***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Insecticide-treated bed nets ( ITN ) provide real hope for the reduction of the malaria burden across Africa . Underst and ing factors that determine access to ITN is crucial to debates surrounding the optimal delivery systems . The influence of homestead wealth on use of nets purchased from the retail sector is well documented , however , the competing influence of mother 's education and physical access to net providers is less well understood . Methods Between December 2004 and January 2005 , a r and om sample of 72 rural communities was selected across four Kenyan districts .  Demographic , assets , education and net use data were collected at homestead , mother and child ( aged < 5 years ) levels . An assets-based wealth index was developed using principal components analysis , travel time to net sources was modelled using geographic information systems , and factors influencing the use of retail sector nets explored using a multivariable logistic regression model . Results Homestead heads and guardians of 3,755 children < 5 years of age were interviewed . Approximately 15 % ( 562 ) of children slept under a net the night before the interview ; 58 % ( 327 ) of the nets used were purchased from the retail sector . Homestead wealth ( adjusted OR = 10.17 , 95 % CI = 5.45–18.98 ) , travel time to nearest market centres ( adjusted OR = 0.51 , 95 % CI = 0.37–0.72 ) and mother 's education ( adjusted OR = 2.92 , 95 % CI = 1.93–4.41 ) were significantly associated with use of retail sector nets by children aged less than 5 years . Conclusion Approaches to promoting access to nets through the retail sector disadvantage poor and remote communities where mothers are less well educated Background Malaria is a leading cause of disease burden in Ug and a , although surprisingly few contemporary , age-stratified data exist on malaria epidemiology in the country . This report presents results from a total population survey of malaria infection and intervention coverage in a rural area of eastern Ug and a , with a specific focus on how risk factors differ between demographic groups in this population . Methods In 2008 , a cross-sectional survey was conducted in four contiguous villages in Mul and a , sub-county in Tororo district , eastern Ug and a , to investigate the epidemiology and risk factors of Plasmodium species infection . All permanent residents were invited to participate , with blood smears collected from 1,844 individuals aged between six months and 88 years ( representing 78 % of the population ) . Demographic , household and socio-economic characteristics were combined with environmental data using a Geographical Information System . Hierarchical models were used to explore patterns of malaria infection and identify individual , household and environmental risk factors . Results Overall , 709 individuals were infected with Plasmodium , with prevalence highest among 5 - 9 year olds ( 63.5 % ) . Thin films from a r and om sample of 20 % of parasite positive participants showed that 94.0 % of infections were Plasmodium falciparum and 6.0 % were P. malariae ; no other species or mixed infections were seen . In total , 68 % of households owned at least one mosquito although only 27 % of school-aged children reported sleeping under a net the previous night . In multivariate analysis , infection risk was highest amongst children aged 5 - 9 years and remained high in older children . Risk of infection was lower for those that reported sleeping under a bed net the previous night and living more than 750 m from a rice-growing area . After accounting for clustering within compounds , there was no evidence for an association between infection prevalence and socio-economic status , and no evidence for spatial clustering . Conclusion These findings demonstrate that mosquito net usage remains inadequate and is strongly associated with risk of malaria  among school-aged children .  Infection risk amongst adults is influenced by proximity to potential mosquito breeding grounds . Taken together , these findings emphasize the importance of increasing net coverage , especially among school-aged children OBJECTIVE To identify risk factors for  uncomplicated malaria in highl and areas of East Africa at higher risk of malaria epidemics , in order to design appropriate interventions . METHODS Prospect i ve , population -based , case-control study in the N and i Hills , a highl and area of western Kenya , to identify environmental , sociodemographic and behavioural factors associated with clinical malaria . Data were collected using field observation , a structured question naire , and a global positioning system device . RESULTS We interviewed 488 cases of slide-confirmed malaria and 980 age-matched controls . Multivariate analyses associated higher malaria risk with living < 250 m of a forest [ OR = 3.3 ( 95 % CI 1.5 , 7.1 ) ] , < 250 m of a swamp [ 2.8 ( 1.3 , 5.9 ) ] , < 200 m of maize fields [ 2.0 ( 1.2 , 3.4 ) ] , in the absence of trees < 200 m [ 1.6 ( 1.2 , 2.2 ) ] , on flat l and [ 1.6 ( 1.2 , 2.2 ) ] , in houses without ceilings [ 1.5 ( 1.1 , 2.2 ) ] , in houses with a separate kitchen building [ 1.8 ( 1.4 , 2.3 ) ] and in households where the female household head had no education [ 1.9 ( 1.1 , 3.1 ) ] . Travelling out of the study site [ 2.2 ( 1.2 , 4.1 ) ] was also associated with increased risk . CONCLUSIONS ; In this East African highl and area , risk of developing uncomplicated malaria was multifactorial with a risk factor profile similar to that in endemic regions . Households within close proximity to forest and swamp borders are at higher risk of malaria and should be included in indoor residual spraying campaigns Background Increased control has produced remarkable reductions of malaria in some parts of sub-Saharan Africa , including Rw and a. In the southern highl and s , near the district capital of Butare ( altitude , 1,768 m ) , a combined community- and facility-based survey on Plasmodium infection was conducted early in 2010 . Methods A total of 749 children below five years of age were examined including 545 r and omly selected from 24 villages , 103 attending the health centre in charge , and 101 at the referral district hospital . Clinical , parasitological , haematological , and socio-economic data were collected . Results Plasmodium falciparum infection ( mean multiplicity , 2.08 ) was identified by microscopy and PCR in 11.7 % and 16.7 % , respectively ; 5.5 % of the children had malaria . PCR-based P. falciparum prevalence ranged between 0 and 38.5 % in the villages , and was 21.4 % in the health centre , and 14.9 % in the hospital . Independent predictors of infection included increasing age , low mid-upper arm circumference , absence of several household assets , reported recent intake of artemether-lumefantrine , and chloroquine in plasma , measured by ELISA . Self-reported bed net use ( 58 % ) reduced infection only in univariate analysis . In the communities , most infections were seemingly asymptomatic but anaemia was observed in 82 % and 28 % of children with and without parasitaemia , respectively , the effect increasing with parasite density , and significant also for su bmi croscopic infections . Conclusions Plasmodium falciparum infection in the highl and s surrounding Butare , Rw and a , is seen in one out of six children under five years of age . The abundance of seemingly asymptomatic infections in the community forms a reservoir for transmission in this epidemic-prone area . Risk factors suggestive of low socio-economic status and insufficient effectiveness of self-reported bed net use refer to areas of improvable intervention OBJECTIVES To ascertain whether malaria parasitaemia in children is associated with HIV status . To examine the effect of vitamin A supplementation on malaria parasitaemia in children . METHODS We studied the cross-sectional associations between HIV status and malaria parasitaemia among 546 children 6 - 60 months of age who participated in a double-blind , r and omized clinical trial of vitamin A supplementation .  Prevalence ratios and 95 % confidence intervals ( CI ) were estimated for the presence of malaria parasites at baseline by HIV status in uni- and multivariate models that adjusted for sociodemographic and environmental variables . Among children with malaria , correlates of high parasite loads were identified . Next , we examined the effect of vitamin A supplementation on the risk of malaria parasitaemia and high parasite density at 4 - 8 months of the first dose in a subset of children . RESULTS The prevalence of malaria parasitaemia was 11.4 % among HIV-infected children , compared with 27.6 % among uninfected . After adjusting for season , anaemia , use of bednets , maternal education and indicators of socioeconomic status , we found some evidence for lower prevalence of parasitaemia among HIV positive compared with HIV-negative children ( prevalence ratio=0.56 ; 95 % CI=0.29 , 1.09 ; P=0.09 ) . Other important correlates of malaria parasitaemia at baseline included low level of maternal education , poor quality of water supply , and the presence of animals at home .  