While malaria remains a major global public health problem, total annual incidence fell by 30%
during 2000–2013, largely due to the scale–up of long–lasting insecticide–treated nets and
indoor residual spraying. In the future, sustainable methods of control and elimination are
needed to maintain this progress. Since malaria is associated with poverty, malaria control and
economic development can be mutually supportive. This thesis tests specific hypotheses
relating to the causal pathways between poverty and malaria, to identify potential routes to
controlling malaria alongside development.
Two systematic reviews found that in sub-Saharan Africa: (1) parasite prevalence and clinical
malaria incidence are on average halved in the wealthiest children, compared to the poorest
within a community and (2) parasite prevalence and clinical malaria incidence are on average
halved in residents of modern housing, compared to traditional housing. In-depth interviews
and cross-sectional surveys collected socioeconomic information for all children aged six
months to 10 years living in 100 households, who were followed for 36 months in Nagongera,
an agrarian and highly endemic setting in rural Uganda. Analyses of the relationships between
socioeconomic position (SEP), potential determinants of SEP and malaria found that: (3)
relative success in smallholder agriculture was associated with higher SEP, (4) human biting
rate (HBR) and parasite prevalence were approximately halved in children of highest SEP,
compared to the poorest, (5) wealth indices, income and education were more sensitive
indicators of socioeconomic inequalities in malaria risk than occupation, (6) HBR and parasite
prevalence were halved in modern housing, compared to traditional housing and (7) house
quality may partly explain the association between SEP and malaria.
Together, these studies indicate that housing improvements and agricultural development
interventions to reduce poverty merit further investigation as ‘intersectoral’ interventions
against malaria.