Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 Household Determinants of Malaria in Mutasa District of Zimbabwe David Takudzwa Zinyengere Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by David Takudzwa Zinyengere has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Shingairai Feresu, Committee Chairperson, Public Health Faculty Dr. Tolulope Osoba, Committee Member, Public Health Faculty Dr. Chester Jones, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2018 Abstract Household Determinants of Malaria in Mutasa District of Zimbabwe by David Takudzwa Zinyengere MSc, University of Derby, 1999 BTech, Pretoria Technikon, 2001 PGDip (HIV &AIDS Management), Stellenbosch University 2013 Dip Public Health –Royal Society of Health, 1979 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2018 Abstract Malaria is a vector borne, acute febrile illness, caused by Plasmodium parasites. Malaria impacts the medical and socioeconomic development programs of affected communities, as it diverts both individual and national resources into managing the disease burden. The purpose of this study was to explore and evaluate household determinants of malaria in Mutasa District, Zimbabwe. The precede–proceed theoretical model guided the study. Secondary data from Demographic Health Survey and District Health Management Information System, and current data from household determinant questionnaires, were used to evaluate the influence and significance of identified household determinants. Multiple logistic regression models were used to examine the association between malaria prevalence and the identified household determinant factors. The study result showed the existence of household determinant factors that affected the prevalence of malaria in Mutasa District. The presence of livestock animals within a 50-meter radius of the household, ownership of animal drawn carts and low socioeconomic status significantly increased malaria risk, while availability of drinking water within a 50- meter radius of the household, significantly reduced malaria risk. Other variables, although not statistically significant, had varied levels of malaria infection risk. The study results may contribute to positive social change by providing an insight into innovative strategies that enhance existing interventions. The study results may also provide opportunities for upgrading malaria intervention policies and sustainable community participation, thus enhancing malaria elimination efforts. Household Determinants of Malaria in Mutasa District of Zimbabwe by David Takudzwa Zinyengere MSc, University of Derby, 1999 BTech, Pretoria Technikon, 2001 PGDip (HIV &AIDS Management), Stellenbosch University 2013 Dip Public Health –Royal Society of Health, 1979 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2018 Dedication I dedicate this dissertation to my late parents, Eric and Sithembeni Zinyengere. You inspired me throughout my life and gave me hope in everything I did. May your Saul’s rest in eternal peace. Acknowledgments This has been an incredible and invaluable journey. Ever since my enrolment as a Walden Student back in September 2013 the study program has been a major part of my life. I spent countless hours sifting through literature and discussing with relevant colleagues in the Malaria fraternity with regards my study subject. Up until then I did not realize how passionate I felt about the elimination of malaria, not only in Zimbabwe but throughout the world. Apart from the subject matter, I learnt a lot more about myself and my relationships with family, friends and pears. My studies would not have been possible without the help, advice, support, and continuous prodding when necessary from a number of extraordinary people, and I am forever grateful to all of them. First, I would like to thank the Almighty God for making this endeavor possible for me. Next, I would like to extend my sincere gratitude to Professor Shingairai Feresu, my committee chairperson, for her invaluable guidance, advice, and for continuously challenging me to achieve more. I would also like to express my appreciation to all my associates and colleagues in my diverse work environment for their support and appropriate insights at relevant moments. I would also like to thank the Walden Academic advising team whenever I was experiencing technical challenges. I would also like to appreciate the support I received from colleagues in the Ministry of Health and Child Care. Lastly, but not the least, I would like to thank all my family members for their support, motivation, and having to endure some of my difficult moments and whom I deprived of the full attention and love whenever they so dearly needed it. To all I say I can never thank you enough. Table of Contents List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Background ....................................................................................................................3 Household Determinants of Malaria to be Considered ..................................................5 Problem Statement .........................................................................................................5 Purpose of Study ............................................................................................................8 Significance of Study .....................................................................................................9 Theoretical Framework ................................................................................................10 Research Questions ......................................................................................................12 Nature of Study ............................................................................................................14 Definitions....................................................................................................................15 Limitations of the Study...............................................................................................17 Assumptions .................................................................................................................18 Study Delimitations .....................................................................................................19 Summary and Transition ..............................................................................................19 Chapter 2: Literature Review .............................................................................................21 Introduction ..................................................................................................................21 Literature Search Strategy............................................................................................22 Malaria Morbidity and Mortality .................................................................................22 i Global Malaria Morbidity and Mortality .............................................................. 22 Zimbabwe-Malaria Morbidity and Mortality........................................................ 24 Malaria Pathophysiology .............................................................................................25 Implications of Malaria ................................................................................................27 Malaria Prevention and Elimination ............................................................................28 Challenges to Malaria Elimination ....................................................................... 29 Current Focus ........................................................................................................ 29 Determinants of Malaria ..............................................................................................31 Biological Determinants ....................................................................................... 32 Environmental Determinants ................................................................................ 33 Socioeconomic Determinants ............................................................................... 34 Sociodemographic Determinants .......................................................................... 35 Cultural Determinants