Independent associations of maternal education and household wealth with malaria risk in children

Despite evidence that they play similar but independent roles, maternal education and household wealth are usually
conflated in studies of the effects of socioeconomic status (SES) on malaria risk. Demographic and Health Survey and Malaria Indicator
Survey data from nine countries in sub-Saharan Africa were used to explore the relationship of malaria parasitemia in children with
SES factors at individual and cluster scales, controlling for urban/rural residence and other important covariates. In multilevel logistic
regression modeling, completion of six years of maternal schooling was associated with significantly lower odds of infection in children
(OR = 0.73), as was a household wealth index at the 40th percentile compared to the lowest percentile (OR = 0.48). These relationships
were nonlinear, with significant quadratic terms for both education and wealth. Cluster-level wealth index was also associated with a
reduction in risk (OR = 0.984 for a one percentile increase in mean wealth index), as was urban residence (OR = 0.59). Among other
covariates, increasing child’s age and household size category were positively correlated with infection, and sleeping under an insecticidetreated
bednet the previous night (OR = 0.80) was associated with a moderate reduction in risk. Considerable variation in parameter
estimates was observed among country-specific models. Future work should clearly distinguish between maternal education and
household resources in assessing malaria risk, and malaria prevention and control efforts should be aware of the potential benefits of
supporting the development of human capital.