![]() ![]() Strategies aimed at improving disease awareness and access to healthcare interventions, such as LLINs, are needed to improve malaria control and prevention among these vulnerable groups. The study revealed that environmental factors and non-use of malaria preventive measures are the main determinants of malaria transmission among adolescents living in areas with persistent malaria transmission in Senegal. In a multivariate analysis, factors associated with clinical malaria included non-use of long-lasting insecticidal net (LLIN) (aOR = 2.65 95% CI 1.58–4.45), non-use of other preventive measures (aOR = 2.51 95% CI 1.53–4.11) and indoor sleeping (aOR = 3.22 95% CI 1.66–6.23). In total, 492 individuals were recruited (246 cases and 246 controls). Factors associated with clinical malaria were assessed using stepwise logistic regression analysis. A standardized, pre-tested questionnaire was administered to each study participant followed by a home visit to assess the participant's living conditions. Controls were from the same age group, living in the neighbourhood of the case, presenting a negative RDT. Cases were defined as adolescents (10–19 years) with an uncomplicated malaria episode with fever (temperature > 37.5°) or a history of fever and positive malaria rapid diagnostic test (RDT). MethodsĪ case–control study was conducted from November to December 2020 in four health posts located in the Saraya district. This study aimed to identify factors associated with clinical malaria among adolescents in Senegal. A better understanding of malaria transmission among this newly emerging vulnerable group will guide future interventions targeting this population group. Little is known about factors associated with clinical malaria among this group. However, malaria epidemiology remains heterogeneous with persistent transmission in the southeastern part of the country and many cases among older children and adolescents. ![]() Throughout, we emphasize distinctions from the more intuitive impacts of cohort matching.īias Case–control studies Confounding Matching Odds ratio.In Senegal, malaria morbidity has sharply decreased over these past years. On the positive side, odds ratio modification by matched variables can be assessed in matched case-control studies without further data, and when one knows either the distribution of the matching factors or their relation to the outcome in the source population, one can estimate and study patterns in absolute rates. These problems support advice to limit case-control matching to a few strong well-measured confounders, which would devolve to no matching if no such confounders are measured. We discuss several subtle problems associated with matched case-control studies that do not arise or are minor in matched cohort studies: (1) matching, even for non-confounders, can create selection bias (2) matching distorts dose-response relations between matching variables and the outcome (3) unbiased estimation requires accounting for the actual matching protocol as well as for any residual confounding effects (4) for efficiency, identically matched groups should be collapsed (5) matching may harm precision and power (6) matched analyses may suffer from sparse-data bias, even when using basic sparse-data methods. ![]() Misconceptions about the impact of case-control matching remain common. ![]()
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