title: Is maternal education a social vaccine for childhood malaria infection? A cross-sectional study from war-torn Democratic Republic of Congo.
abstract: In zones of violent conflict in the tropics, social disruption leads to elevated child mortality, of which malaria is the leading cause. Understanding the social determinants of malaria transmission may be helpful to optimize malaria control efforts. We conducted a cross-sectional study of healthy children aged 2 months to 5 years attending well-child and/or immunization visits in the Democratic Republic of Congo (DRC). Six hundred and forty-seven children were tested for malaria antigenemia by rapid diagnostic test and the accompanying parent or legal guardian simultaneously completed a survey questionnaire related to demographics, socioeconomic status, maternal education, as well as bednet use and recent febrile illness. We examined the associations between variables using multivariable logistic regression analysis, chi-squared statistic, Fisher's exact test, and Spearman's rank correlation, as appropriate. One hundred and twenty-three out of the 647 (19%) children in the study tested positive for malaria. Higher levels of maternal education were associated with a lower risk of malaria in their children. The prevalence of malaria in children of mothers with no education, primary school, and beyond primary was 41/138 (30%), 41/241 (17%), and 39/262 (15%), respectively (p = 0.001). In a multivariable logistic regression model adjusting for the effect of a child's age and study site, the following remained significant predictors of malaria antigenemia: maternal education, number of children under five per household, and HIV serostatus. Higher maternal education, through several putative causal pathways, was associated with lower malaria prevalence among children in the DRC. Our findings suggest that maternal education might be an effective 'social vaccine' against malaria in the DRC and globally.
authors.affiliation: a Department of Pediatrics , University of Alberta , Edmonton , Canada.
authors.forename: Cary
authors.initials: C
authors.lastname: Ma
authors.affiliation: b Department of Pediatrics , Université Catholique du Graben , Butembo , Democratic Republic of Congo.
authors.forename: Kasereka Masumbuko
authors.initials: KM
authors.lastname: Claude
authors.affiliation: b Department of Pediatrics , Université Catholique du Graben , Butembo , Democratic Republic of Congo.
authors.forename: Zacharie Tsongo
authors.initials: ZT
authors.lastname: Kibendelwa
authors.affiliation: a Department of Pediatrics , University of Alberta , Edmonton , Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Brooks
authors.affiliation: a Department of Pediatrics , University of Alberta , Edmonton , Canada.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Zheng
authors.affiliation: a Department of Pediatrics , University of Alberta , Edmonton , Canada.|c Department of Global Health, School of Public Health , Edmonton Clinic Health Academy , Edmonton , Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Hawkes
mesh_terms: D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D057147:Mosquito Nets / Q000706:statistics & numerical data; D015995:Prevalence; D012923:Social Class; D064890:Social Determinants of Health; D014857:Warfare
keywords: Democratic Republic of Congo; childhood malaria; maternal education; prevention; social determinants; social vaccine