Ranking malaria risk factors to guide malaria control efforts in African highlands.
BACKGROUND
Malaria is re-emerging in most of the African highlands exposing the non immune population to deadly epidemics. A better understanding of the factors impacting transmission in the highlands is crucial to improve well targeted malaria control strategies.


RESULTS
A conceptual model of potential malaria risk factors in the highlands was built based on the available literature. Furthermore, the relative importance of these factors on malaria can be estimated through "classification and regression trees", an unexploited statistical method in the malaria field. This CART method was used to analyse the malaria risk factors in the Burundi highlands. The results showed that Anopheles density was the best predictor for high malaria prevalence. Then lower rainfall, no vector control, higher minimum temperature and houses near breeding sites were associated by order of importance to higher Anopheles density.


CONCLUSIONS
In Burundi highlands monitoring Anopheles densities when rainfall is low may be able to predict epidemics. The conceptual model combined with the CART analysis is a decision support tool that could provide an important contribution toward the prevention and control of malaria by identifying major risk factors.
Protopopoff
Natacha
N
Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium. nprotopopoff@itg.be
Van Bortel
Wim
W
Speybroeck
Niko
N
Van Geertruyden
Jean-Pierre
JP
Baza
Dismas
D
D'Alessandro
Umberto
U
Coosemans
Marc
M
D000293:Adolescent; D000328:Adult; D000818:Animals; D000852:Anopheles; D001512:Bedding and Linens; D002063:Burundi; D002648:Child; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007303:Insect Vectors; D007306:Insecticides / Q000494:pharmacology; D008288:Malaria / Q000175:diagnosis* / Q000235:genetics*; D008297:Male; D009032:Mosquito Control / Q000379:methods*; D057147:Mosquito Nets; D015999:Multivariate Analysis; D012044:Regression Analysis; D012307:Risk Factors; D013696:Temperature
D007306:Insecticides