Socioeconomic determinants for malaria transmission risk in Colombia: An ecological study

Introduction. The risk of becoming ill and dying from malaria is associated with social inequalities that are expressed through differential access to opportunities for protection and health care in different socioeconomic settings. Thus, it is important to study the role of socioeconomic determinants in the persistence of malaria transmission in Colombia. This study aimed to assess the effect of various socioeconomic factors on the cumulative incidence of malaria in areas of Colombia with active foci. Methods: This is an ecological study of municipalities with active malaria transmission between 2010 and 2019. Socioeconomic variables documented in the last National Population Census carried out in 2018 were used. Simple analyses of the variables of interest were performed, and a multivariate linear regression model was adjusted to assess the impact of independent socioeconomic factors with raw malaria incidence rate. Results: In the period studied, of the 1,122 municipalities in the country, 583 (51.9%) reported a total of 607,042 malaria cases. Of these municipalities, 107 presented active foci, and 96.7% (586,756 cases) of the total cases were registered in the country. The potential risk factors that are negatively associated with the average municipal raw malaria rate were the fiscal performance index (-0.034) and the absence of walls made from adequate material in houses (-0.042). In addition, illiteracy (0.065) and the absence of formal employment for the head of the household (0.065) had a direct positive relationship with the raw rate of malaria. Discussion: The present study has identified potential socioeconomic and housing factors associated with malaria in Colombia, many of which are closely related to poverty. Improving literacy, housing and employment conditions may help Colombia's malaria elimination effort.