title: Nutritional and socio-economic factors associated with Plasmodium falciparum infection in children from Equatorial Guinea: results from a nationally representative survey.
abstract: BACKGROUND
  Malaria has traditionally been a major endemic disease in Equatorial Guinea. Although parasitaemia prevalence on the insular region has been substantially reduced by vector control in the past few years, the prevalence in the mainland remains over 50% in children younger than five years. The aim of this study is to investigate the risk factors for parasitaemia and treatment seeking behaviour for febrile illness at country level, in order to provide evidence that will reinforce the EG National Malaria Control Programme.
  
  
  METHODS
  The study was a cross-sectional survey of children 0 to 5 years old, using a multistaged, stratified, cluster-selected sample at the national level. It included a socio-demographic, health and dietary questionnaires, anthropometric measurements, and thick and thin blood smears to determine the Plasmodium infection. A multivariate logistic regression model was used to determine risk factors for parasitaemia, taking into account the cluster design.
  
  
  RESULTS
  The overall prevalence of parasitemia was 50.9%; it was higher in rural (58.8%) compared to urban areas (44.0%, p = 0.06). Age was positively associated with parasitemia (p < 0.0001). In rural areas, risk factors included longer distance to health facilities (p = 0.01) and a low proportion of households with access to protected water in the community (p = 0.02). Having had an episode of cough in the 15 days prior to the survey was inversely related to parasitemia (p = 0.04). In urban areas, the risk factors were stunting (p = 0.005), not having taken colostrum (p = 0.01), and that someone in the household slept under a bed net (p = 0.002); maternal antimalarial medication intake during pregnancy (p = 0.003) and the household socio-economic status (p = 0.0002) were negatively associated with parasitemia. Only 55% of children with fever were taken outside their homes for care, and treatment seeking behaviour differed substantially between rural and urban populations.
  
  
  CONCLUSIONS
  Results suggest that a national programme to fight malaria in Equatorial Guinea should take into account the differences between rural and urban communities in relation to risk factors for parasitaemia and treatment seeking behaviour, integrate nutrition programmes, incorporate campaigns on the importance of early treatment, and target appropriately for bed nets to reach the under-fives.
authors.affiliation: Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Sinesio Delgado 6, Pab 13, Madrid 28029, Spain. ecustodio@isciii.es
authors.forename: Estefanía
authors.initials: E
authors.lastname: Custodio
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Descalzo
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villamor
authors.forename: Laura
authors.initials: L
authors.lastname: Molina
authors.forename: Ignacio
authors.initials: I
authors.lastname: Sánchez
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lwanga
authors.forename: Cristina
authors.initials: C
authors.lastname: Bernis
authors.forename: Agustín
authors.initials: A
authors.lastname: Benito
authors.forename: Jesús
authors.initials: J
authors.lastname: Roche
mesh_terms: D000818:Animals; D000886:Anthropometry; D001769:Blood / Q000469:parasitology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D016701:Guinea / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology*; D008297:Male; D044342:Malnutrition / Q000150:complications*; D018512:Parasitemia / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population