Assessing the effect of water storage practices on the relationship between mosquito exposure and fever in urban informal settlements in Makassar, Indonesia and Suva, Fiji Open Access

Abstract

Globally, over 1 billion people live in urban informal settlements that lack proper water infrastructure. Residents of these settlements may be more likely to store water, including in ways that could promote mosquito proliferation and the spread of vector-borne diseases. This study aimed to evaluate the association between exposure to mosquitoes and fever, stratified by water storage practices, in urban informal settlements in two countries. Survey data were collected through Revitalizing Informal Settlements and their Environments (RISE), a randomized control trial working in 24 urban informal settlements in Suva, Fiji and Makassar, Indonesia. The main survey items of interest were self-reported fever in the last week, self-reported frequency of exposure to mosquitoes in the last six weeks, and whether respondents stored drinking water. Multi-variate logistic regression models were used to analyze associations between fever and exposure to mosquitoes in the total sample and in a sub-sample of households that stored water. Models were adjusted for settlement-level clustering and relevant covariates, including wall materials, garbage disposal practices, water source, water access, and household wealth. We observed a positive association between daily mosquito exposure and having a fever in both Makassar [(adjusted OR 1.45, 95% CI: 0.24-8.67)] and Suva [(AOR 1.88, 95% CI: 1.18-3.02)]. A sub-analysis restricted only to respondents that stored water produced similar results for both Makassar (AOR 1.46, 95% CI: 0.27-7.78) models] and Suva (AOR 1.53, 95% CI: 0.99-2.34)]. Our study demonstrated that a higher self-reported frequency of mosquito encounters was associated with a higher odds of self-reported fever, including when stratified by water storage. Furthermore, our study provides impetus for including socio-environmental factors that increase people’s vulnerability to mosquito exposure in studies of mosquito-borne infectious disease. With the rapid growth of urbanization and climate change, this relationship merits further attention. 

Table of Contents

Contents

Introduction. 1

Methods. 6

Setting. 6

Data Collection and Data Management 7

Variables. 8

Study Design and Statistical Method. 11

Informed consent and institutional review.. 12

Results. 13

Surveys Completed. 13

Frequencies of Main Variables. 13

Participant Characteristics. 15

Built Environment 15

Associations between self-reported mosquito exposure and self-reported fever 18

Indonesia. 21

Fiji 24

Indonesia and Fiji Combined. 26

Discussion. 29

References. 38

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health Health Sciences, Public Health
Keyword	Water Storage Fever Urban Informal Settlements Infectious Diseases Mosquitoes
Committee Chair / Thesis Advisor	Dr. Sheela Sinharoy, Emory University Dr. Thomas Clasen, Emory University

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