title: Is malaria illness among young children a cause or a consequence of low socioeconomic status? evidence from the united Republic of Tanzania.
abstract: BACKGROUND
  Malaria is commonly considered a disease of the poor, but there is very little evidence of a possible two-way causality in the association between malaria and poverty. Until now, limitations to examine that dual relationship were the availability of representative data on confirmed malaria cases, the use of a good proxy for poverty, and accounting for endogeneity in regression models.
  
  
  METHODS
  A simultaneous equation model was estimated with nationally representative data for Tanzania that included malaria parasite testing with RDTs for young children (six-59 months), and accounted for environmental variables assembled with the aid of GIS. A wealth index based on assets, access to utilities/infrastructure, and housing characteristics was used as a proxy for socioeconomic status. Model estimation was done with instrumental variables regression.
  
  
  RESULTS
  Results show that households with a child who tested positive for malaria at the time of the survey had a wealth index that was, on average, 1.9 units lower (p-value < 0.001), and that an increase in the wealth index did not reveal significant effects on malaria.
  
  
  CONCLUSIONS
  If malaria is indeed a cause of poverty, as the findings of this study suggest, then malaria control activities, and particularly the current efforts to eliminate/eradicate malaria, are much more than just a public health policy, but also a poverty alleviation strategy. However, if poverty has no causal effect on malaria, then poverty alleviation policies should not be advertised as having the potential additional effect of reducing the prevalence of malaria.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Bldg I, Room 1113, Boston, MA 02115, USA. mcastro@hsph.harvard.edu
authors.forename: Marcia Caldas
authors.initials: MC
authors.lastname: de Castro
authors.forename: Monica G
authors.initials: MG
authors.lastname: Fisher
mesh_terms: D002675:Child, Preschool; D005191:Family Characteristics; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D008962:Models, Theoretical; D011203:Poverty; D015995:Prevalence; D012044:Regression Analysis; D012923:Social Class; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology