World's poorest children twice as likely to contract malaria as least poor

The findings of the systematic review and meta-analysis, published Online First in The Lancet, suggest that investment in socioeconomic development (eg, better housing and improved education and nutrition) should be a vital part of efforts to control and eliminate malaria.

"The honeymoon period for malaria control is threatened by drug and insecticide resistance and donor fatigue. Since malaria control in Europe and North America was mainly achieved through advances in development (improved living conditions and increased wealth) and without malaria-specific interventions such as insecticidal nets and indoor spraying, socioeconomic development could provide a highly effective and sustainable means of control in malaria-endemic countries when combined with existing efforts", explains Steve Lindsay from Durham University in the UK, who led the research.

Lindsay and colleagues identified 4969 English-language studies published in the past 30 years that looked at the relationship between the risk of malaria infection and socioeconomic status in children aged 0 years.

Analysis of data from 15 studies involving 19 620 children showed that the very poorest children have roughly double the chance of contracting malaria than their better-off counterparts. Importantly, this effect was consistent across different measures of socioeconomic status.

According to Lindsay, "The difference in the odds of malaria in the poorest children would probably be even greater if the studies were expanded to include children from wealthier backgrounds."

2.57 billion people worldwide are at risk of malaria, which is endemic in 106 countries. Between 655 000 and 1.24 million people die every year from Plasmodium falciparum infection.

The authors conclude, "That malaria control remains largely the preoccupation of the health sector alone is a failing of both those who work in health and those who work in international development. The disease severely compromises socioeconomic development, and its control and elimination would improve economic prosperity worldwide."

Commenting on the study, Jürg Utzinger and Marcel Tanner from the Swiss Tropical and Public Health Institute and the University of Basel in Switzerland say, "We agree…that investments that support socioeconomic development in malarious settings will prove an effective and sustainable intervention against not only malaria, but also a host of other poverty-related diseases, including the neglected tropical diseases.14 Such action requires innovative multi-disease, multi-intervention, cross-sectoral collaboration, coupled with further longitudinal intervention studies."