There was a recent systematic review and meta-analysis of the relationship between the risk of malaria in kids <16 yo and socioeconomic status (see http://dx.doi.org/10.1016/S0140-6736(13)60851-X). 15 studies are included in the meta-analysis.
–Baseline data:
–2.57 million people were at risk for falciparum malaria in 2010, a huge global public health issue.
–Both national income and rates of economic growth are lower in malaria endemic countries than in countries where it is not endemic
–an intervention which decreases malaria 10% is associated with a 0.3% increased economic growth (ie bad cycle: poor areas have more malaria which decreases economic growth).
–Using a medical/pharmacologic approach to decrease malaria inevitably leads to resistant strains of mosquitoes and malaria parasites
–Malaria elimination in many high income countries was achieved without malaria-specific interventions; prevalence started to fall in North America and Europe as a byproduct of improved living conditions and increased wealth, such that anopheles mosquitoes that exist there do not carry malaria (or, as the brits say it in lancet: “anophelism without malaria”)
-Results of meta-analysis:
–Comparing children in the same locality: There was roughly a two-fold increased incidence of clinical malaria or parasitemia in the very poorest versus the least poor in the same impoverished communities.
–Of course, the least poor in the above comparison were probably better educated, had better housing quality (which could decrease the ability of the mosquitoes to enter the house) and improved nutrition status of the children
–The studies included different methodologies for ascertaining malaria risk factors, however the results were consistent across the studies and settings suggesting they were robust.
so, again brings to mind the old Virchow quote that “crowd diseases (ie, epidemics) point to deficiencies of society”. ie, the fix is not primarily medical but social.
geoff