title: Population, behavioural and environmental drivers of malaria prevalence in the Democratic Republic of Congo.
abstract: BACKGROUND
  Malaria is highly endemic in the Democratic Republic of Congo (DRC), but the limits and intensity of transmission within the country are unknown. It is important to discern these patterns as well as the drivers which may underlie them in order for effective prevention measures to be carried out.
  
  
  METHODS
  By applying high-throughput PCR analyses on leftover dried blood spots from the 2007 Demographic and Health Survey (DHS) for the DRC, prevalence estimates were generated and ecological drivers of malaria were explored using spatial statistical analyses and multilevel modelling.
  
  
  RESULTS
  Of the 7,746 respondents, 2268 (29.3%) were parasitaemic; prevalence ranged from 0-82% within geographically-defined survey clusters. Regional variation in these rates was mapped using the inverse-distance weighting spatial interpolation technique. Males were more likely to be parasitaemic than older people or females (p < 0.0001), while wealthier people were at a lower risk (p < 0.001). Increased community use of bed nets (p = 0.001) and community wealth (p < 0.05) were protective against malaria at the community level but not at the individual level. Paradoxically, the number of battle events since 1994 surrounding one's community was negatively associated with malaria risk (p < 0.0001).
  
  
  CONCLUSIONS
  This research demonstrates the feasibility of using population-based behavioural and molecular surveillance in conjunction with DHS data and geographic methods to study endemic infectious diseases. This study provides the most accurate population-based estimates to date of where illness from malaria occurs in the DRC and what factors contribute to the estimated spatial patterns. This study suggests that spatial information and analyses can enable the DRC government to focus its control efforts against malaria.
authors.affiliation: Department of Geography, University of North Carolina, Chapel Hill, NC, USA. jmessina@email.unc.edu
authors.forename: Jane P
authors.initials: JP
authors.lastname: Messina
authors.forename: Steve M
authors.initials: SM
authors.lastname: Taylor
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Linke
authors.forename: Antoinette K
authors.initials: AK
authors.lastname: Tshefu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Atua
authors.forename: Kashamuka
authors.initials: K
authors.lastname: Mwandagalirwa
authors.forename: Michael
authors.initials: M
authors.lastname: Emch
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001769:Blood / Q000469:parasitology; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D019353:Endemic Diseases; D005260:Female; D005843:Geography; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000635:transmission*; D008297:Male; D008875:Middle Aged; D057147:Mosquito Nets / Q000706:statistics & numerical data; D018512:Parasitemia / Q000175:diagnosis / Q000453:epidemiology; D016133:Polymerase Chain Reaction / Q000379:methods; D015995:Prevalence; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult