title: Social inequalities in malaria knowledge, prevention and prevalence among children under 5 years old and women aged 15-49 in Madagascar.
abstract: BACKGROUND
  Approximately 15 % of all deaths in Africa among children under five years old are due to malaria, a preventable and treatable disease. A prevailing sociological theory holds that resources (including knowledge, money, power, prestige, or beneficial social connections) are particularly relevant when diseases are susceptible to effective prevention. This study examines the role of socioeconomic inequalities by broadly predicting malaria knowledge and use of preventive technology among women aged 15-49, and malaria among children aged 6-59 months in Madagascar.
  
  
  METHODS
  Data came from women aged 15-49 years (N = 8279) interviewed by Madagascar's 2011/2013 Malaria Indicator Studies, and their children aged under five years (N = 7644). Because geographic location may be associated with socioeconomic factors and exposure to malaria, multilevel models were used to account for unobserved geographic and administrative variation. Models also account for observed social, economic, demographic, and seasonal factors.
  
  
  RESULTS
  Prevalence among children four years old and younger was 7.8 %. Results showed that both mother's education and household wealth strongly influence knowledge about and efforts to prevent and treat malaria. Analyses also revealed that the prevalence of malaria among children aged 6-59 months was determined by household wealth (richest vs poorest: OR = 0.25, 95 % CI [0.10, 0.64]) and maternal education (secondary vs none: OR = 0.51, 95 % CI [0.28, 0.95]).
  
  
  CONCLUSIONS
  Malaria may be subject to socio-economic forces arising from a broad set of behavioural and geographic determinants, even after adjusting for geographic risk factors and seasonality. Nearly 21 % of the sample lacked primary schooling. To improve malaria reduction efforts, broad-based interventions may need to attack inequalities to ensure that knowledge, prevention and treatment are improved among those who are most vulnerable.
authors.affiliation: Program in Public Health and Department of Preventive, Population and Family Medicine, Stony Brook University, 101 Nichols Rd., Health Sciences Center #3-071, Stony Brook, NY, 11794, USA. sean.clouston@stonybrookmedicine.edu.
authors.forename: Sean A P
authors.initials: SA
authors.lastname: Clouston
authors.affiliation: Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Ste. 2301, New Orleans, LA, 70112, USA. jyukich@tulane.edu.
authors.forename: Josh
authors.initials: J
authors.lastname: Yukich
authors.affiliation: Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Ste. 2210, New Orleans, LA, 70112, USA. panglewi@tulane.edu.
authors.forename: Phil
authors.initials: P
authors.lastname: Anglewicz