
D000328:Adult; D000818:Animals; D001294:Attitude to Health; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D006801:Humans; D016779:Malaria, Cerebral / Q000453:epidemiology*; D018512:Parasitemia / Q000453:epidemiology; D010963:Plasmodium falciparum; D012307:Risk Factors; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D014774:Virulence