Environment affects childhood risk of fever and diarrhoea in Malawi

Diarrhoea and fever are leading causes of death and ill-health among infants and young children in sub-Saharan Africa. However, few studies have examined the patterns of these diseases and their risk factors in the most affected communities. Until recently, the only information on childhood ill-health came from clinics and hospital records.

A study funded bythe UK Department for International Development (DFID) and led by SouthamptonUniversity, UK, used new Geographic Information System (GIS) technology tostudy the spatial, or geographic, distribution of childhood diarrhoea and feverin Malawi. They then looked at the link between this distribution andenvironmental exposure to the diseases.

The researchersused individual data for 10,185 children with diarrhoea and 10,180 childrenwith fever from a household survey (The Malawi 2003 Demographic and Health Survey).The survey included information on the children's health and child and mothers'ages. They focused particularly on whether there were district level variationsin the prevalence of both diseases in Malawi. They then examined what possiblerisk factors might explain these variations.

The study showed adistinct district pattern of childhood ill-health for both fever and diarrhoea.Children living in Lilongwe, the capital city, are less likely to have feverthan those in rural areas. However, they are just as likely to suffer fromdiarrhoea, and in some urban districts are more likely to, than children inrural areas. Living in a remote area increases the risk of ill-health from bothdiseases. The researchers also found that:

• Children in the low-lying centraldistricts of the country are at higher risk from both diseases, mainly dueto climatic problems of drought, flooding and food insecurity.
• Children living in the south of thecountry are at higher risk from both diseases than those in the north, dueto higher population densities.
• Exclusively breastfed children are atlower risk of ill-health from diarrhoea than children who are fed acombination of mother’s milk and other liquids, but they are at the samerisk from fever.
• Children of better educated mothers areat lower risk from fever and diarrhoea.
• The rate of ill-health from bothdiseases worsens from birth up to eight months in the case of fever, andup to 12 months in the case of diarrhoea, before then declining.
• The older the mother, the lower thechild’s risk of both fever and diarrhoea.

The researchersconclude that there are significant inequalities in child health betweendistricts, causing a stark north-central divide across the country. Inparticular, they note that children in some urban districts of Malawi have ahigher risk of diarrhoea than those in rural areas, as a result of living incrowded slum conditions. They recommend:

• giving more attention to infant and childfeeding practices, particularly during the first six months after birth
• targeting messages promoting childhealth at younger parents
• focusing more on the role ofremoteness as well as climatic, environmental and geographic factors onchildhood ill-health
• researching the spatial distributionof waterborne diseases in exact locations in order to target thepopulations who are most at risk.