Malaria is one of the major health problems in Africa. With increasing resistance towards the commonly used antimalarial drugs it is becoming even more important to identify risk-factors for developing malarial disease.
Methods: Children attending the Bandim Health Centre in Bissau, Guinea-Bissau with malarial symptoms and 20 or more parasites per 200 leukocytes were eligible if living in the study area. From the registration system of the Bandim Health Project an age-matched control was selected. A structured questionnaire was administered to collect data on socio-economic parameters, malaria risk-factors, and habits related to treatment of malaria.
Results: 145 age-matched cases and controls were included. There were no differences in sex (50% vs. 54% were males) or age (mean: 4.5 years vs. 4.6 years). Risk factors were analysed in univariate analyses, and if the p-values for unadjusted OR were less than 0.1 they were included in a multivariate analyses. Sleeping less than 3 people in the same bed as the child, having chloroquine in the house, and having been treated for malaria during the preceeding 12 months were protective factors.
Conclusion: The number of persons per bed is a sensitive paramether of crowding. The cases slept in beds with almost 50% more people than the controls. However, the most striking result of the study is the effect of home-treatment. Most mothers treated their children when having fever. The controls were 3 times as likely to have chloroquine in the house, and had more often been treated for malaria during the past 12 months. Children whose mothers identify symptoms as malaria and treat at home are less likely to need treatment at a health centre. If they are less likely to develop severe or complicated malaria as well can not be answered from this study.