Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Debbie Humphries

Abstract

In June 2010 286 children from 16 participating schools were enrolled, with no more than one child from each household. Serum samples, fecal samples, and household surveys were used to assess the associations between the presence or density of malaria parasites and risk factors including nutritional status, hookworm infection, household risk prevention behaviors, and serum measures of parasite-specific immunoglobulin G (IgG).

Anthropometric and nutritional indicators were not associated with either outcome, nor was total malaria IgG. The primary risk factors for presence of infection included the house being sprayed in the past year (OR=0.04, p<0.001), child having a health care visit in the past year (OR=0.39, p<0.001), household malaria in the past year (OR=0.37, p=0.001), hookworm antibody density, with higher quartiles associated with elevated risk, greater household food insecurity, and geographic location.

Primary risk factors for elevated parasite density included the house being sprayed in the past year (OR=9.83, p<0.001), higher proportion of the household using a bednet the previous night, household and child history of malaria in the past year (OR=2.80, p=0.039; OR=0.15, p<0.001, respectively), hookworm antibody density, with the highest quartile associated with reduced parasite density, frequency of consumption of protein-rich food groups, with the middle tertile associated with elevated risk (OR=4.72, p=0.001), and geographic location. In addition, presence of hookworm infection increased both the risk of malaria infection and the risk of higher density of malaria parasites among those infected (OR=2.65, p=0.010; OR=2.81, p=0.001, respectively).

These risk factors highlight areas of programmatic interest, particularly the elevated risk of both any malaria infection and higher density of parasites among those infected with hookworm. Further research should focus on elucidating the mechanism of this interaction, and health prevention and treatment measures should focus on reducing the burden of hookworm infection, especially among malaria infected children.

Comments

This is an Open Access Thesis.

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