title: Who develops severe malaria? Impact of access to healthcare, socio-economic and environmental factors on children in Yemen: a case-control study.
abstract: OBJECTIVE
  To investigate the impact of socio-economic and environmental factors on developing severe malaria in comparison with mild malaria in Yemen.
  
  
  METHODS
  Case-control study comparing 343 children aged 6 months to 10 years diagnosed with WHO-defined severe malaria (cases) at the main children's hospital in Taiz and 445 children with mild malaria (controls) diagnosed in the health centres, which serve the areas where the cases came from.
  
  
  RESULTS
  In univariate analysis, age <1 year, distance from health centre, delay to treatment and driving time to health centre were associated with progression from mild to severe malaria. In multivariate analysis, distance to nearest health centre >2 km was significantly associated with progression to severe disease. Environmental and vector control factors associated with protection from acquiring malaria (such as sleeping under bednets) were not associated with protection from moving from mild to severe disease.
  
  
  CONCLUSIONS
  Innovative ways to improve access to antimalarial treatment for those living more then 2 km away from health centres such as home management of malaria, especially for infants and young children, should be explored in malaria-endemic areas of Yemen.
authors.affiliation: Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. a_m_altaiar@yahoo.com
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Taiar
authors.forename: Shabbar
authors.initials: S
authors.lastname: Jaffar
authors.forename: Ali
authors.initials: A
authors.lastname: Assabri
authors.forename: Molham
authors.initials: M
authors.lastname: Al-Habori
authors.forename: Ahmed
authors.initials: A
authors.lastname: Azazy
authors.forename: Arwa
authors.initials: A
authors.lastname: Al-Gabri
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Ganadi
authors.forename: Bothaina
authors.initials: B
authors.lastname: Attal
authors.forename: Christopher J M
authors.initials: CJ
authors.lastname: Whitty
mesh_terms: D017677:Age Distribution; D000704:Analysis of Variance; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004777:Environment; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D007223:Infant; D008288:Malaria / Q000209:etiology* / Q000635:transmission; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D015006:Yemen