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Nutritional and socio-economic factors associated with Plasmodium falciparum infection in children from Equatorial Guinea: results from a nationally representative survey

Estefanía Custodio1*, Miguel Ángel Descalzo2, Eduardo Villamor3, Laura Molina4, Ignacio Sánchez1, Magdalena Lwanga4, Cristina Bernis5, Agustín Benito1 and Jesús Roche1

Author Affiliations

1 Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Sinesio Delgado 6, Pab 13, Madrid 28029, Spain

2 Research Unit, Fundación Española de Reumatología, Calle Marques del Duero, 5, 1, Madrid 28001, Spain

3 Department of Environmental Health Sciences, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA

4 Centro de Referencia para el Control de Endemias, Laboratorio de Referencia de Paludismo, Hospital Regional de Malabo, Equatorial Guinea

5 Departamento de Biología, Universidad Autónoma de Madrid, Calle Darwin, 2 Campus Universitario de Cantoblanco, Madrid 28049, Spain

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Malaria Journal 2009, 8:225  doi:10.1186/1475-2875-8-225

Published: 8 October 2009



Malaria has traditionally been a major endemic disease in Equatorial Guinea. Although parasitaemia prevalence on the insular region has been substantially reduced by vector control in the past few years, the prevalence in the mainland remains over 50% in children younger than five years. The aim of this study is to investigate the risk factors for parasitaemia and treatment seeking behaviour for febrile illness at country level, in order to provide evidence that will reinforce the EG National Malaria Control Programme.


The study was a cross-sectional survey of children 0 to 5 years old, using a multistaged, stratified, cluster-selected sample at the national level. It included a socio-demographic, health and dietary questionnaires, anthropometric measurements, and thick and thin blood smears to determine the Plasmodium infection. A multivariate logistic regression model was used to determine risk factors for parasitaemia, taking into account the cluster design.


The overall prevalence of parasitemia was 50.9%; it was higher in rural (58.8%) compared to urban areas (44.0%, p = 0.06). Age was positively associated with parasitemia (p < 0.0001). In rural areas, risk factors included longer distance to health facilities (p = 0.01) and a low proportion of households with access to protected water in the community (p = 0.02). Having had an episode of cough in the 15 days prior to the survey was inversely related to parasitemia (p = 0.04). In urban areas, the risk factors were stunting (p = 0.005), not having taken colostrum (p = 0.01), and that someone in the household slept under a bed net (p = 0.002); maternal antimalarial medication intake during pregnancy (p = 0.003) and the household socio-economic status (p = 0.0002) were negatively associated with parasitemia. Only 55% of children with fever were taken outside their homes for care, and treatment seeking behaviour differed substantially between rural and urban populations.


Results suggest that a national programme to fight malaria in Equatorial Guinea should take into account the differences between rural and urban communities in relation to risk factors for parasitaemia and treatment seeking behaviour, integrate nutrition programmes, incorporate campaigns on the importance of early treatment, and target appropriately for bed nets to reach the under-fives.