London School of Hygiene & Tropical Medicine

The world’s poorest children are twice as likely to catch malaria as the least poor, according to a study published in the Lancet. The research, led by the London School of Hygiene & Tropical Medicine, makes the case for socioeconomic development to play a key role in efforts to control and eliminate malaria.

Researchers examined how effective various aspects of development, including improved living conditions and increased wealth, in malaria-endemic countries were at complementing existing prevention techniques such as bed nets and insecticide spray.

Lucy Tusting and colleagues indentified 4,969 English-language studies from the past 30 years on the link between the risk of malaria infection and the socioeconomic of children aged 15 and under. Analysis of the data showed that the poorest children have close to double the chance of contracting malaria than their better-off counterparts. A particularly well cited example suggests that a 0.3% GDP growth in sub-Saharan Africa is associated with a 10% reduction in malaria.

Professor Richard Smith, a health economist at the London School of Hygiene & Tropical Medicine, said: "The analysis represents a comparison of the very poorest children with the least poor children within highly impoverished communities. The difference in the odds of malaria in the poorest children is likely to have been even greater if the studies were expanded to include children from wealthier homes."

Lead author, Lucy Tusting, an epidemiologist at the School, said: "Malaria and poverty have been closely associated throughout history and it was mainly development that caused the disease to disappear from Europe and North America in previous centuries. As Africa develops, the story is likely to be similar. However it is vital to maintain high use of insecticide-treated bednets, indoor residual spraying and effective antimalarial drugs."

According to the World Health Organization, there were approximately 219 million cases of malaria in 2010 and an estimated 660,000 deaths. Around 2.57 billion people worldwide are at risk of malaria, which is endemic in 106 countries. Africa is the most affected continent: about 90 per cent of all malaria deaths occur there.

The researchers state that development programmes should be an essential component of malaria control. Increased wealth and improved standards of living directly stemming from socio-economic development could prove fundamental in ensuring that malaria transmission continues to decline in much of Asia, South America and Africa, as witnessed historically in Europe and North America.

Publication

• Lucy Tusting, Barbara Willey, Henry Lucas, John Thompson, Hmooda Kafy, Richard Smith, Steve Lindsay. Socioeconomic development as an intervention against malaria: a systematic review and meta-analysis. Lancet. doi:10.1016/S0140-6736(13)60851-X