Table 3:
Multivariate associations with endemic Burkitt lymphoma the EMBLEM Study, 2010–2016.
| Uganda | Tanzania | Kenya | All countries combined† | |
|---|---|---|---|---|
| Characteristics | aOR* (95% CI) | aOR* (95% CI) | aOR* (95% CI) | aOR* (95% CI) |
| Season‡ | ||||
| Dry | Ref | Ref | Ref | Ref |
| Wet | 2.54 (1.67, 3.86) | 1.51 (0.79, 2.86) | 0.28 (0.18, 0.45) | 1.28 (0.99, 1.66) |
| p-value | <0.0001 | 0.211 | <0.0001 | 0.058 |
| Measure of malaria | ||||
| Indoor residual insecticide sprayed in house | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 1.71 (1.07, 2.73) | 3.93 (2.03, 7.62) | 6.78 (3.51, 13.10) | 2.32 (1.75, 3.09) |
| p-value | 0.026 | <0.0001 | <0.0001 | <0.0001 |
| Mosquito net ownership and use the night before | ||||
| No | Ref | Ref | Ref | Ref |
| Yes, but not used | 39.7 (13.3, 118) | 4.09 (1.25, 13.35) | 5.74 (2.48, 13.3) | 9.23 (5.59, 15.24) |
| Yes, and used | 4.12 (2.64, 6.42) | 1.32 (0.60, 2.90) | 1.47 (0.86, 2.53) | 2.36 (1.76, 3.18) |
| p-value | <0.0001 | 0.058 | 0.0002 | <0.0001 |
| Regularly uses mosquito insecticide sprays | ||||
| No | Ref | Ref | Ref | |
| Yes | 5.62 (1.85, 17.01) | 3.47 (1.16, 10.37) | 2.97 (1.65, 5.32) | |
| p-value | 0.002 | 0.026 | 0.0003 | |
| Malaria rapid diagnostic test | ||||
| Negative | Ref | Ref | Ref | Ref |
| Positive | 0.43 (0.28, 0.68) | 0.56 (0.27, 1.16) | 0.33 (0.20, 0.55) | 0.46 (0.35, 0.60) |
| p-value | 0.0003 | 0.120 | <0.0001 | <0.0001 |
| History of fevers, and malaria treatment | ||||
| ≥1 fever due to malaria up to 6 months before enrollment | ||||
| No | Ref | Ref | Ref | |
| Yes | 0.48 (0.29, 0.77) | 0.59 (0.35, 0.98) | 0.63 (0.47, 0.84) | |
| p-value | 0.003 | 0.042 | 0.001 | |
| ≥1 fever not due to malaria up to 6 months before enrollment | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 8.82 (5.37, 14.49) | 3.88 (2.05, 7.36) | 6.98 (4.39, 11.09) | 5.66 (4.31, 7.42) |
| p-value | <0.0001 | <0.0001 | <0.0001 | <0.0001 |
| ≥1 hospital admission | ||||
| No | Ref | Ref | ||
| Yes | 21.29 (9.61, 47.17) | 9.35 (6.85, 12.77) | ||
| p-value | <0.0001 | <0.0001 | ||
| Inpatient malaria treatment | ||||
| Yes, past 12 months | Ref | Ref | Ref | Ref |
| Yes, > 12 months | 3.97 (1.66, 9.51) | 2.89 (0.80, 10.41) | 0.18 (0.07, 0.48) | 0.99 (0.62, 1.57) |
| Never | 3.41 (1.52, 7.67) | 26.43 (7.73, 90.36) | 0.48 (0.25, 0.91) | 5.59 (3.61, 8.66) |
| p-value | 0.007 | <0.0001 | 0.003 | <0.0001 |
| Outpatient malaria treatment | ||||
| Yes, past 12 months | Ref | Ref | Ref | Ref |
| Yes, > 12 months | 2.17 (1.17, 4.03) | 0.45 (0.14, 1.48) | 1.61 (0.70, 3.72) | 2.23 (1.50, 3.31) |
| Never | 0.59 (0.35, 0.99) | 0.54 (0.27, 1.07) | 1.48 (0.87, 2.53) | 0.96 (0.71, 1.29) |
| p-value | 0.0001 | 0.154 | 0.277 | <0.0001 |
| Parental characteristics | ||||
| Mother’s education | ||||
| Up to standard 4 | Ref | Ref | ||
| Standard 5–7 | 0.81 (0.52, 1.26) | 0.81 (0.60, 1.08) | ||
| ≥ Senior secondary school | 0.46 (0.19, 1.12) | 0.77 (0.50, 1.20) | ||
| p-value | 0.197 | 0.319 | ||
| p-trend | 0.082 | 0.227 | ||
| Father’s education | ||||
| Up to standard 4 | Ref | Ref | Ref | Ref |
| Standard 5–7 | 0.75 (0.44, 1.26) | 0.25 (0.11, 0.55) | 1.13 (0.54, 2.37) | 0.71 (0.51, 1.00) |
| ≥ Senior secondary school | 0.53 (0.28, 0.99) | 0.19 (0.05, 0.68) | 1.03 (0.49, 2.17) | 0.70 (0.47, 1.04) |
| p-value | 0.136 | 0.002 | 0.908 | 0.116 |
| p-trend | 0.033 | 0.002 | 0.943 | 0.068 |
| Mother’s occupation | ||||