Vitamin A supplementation did not have a significant effect on malaria parasitaemia at 4 - 8 months of follow-up , overall or within levels of potential effect modifiers . CONCLUSION HIV infection appears to be negatively correlated with malaria parasitaemia in this group of children . Investing in women 's education is likely to decrease the prevalence of malaria parasitaemia in children . Vitamin A supplementation does not seem to have an effect on malaria parasitaemia in this population ; possible benefits against clinical episodes and severe malaria deserve further examination Background Several studies conducted in Northeast Tanzania have documented declines in malaria transmission even before interventions were scaled up . One explanation for these reductions may be the changes in socio-environmental conditions associated with economic development , and in particular improvements in housing construction . Objective This analysis seeks to identify ( 1 ) risk factors for malaria incidence among young children and ( 2 ) household and environmental factors associated with mosquito vector numbers collected in the child ’s sleeping area . Both analyses focus on housing construction quality as a key determinant . Methodology For 435 children enrolled in a larger trial of intermittent preventive treatment for malaria in infants in the Korogwe District in Tanga , Northeastern Tanzania , detailed information on their dwelling characteristics were collected in the last year of the trial . Principal components analysis was used to construct an index of housing structure quality and converted to quintile units for regression analysis . Univariate and multivariate r and om effects negative binomial regressions were used to predict risk factors for child malaria incidence and the mean total number of indoor female Anopheles gambiae and funestus mosquitoes collected per household across three occasions . Findings Building material s have substantially improved in Korogwe over time . Multivariate regressions showed that residing in rural areas ( versus urban ) increased malaria incidence rates by over three-fold and mean indoor female A. gambiae and funestus numbers by nearly two-fold . Compared to those residing in the lowest quality houses , children residing in the highest quality houses had one-third lower malaria incidence rates , even when wealth and rural residence were controlled for . Living in the highest quality houses reduced vector numbers while having cattle near the house significantly increased them . Conclusions Results corroborate findings from other studies that show associations between malaria incidence and housing quality ; associations were concentrated amongst the highest quality houses Background Underst and ing the role of local environmental risk factors for malaria in holo-endemic , poverty-stricken setting s will be critical to more effectively implement- interventions aim ed at eventual elimination . Household-level environmental drivers of malaria risk during the dry season were investigated in rural southern Malawi among children < five years old in two neighbouring rural Traditional Authority ( TA ) regions dominated by small-scale agriculture . Methods Ten villages were r and omly selected from TA Sitola ( n = 6 ) and Nsamala ( n = 4 ) . Within each village , during June to August 2011 , a census was conducted of all households with children under-five and recorded their locations with a geographic position system ( GPS ) device . At each participating house , a nurse administered a malaria rapid diagnostic test ( RDT ) to  children under five years of age , and a question naire to parents . Environmental data were collected for each house , including l and cover within 50-m radius . Variables found to be significantly associated with P. falciparum infection status in bivariate analysis were included in generalized linear models , including multivariate logistic regression ( MLR ) and multi-level multivariate logistic regression ( MLLR ) . Spatial clustering of RDT status , environmental factors , and Pearson residuals from MLR and MLLR were analysed using the Getis-Ord Gi * statistic . Results Of 390 children enrolled from six villages in Sitola ( n = 162 ) and four villages in Nsamala ( n = 228 ) , 45.6 % tested positive ( n = 178 ) for Plasmodium infection by RDT . The MLLR modelled the statistical relationship of Plasmodium positives and household proximity to agriculture ( < 25-m radius ) , controlling for the child sex and age ( in months ) , bed net ownership , elevation , and r and om effects intercepts for village and TA-level unmeasured factors . After controlling for area affects in MLLR , proximity to active agriculture remained a significant predictor of positive RDT result ( OR 2.80 , 95 % CI 1.41 
    Output:
    
Lack of education , low income , low wealth , living in poorly constructed houses , and having an occupation in farming may increase risk of Plasmodium infection among people in SSA .
Public policy measures that can reduce inequity in health coverage , as well as improve economic and educational opportunities for the poor , will help in reducing the burden of malaria in SSA