Socioeconomic development as an intervention against malaria: a systematic review and meta-analysis

14 Sep 2013
Tusting L, Willey B, Lucas H, Thompson J, Kafy HT, Smith R, et al.

Future progress in tackling malaria mortality will probably be hampered by the development of resistance to drugs and insecticides and by the contraction of aid budgets. Historically, control was often achieved without malaria-specific interventions. The authors aimed to assess whether socioeconomic development can contribute to malaria control.

The authors did a systematic review and meta-analysis to assess whether the risk of malaria in children aged 0–15 years is associated with socioeconomic status. Medline, Web of Science, Embase, the Cochrane Database of Systematic Reviews, the Campbell Library, the Centre for Reviews and Dissemination, Health Systems Evidence, and the Evidence for Policy and Practice Information and Co-ordinating Centre evidence library were searched for studies published in English between Jan 1, 1980, and July 12, 2011, that measured socioeconomic status and parasitologically confirmed malaria or clinical malaria in children. Unadjusted and adjusted effect estimates were combined in fixed-effects and random-effects meta-analyses, with a subgroup analysis for different measures of socioeconomic status. Funnel plots and Egger's linear regression were used to test for publication bias.

Of 4696 studies reviewed, 20 met the criteria for inclusion in the qualitative analysis, and 15 of these reported the necessary data for inclusion in the meta-analysis. The odds of malaria infection were higher in the poorest children than in the least poor children (unadjusted odds ratio [OR] 1·66, 95% CI 1·35–2·05, p<0·001, I2=68%; adjusted OR 2·06, 1·42–2·97, p<0·001, I2=63%), an effect that was consistent across subgroups.

Although the authors would not recommend discontinuation of existing malaria control efforts, they believe that increased investment in interventions to support socioeconomic development is warranted, since such interventions could prove highly effective and sustainable against malaria in the long term.