| Trader/Sales | Ref | Ref | Ref | Ref |
| Peasant farmer | 0.64 (0.23, 1.75) | 0.47 (0.17, 1.34) | 2.80 (1.53, 5.11) | 1.31 (0.86, 1.97) |
| Manual laborer | 0.79 (0.19, 3.21) | 0.75 (0.18, 3.02) | 2.36 (1.07, 5.22) | 1.54 (0.89, 2.69) |
| p-value | 0.668 | 0.334 | 0.004 | 0.272 |
| Mother’s income, US dollars§ | ||||
| 7.5 | Ref | Ref | Ref | Ref |
| 7.6-≤15.0 | 0.97 (0.60, 1.58) | 0.68 (0.31, 1.46) | 0.78 (0.42, 1.43) | 0.88 (0.65, 1.20) |
| >15.0 | 0.27 (0.14, 0.52) | 0.20 (0.08, 0.47) | 0.70 (0.40, 1.24) | 0.46 (0.33, 0.64) |
| p-value | 0.0004 | 0.001 | 0.468 | <0.0001 |
| p-trend | 0.0003 | 0.001 | 0.249 | <0.0001 |
| Home characteristics | ||||
| Distance of home from main road | ||||
| Far from the main road | Ref | Ref | Ref | |
| Near the main road | 4.33 (2.00, 9.37) | 1.88 (1.15, 3.07) | 1.66 (1.23, 2.24) | |
| In town or city | 9.17 (2.84, 29.63) | 1.94 (0.97, 3.90) | 2.92 (1.83, 4.67) | |
| p-value | <0.0001 | 0.026 | <0.0001 | |
| Number of rooms in house | ||||
| 1–2 room | Ref | Ref | Ref | |
| ≥ 3 rooms | 1.33 (0.67, 2.65) | 1.46 (0.91, 2.33) | 1.19 (0.88, 1.62) | |
| p-value | 0.419 | 0.117 | 0.256 | |
| Number of children and adult resident | ||||
| 2–4 people | Ref | Ref | Ref | |
| 5–7 people | 1.51 (0.99, 2.31) | 1.12 (0.49, 2.58) | 1.23 (0.92, 1.66) | |
| ≥ 8 people | 1.47 (0.62, 3.49) | 1.35 (0.56, 3.29) | 1.21 (0.81, 1.80) | |
| p-value | 0.144 | 0.788 | 0.365 | |
| p-trend | 0.08 | 0.497 | 0.428 | |
| Number of people sleeping in the same room as child | ||||
| 0–2 people | Ref | Ref | ||
| 3 people | 1.27 (0.75, 2.16) | 1.42 (1.02, 1.97) | ||
| ≥ 4 people | 1.10 (0.63, 1.93) | 1.31 (0.94, 1.84) | ||
| p-value | 0.673 | 0.109 | ||
| p-trend | 0.649 | 0.177 | ||
| Source of drinking water | ||||
| Unprotected spring/well | Ref | Ref | ||
| Protected spring/well | 1.44 (0.82, 2.53) | 1.53 (1.11, 2.10) | ||
| Public tap/piped household | 0.97 (0.53, 1.76) | 1.08 (0.72, 1.63) | ||
| p-value | 0.395 | 0.032 | ||
| Distance to water source, meters | ||||
| < 500 | Ref | Ref | Ref | Ref |
| 500–999 | 5.58 (2.81, 11.08) | 0.32 (0.13, 0.78) | 0.57 (0.32, 1.02) | 1.30 (0.91, 1.86) |
| 1000–4999 | 3.48 (1.99, 6.10) | 0.10 (0.05, 0.24) | 0.38 (0.21, 0.70) | 0.84 (0.61, 1.14) |
| ≥ 5000 | 14.75 (7.34, 29.66) | 0.46 (0.17, 1.28) | 0.19 (0.07, 0.50) | 2.39 (1.60, 3.57) |
| p-value | <0.0001 | <0.0001 | 0.0004 | <0.0001 |
| p-trend | <0.0001 | <0.0001 | <0.0001 | 0.034 |
Abbreviation: aOR= adjusted odds ratio; CI = confidence interval
Note: p-values are for heterogeneity
*
In addition to the adjustment for age, sex, proximity to water and population density of children 0–15 years, the associations are mutually adjusted for all variables included in the multivariate model. In addition, the multivariate models were adjusted for keeping animals inside the house or nearby (chicken, pigs, goat, cows, birds, dogs).
†
This column shows the observed associations based on data from all the three study countries combined, adjusted for each country
‡
The months of April to June and September to December were classified as wet season months, while the months of January to March and July to August were classified as dry season months.
§
Income was categorized based on the international poverty line of $1.90 per a day to calculate the average 30-day monthly income. Total household income or father’s income were not analyzed because the results for these were considered unreliable.