title: Identifying risk factors for Plasmodium infection and anaemia in Kinshasa, Democratic Republic of Congo.
abstract: There is little data on the risk factors for malaria infection in large cities in central Africa and in all age groups. There may be different associations with the risk factors for areas with different malaria transmission intensities such as the effect of fever or age. This study aimed at identifying risk factors associated with Plasmodium infection and anaemia among children 6-59 months and individuals aged older than 5 years in Kinshasa, a large city with heterogeneity in malaria prevalence.
  
  
  
  This study analysed data from 3342 children aged 6-59 months from 25 non-rural health zones (HZs) and for 816 individuals aged older than 5 years from two HZs in Kinshasa (non-rural), collected during a cross sectional malaria survey in 2011. Logistic regression with random effects was used to investigate predictors for malaria and anaemia. Differences in risk factors in areas with a prevalence of less than 10 and 10 % or greater were investigated.
  
  
  
  There was evidence of a different age-pattern in the two transmission settings. For children under 5 years, the highest prevalence of malaria was observed in the 48-59 months group in both transmission settings, but it increased more gently for the lower transmission HZs (p = 0.009). In a separate analysis in children over 5 years in two selected HZs, the peak prevalence was in 5-9 years old in the higher transmission setting and in 15-19 years old in the lower transmission setting. Reported fever was associated with malaria in both transmission strata, with no evidence of a difference in these associations (p = 0.71); however in children older than 5 years there was a significant interaction with a stronger association in the low transmission HZ. Insecticide-treated net (ITN) use was associated with a lower risk of malaria infection in children 6-59 months in the high transmission HZs. Similar estimates were found in children over 5 years and the lower transmission HZ but the associations there were not significant. There was no evidence of a difference in these associations by strata. The risk of anaemia decreased with increasing age in all strata, whereas it increased with malaria infection and reported fever. ITN use did not show evidence of protection against anaemia. Low socio-economic status was associated with malaria in high transmission setting in children 6-59 months and anaemia in low transmission setting.
  
  
  
  This study shows that in areas of low transmission in Kinshasa, the peak prevalence occurs in older age groups however ITN use was highest in children under 5 years. Targeted distribution of ITN to all age groups should be continued. For most risk factors, there was no evidence of an interaction with transmission intensity however the associations with age and with fever in the last 2 weeks did vary significantly.
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland. Giovanfrancesco.Ferrari@unibas.ch.|University of Basel, Basel, Switzerland. Giovanfrancesco.Ferrari@unibas.ch.
authors.forename: Giovanfrancesco
authors.identifier: 0000-0002-0722-7772
authors.initials: G
authors.lastname: Ferrari
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.|University of Basel, Basel, Switzerland.|Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
authors.forename: Henry M T
authors.initials: HM
authors.lastname: Ntuku
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Amanda
authors.initials: A
authors.lastname: Ross
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Sandro
authors.initials: S
authors.lastname: Schmidlin
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Didier M
authors.initials: DM
authors.lastname: Kalemwa
authors.affiliation: Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
authors.forename: Antoinette K
authors.initials: AK
authors.lastname: Tshefu
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Lengeler
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002947:Cities / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data; D008288:Malaria / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
keywords: Anaemia; Democratic Republic of Congo; Fever; ITN ownership; ITN use; Kinshasa; Malaria; Malaria risk