title: Determinants of low socio-economic status and risk of Plasmodium vivax malaria infection in Panama (2009-2012): a case-control study.
abstract: BACKGROUND
  Identification of risk factors is important for the establishment of malaria elimination programmes tailored to specific regions. Type of house construction had been associated with increasing risk of acquiring malaria. This study aimed at establishing the association between determinants of low socio-economic status (SES) and type of house construction with the likelihood of living in a Plasmodium vivax malarious corregimiento (smallest political division) in Panama during 2009-2012.
  
  
  METHODS
  To determine the association between type-2 houses (build with deciduous materials) and other determinants of low SES, with living in a malarious corregimiento, this study analyzed demographic and housing census data (2010), and malaria incidence aggregated at the corregimiento level (2009-2012), using a Spearman's non-parametric correlation test to explore for associations, followed by a case-control study and a reduced multivariate logistic regression approach for confirmation.
  
  
  RESULTS
  A descriptive temporal and spatial analysis indicated that P. vivax in Panama was associated with Amerindian reservations. Moreover, this study demonstrated that a strong correlation (deleterious effect) existed between living in a malarious corregimiento and being exposed to a type-2 house (OR = > 1.0) (p < 0.001), while, it showed an inverse correlation for exposure to type-1 houses (protective effect) (build with permanent materials) (OR = < 1.0) (p < 0.001). In the same way, a significant association between exposure to type-2 houses and the outcome of living in a malarious corregimiento was found using a case-control study approach (Chi(2) test = p < 0.001), that was confirmed applying a reduced multivariate logistic regression fitted model.
  
  
  CONCLUSIONS
  This study demonstrated that living in a P. vivax malarious corregimiento in Panama during 2009-2012 was strongly correlated with those corregimientos having a high proportion of type-2 houses. A multivariate logistic regression approach at the house and corregimiento level indicated a strong association of type-2 houses, dirt floors and illiteracy with the likelihood of living in a malarious corregimiento. It is expected that these findings will help implement a multi-sectorial approach for the elimination of malaria in poor areas of Panama where malaria is endemic, which emphasizes house improvements such as mosquito-proofing and socio-economic development.
authors.affiliation: Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA. nobaldia@hsph.harvard.edu.|Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama, Panama. nobaldia@hsph.harvard.edu.
authors.forename: Nicanor
authors.initials: N
authors.lastname: Obaldia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006798:Housing; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016780:Malaria, Vivax / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010176:Panama / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult