Is maternal education a social vaccine for childhood malaria infection? A cross-sectional study from war-torn Democratic Republic of Congo

<p>In zones of violent conflict in the tropics, social disruption leads to elevated child mortality, of which malaria is the leading cause. Understanding the social determinants of malaria transmission may be helpful to optimize malaria control efforts. We conducted a cross-sectional study of healthy children aged 2 months to 5 years attending well-child and/or immunization visits in the Democratic Republic of Congo (DRC). Six hundred and forty-seven children were tested for malaria antigenemia by rapid diagnostic test and the accompanying parent or legal guardian simultaneously completed a survey questionnaire related to demographics, socioeconomic status, maternal education, as well as bednet use and recent febrile illness. We examined the associations between variables using multivariable logistic regression analysis, chi-squared statistic, Fisher’s exact test, and Spearman’s rank correlation, as appropriate. One hundred and twenty-three out of the 647 (19%) children in the study tested positive for malaria. Higher levels of maternal education were associated with a lower risk of malaria in their children. The prevalence of malaria in children of mothers with no education, primary school, and beyond primary was 41/138 (30%), 41/241 (17%), and 39/262 (15%), respectively (<i>p =</i> 0.001). In a multivariable logistic regression model adjusting for the effect of a child’s age and study site, the following remained significant predictors of malaria antigenemia: maternal education, number of children under five per household, and HIV serostatus. Higher maternal education, through several putative causal pathways, was associated with lower malaria prevalence among children in the DRC. Our findings suggest that maternal education might be an effective ‘social vaccine’ against malaria in the DRC and globally.</p

Characteristics of sexual assault according to patient age.

<p><b>A</b>.The largest number of cases in our retrospective sample from a single centre between 2006 and 2009 was in the age group 10–18 years. <b>B</b>. The proportion of cases allegedly perpetrated by military personnel was significantly higher in adult compared to pediatric rape victims (p<0.001). <b>C</b>. Delayed (>72hours) presentation was more common in youth aged 10–18 years than adults and younger children. <b>D</b>. Genital injury was more commonly observed on physical examination at presentation in youth aged 10–18 years than adults and younger children.</p

Features of pediatric sexual assault cases compared to adult cases seen in Goma, eastern DRC.

<p>*In eastern DRC, the presence of multiple armed groups without central leadership, deserters known as “inciviques <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0015911#pone.0015911-Alberti1" target="_blank">[11]</a>,” widely available military uniforms in the post-war period, and the possibility that civilians may wear military uniforms leaves open the possibility that patients' description of uniformed assailant may not always be military personnel.</p