title: Risk factors for severe malaria in Bamako, Mali: a matched case-control study.
abstract: The aim of this case-control study was to identify epidemiological risk factors for severe malaria among children living in Bamako, a malaria-endemic area. For this, 260 healthy community controls were matched to 130 patients with severe malaria. Conditional multiple logistic regression analysis indicated that all examined independent factors associated with severe malaria are directly related to characteristics of the child's mother, with the exception of the child's own yellow fever vaccination history (odds ratio (OR): 1.93, 95% confidence intervals (CI(95%)) [1.10-3.37]). The following characteristics were all associated with a decreased risk of severe malaria in the child: maternal education (OR: 0.52, CI(95%) [0.31-0.86]), the mother's adequate knowledge about malaria (OR: 0.46, 95% CI(95%) [0.25-0.86]), her use of mosquito bed nets (OR: 0.53, CI(95%) [0.30-0.92]) and breast-feeding for at least 2 years (OR: 0.57, CI(95%) [0.33-0.94]). Conversely, chronic maternal disease (OR: ?3.16, CI(95%) [1.31-7.61]) was associated with an increased risk of severe malaria. These findings strongly support the hypothesis that maternal factors are central to the development of severe malaria in children. Programmes aiming to improve both maternal health and maternal education may reduce the incidence of severe malaria in children and should therefore be advocated in Bamako and in areas with similar epidemiological patterns for malaria.
authors.affiliation: Laboratoire de Parasitologie-Mycologie, Immunology and Genetics of Parasitic Diseases, Inserm U.399, Faculté de Médecine Timone, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France.
authors.forename: Innocent
authors.initials: I
authors.lastname: Safeukui-Noubissi
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ranque
authors.forename: Belco
authors.initials: B
authors.lastname: Poudiougou
authors.forename: Modibo
authors.initials: M
authors.lastname: Keita
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Traoré
authors.forename: Diamori
authors.initials: D
authors.lastname: Traoré
authors.forename: Mahamadou
authors.initials: M
authors.lastname: Diakité
authors.forename: Mahamadou B
authors.initials: MB
authors.lastname: Cissé
authors.forename: Marouf M
authors.initials: MM
authors.lastname: Keita
authors.forename: Alain
authors.initials: A
authors.lastname: Dessein
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000740:Anemia; D001942:Breast Feeding; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology*; D016779:Malaria, Cerebral / Q000453:epidemiology; D008297:Male; D008302:Mali / Q000453:epidemiology; D008429:Maternal Welfare; D012044:Regression Analysis; D012307:Risk Factors