Wumba, Di-Mosi Roger, Ngatu, Nlandu Roger, Nangana, Luzitu Severin, Sakiko Kanbara, Muchanga, Sifa Marie-Joelle, Mandina, Madone, Kei Tanaka, Wembonyama, Stanislas, and Sayumi Nojima
Background and objective. Malaria is a mosquito-borne infectious disease with high morbidity and mortality in tropical regions, caused by Plasmodium parasite and transmitted to humans by female Anopheles mosquitoes. WHO estimates that African households lose about 25% of income to malaria. The aim of this pilot study was to determine the prevalence and socioeconomic impact of malaria on households in the Democratic Republic of Congo (DRC). Methods. An analytical cross-sectional study was conducted from 16 November through December 2015 in which 152 heads of households took part. They were from a rural (n1=81) and an urban county (n2=71). All participating households made up 1,029 members. The French version of 'Malaria Indicator Survey' questionnaire was completed anonymously. Results. There were 51.3% of male and 48.7% of female heads of households (p>0.05). The mean age was 38.97±9.88 and 22% of them were unemployed. Household size varied from 3 to 18 and more than half (61.7%) of rural households had more than five members (vs. 38.3% for urban households). The estimated household monthly income varied from 10 to 700 $US and only 10.5% of households earned more than 300 US$ a month (vs. 89.5% earning less than 300US$ and 50.6% less than 100 US$; p<0.05). Participants from the urban site had higher level of education, with 37.2% having a college or university degree (vs. 21.6% for rural site); 12.5% either had primary education level or were illiterate. Regarding anti-vector measures for malaria prevention, 15.8% of heads of households reported the existence of a public sanitation activity implemented in their residential area (p<0.001); 65.8% used insecticidetreated bed nets (ITN), 13.8% used spray, 0.6% combined ITN and spray, 12.5 used ordinary bed nets, whereas 7.2% did not use any preventive measure. For monthly anti-mosquito expenditure, 50% (76/152) of participants reported that they spent nothing due to lack of money, 24.3% spent 10-20 $US, 15.7% spent 21-30 $US; the remaining participants (9.9%) spent more than 30 $US a month. The availability of nets showed a positive association with socioeconomic status of households. Overall malaria prevalence-rate among heads of households was 92.4% (at least one episode), with an average of 2.5 malaria episodes per person (range: 1-7 episodes). It was equally high in participants from both rural and urban sites, 90.1% and 88.7%, respectively (p>0.05). In the group of participants who reported using ITN, malaria prevalence-rate was 89%; it was 90.5% in spray users, 100% in ordinary bed net users and 100% in those who did not use any measure. Heads of households who reported earning less than 300 US$ had 2.76 times malaria risk than those from households with a monthly income of 300 US$ or higher (aOR:2.76±1.87; 95% CI: 1.73-10.41; p<0.05); those who had primary education level (or illiterate) had a 33.87 times risk of developing malaria (vs. higher level; aOR: 33.87±34.42; 95% CI: 2.45-89.49; p<0.05); whereas those living in areas without public sanitation program had a 3.01 times malaria risk (aOR: 3.01±2.19; 95% CI: 1.37-24.23; p<0.05). Regarding individual malaria care expenditure in the previous 12-month period, the estimated cost was 101.56 ± 10.63 $US per person. Conclusions. Findings from this pilot study showed high malaria rates in both rural and urban households with a relatively high malaria care expenditure, causing a real socioeconomic burden to Congolese households. There is a necessity to enhance malaria prevention programs with the adoption of an integrated anti-malaria approach aiming at increasing malaria awareness and eliminating its vector in the living environment. [ABSTRACT FROM AUTHOR]