Use of proxy measures in estimating socioeconomic inequalities in malaria prevalence

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Abstract
Summary: Objectives  To present and compare socioeconomic status (SES) rankings of households using consumption and an asset‐based index as two alternative measures of SES; and to compare and evaluate the performance of these two measures in multivariate analyses of the socioeconomic gradient in malaria prevalence.Methods  Data for the study come from a survey of 557 households in 25 study villages in Tanzania in 2004. Household SES was determined using consumption and an asset‐based index calculated using Principal Components Analysis on a set of household variables. In multivariate analyses of malaria prevalence, we also used two other measures of disease prevalence: parasitaemia and self‐report of malaria or fever in the 2 weeks before interview.Results  Household rankings based on the two measures of SES differ substantially. In multivariate analyses, there was a statistically significant negative association between both measures of SES and parasitaemia but not between either measure of SES and self‐reported malaria. Age of individual, use of a mosquito net, and wall construction were negatively and significantly associated with parasitaemia, whilst roof construction was positively associated with parasitaemia. Only age remained significant when malaria self‐report was used as the measure of disease prevalence.Conclusions  An asset index is an effective alternative to consumption in measuring the socioeconomic gradient in malaria parasitaemia, but self‐report may be an unreliable measure of malaria prevalence for this purpose.

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