Table 5.
Multivariable logistic regression analyses to identify factors associated with self-reported symptomatic malaria among children in Zambézia Province, Mozambique with adjusted odds ratios (OR) and 95% confidence intervals (CI) reported
| Main analysisa
OR (95% CI) |
Sensitivity analysis Ab
OR (95% CI) |
Sensitivity analysis Bc
OR (95% CI) |
Sensitivity analysis Cd
OR (95% CI) |
Sensitivity analysis De
OR (95% CI) |
|
|---|---|---|---|---|---|
| District | |||||
| Alto Molócuè (reference) | 1 | 1 | 1 | 1 | 1 |
| Morrumbala | 1.24 (0.76, 2.02) | 0.88 (0.61, 1.26) | 1.38 (0.69, 2.77) | 1.16 (0.69, 1.96) | 1.21 (0.73, 1.99) |
| Namacurra | 1.40 (0.88, 2.24) | 1.38 (0.98, 1.96) | 2.12 (0.95, 4.74) | 1.50 (0.91, 2.47) | 1.54 (0.95, 2.51) |
| Others | 0.86 (0.55, 1.34) | 0.93 (0.69, 1.24) | 1.14 (0.61, 2.13) | 0.87 (0.55, 1.38) | 0.89 (0.57, 1.40) |
| Age (per 6 months) | 1.04 (0.95, 1.14) | 0.94 (0.88, 1.00) | 1.82 (0.99, 3.36) | 1.00 (0.92, 1.09) | 1.01 (0.93, 1.11) |
| Male vs. female child | 0.96 (0.75, 1.24) | 1.00 (0.86, 1.18) | 0.95 (0.62, 1.46) | 0.99 (0.76, 1.28) | 0.98 (0.76, 1.28) |
| Weight (per 1 kg) | 0.87 (0.60, 1.26) | 0.94 (0.73, 1.21) | 0.79 (0.49, 1.28) | 0.88 (0.61, 1.28) | 0.87 (0.60, 1.25) |
| Respondent age (per 10 years) | 1.05 (0.87, 1.27) | 1.01 (0.88, 1.16) | 1.15 (0.85, 1.54) | 1.05 (0.87, 1.27) | 1.07 (0.89, 1.28) |
| Respondent education (5 vs. 0 years) | 1.88 (1.31, 2.70) | 1.30 (0.96, 1.74) | 1.02 (0.63, 1.64) | 1.94 (1.31, 2.85) | 1.96 (1.35, 2.85) |
| Respondent understands Portuguese | 1.15 (0.83, 1.61) | 1.06 (0.81, 1.38) | 1.02 (0.58, 1.79) | 1.15 (0.78, 1.68) | 1.10 (0.77, 1.59) |
| Rural vs. urban | 0.60 (0.36, 1.02) | 0.81 (0.48, 1.35) | 0.77 (0.34, 1.73) | 0.60 (0.34, 1.06) | 0.61 (0.35, 1.06) |
| Household size (per 1 member) | 1.03 (0.94, 1.12) | 1.07 (1.01, 1.15) | 1.06 (0.91, 1.24) | 1.04 (0.96, 1.14) | 1.05 (0.97, 1.15) |
| Children under 5 (per 1 less child) | 1.25 (1.01, 1.56) | 1.01 (0.87, 1.18) | 1.38 (0.94, 2.04) | 1.22 (0.98, 1.54) | 1.25 (0.99, 1.59) |
| Monthly income ≥1000 MZN | 1.56 (1.11, 2.22) | 1.18 (0.87, 1.59) | 1.45 (0.74, 2.78) | 1.59 (1.11, 2.27) | 1.59 (1.12, 2.22) |
| Roofing material | |||||
| Thatch (reference) | 1 | 1 | 1 | 1 | 1 |
| Other | 1.00 (0.56, 1.79) | 1.25 (0.79, 1.99) | 0.75 (0.34, 1.67) | 1.11 (0.56, 2.20) | 1.09 (0.57, 2.09) |
| House has electricity | 0.68 (0.37, 1.23) | 0.60 (0.37, 0.97) | 0.58 (0.23, 1.47) | 0.57 (0.32, 1.04) | 0.58 (0.32, 1.07) |
| Household raises pigs | 1.16 (0.80, 1.68) | 1.10 (0.81, 1.50) | 1.10 (0.60, 2.01) | 1.17 (0.77, 1.79) | 1.17 (0.78, 1.77) |
| Distance of enumeration area to health facility (20 vs. 5 km) | 1.03 (0.87, 1.21) | 1.04 (0.89, 1.22) | 1.27 (0.95, 1.71) | 1.03 (0.85, 1.25) | 1.05 (0.87, 1.25) |
| Child slept under bed net the night prior to survey | 1.28 (0.86, 1.92) | 1.15 (0.85, 1.56) | 1.24 (0.68, 2.23) | 1.30 (0.86, 1.97) | 1.31 (0.87, 1.96) |
| Respondent slept under bed net the night prior to survey | 0.98 (0.64, 1.51) | 0.87 (0.66, 1.15) | 1.32 (0.70, 2.48) | 0.95 (0.62, 1.47) | 0.97 (0.64, 1.49) |
Missing values of covariates were accounted for using multiple imputation in the main and sensitivity analyses
Because there was evidence (p < 0.10) that the relationship with log-odds of symptomatic malaria is non-linear, respondent education was fit using restricted cubic splines in the in the main and sensitivity analyses
aMain analysis: compares those who had symptomatic malaria confirmed by a diagnostic test to the rest of the children in the cohort. There are 2501 children included in this model, 380 of which had symptomatic malaria. There are 18 symptomatic malaria cases for every degree of freedom. The main model was repeated excluding child weight, due to excessive missingness, and results were similar. Respondent education is associated with household income (median [interquartile range] education among those with household income <1000 MZN per month was 3 [0–5] years, and among those with household income ≥1000 MZN per month was 4 [1–6] years). When household income was removed from the model, the OR (95% CI) for 5 vs. 0 years of education was 1.93 (1.32, 2.83). When education was removed from the model, the OR (95% CI) for household income ≥1000 MZN per month was 1.61 (1.15, 2.27)
bSensitivity analysis A: compares those who reported fever in the past 30 days (cases) to those without report of fever. There are 2501 children included in this model, 1092 of which reported fever in the past 30 days
cSensitivity analysis B: compares those who had symptomatic malaria confirmed by a diagnostic test to other symptomatic children who accessed care and were tested for malaria but had a negative test result. There are 533 children included in this model, 380 of which had symptomatic malaria
dSensitivity analysis C: compares those who had symptomatic malaria confirmed by a diagnostic test to those who did not have fever and therefore did not access care or have a malaria diagnostic test. There are 1789 children included in this model, 380 of which had symptomatic malaria
eSensitivity analysis D: compares those who had symptomatic malaria confirmed by a diagnostic test to a group that included both those who were symptomatic but had a negative malaria diagnostic test and those who did not have fever and therefore did not seek care or malaria testing (i.e., the comparison group excluded those who were symptomatic but not tested for malaria). There are 1942 children included in this model, 380 of which had symptomatic malaria