Association Between Patients Behavior, Housing Conditions and Malaria Severity in the Fourteen Military Hospital, Margibi County, Liberia

Downloads
Introduction: Malaria has been a significant public health issue in Liberia, with behavioural and environmental factors influencing transmission and consequences. This study evaluated the association between patient behavior and housing condition with malaria status and severity in a military hospital in Margibi County, Liberia, in 2024. Methods: A cross-sectional study utilising 54 patients infected with P. Falciparum, where 53.7% were male, aged 20 to 49, and 46.3% were female, examining the association between patients' behaviour, housing condition and malaria severity in the Fourteenth Military Hospital in 2024. The association between variables was analysed using Chi-square and Fisher's exact tests. Results and Discussion: The association between patient behavior and housing conditions with malaria case status was statistically insignificant, as was the association between these factors and malaria severity. Small sample sizes and unmeasured confounders may not have provided sufficient statistical power to detect significant differences between groups, even though stronger associations between certain variables might exist but were undetected due to limited data. Further research with a more controlled design and larger sample sizes will be necessary to investigate the association between these variables further. Conclusion: There was no significant association between patient behavior and housing conditions with malaria case status or severity. A more systematic approach to data collection, incorporating factors related to malaria status and severity, could provide a clearer understanding of the contributors to P. falciparum infection status and disease, which can be correlated with patient behavior.
Bashir SG, Ahmed NI, Abdullahi YB, Abdi YH, Abdi MS, Musa MK. The Burden of Malaria in East Africa: Prevalence, Risk Factors, and Control Strategies. Malar J. 2025;24(1):1-11. https://doi.org/10.1186/s12936-025-05492-6
Megersa DM, Luo XS. Effects of Climate Change on Malaria Risk to Human Health: A Review. Atmosphere (Basel). 2025;16(1):1-19. https://doi.org/10.1186/s12936-025-05492-6
Anteneh M, Asres MS, Legese GL, Alemayehu MA, Woldesenbet D, Ayalew DG. Treatment Outcomes and Associated Factors in Severe Malaria Patients at University of Gondar Hospital, Northwest Ethiopia: A Retrospective Study (2020–2023). PLoS One. 2024;19(12):1–12. https://doi.org/10.1371/journal.pone.0309681
Mafwele BJ, Lee JW. Relationships Between the Transmission of Malaria in Africaand Climate Factors. Sci Rep. 2022;12(1):1–8. https://doi.org/10.1038/s41598-022-18782-9
WHO. World malaria report 2023. Geneva, World Health Organization, 2023. 2023. 283.
WHO. Malaria Self Medication. 2022.
Li J, Docile HJ, Fisher D, Pronyuk K, Zhao L. Current Status of Malaria Control and Elimination in Africa: Epidemiology, Diagnosis, Treatment, Progress and Challenges. J Epidemiol Glob Health. 2024;14(3):561–579. https://doi.org/10.1007/s44197-024-00228-2
Jassey B, Manjang B, Camara J, Jallow A. HO, Marong L, Jawneh S, et al. Overview of Malaria Prevention and Treatment Management in the Gambia: A Descriptive Study. JHeS (Journal Heal Sci). 2023;7(1):37-45. https://ejournal.unisayogya.ac.id/index.php/JHeS/article/view/2959
Opoku AS, Antwi KB, Mutala AH, Abbas DA, Addo KA, Tweneboah A, et al. Socio-Demographic Factors, Housing Characteristics, and Clinical Symptoms Associated with Falciparum Malaria in Two Rapidly Urbanizing Areas in the Ashanti Region of Ghana. Malar J . 2024;23(1):1-10. https://doi.org/10.1186/s12936-024-05185-6
Bello AB, Hassan AA. Risk Status of Malaria Based on Sociodemographic, Behavioural and Environmental Risk Factors in Two Communities in Lagos, Nigeria. Journal of Environmental and Occupational Health. 2022;12:1-17. https://doi.org/10.21203/rs.3.rs-488751/v1
Aremu TO, Singhal C, Ajibola OA, Agyin-Frimpong E, Appiah-Num SAA, Ihekoronye MR, et al. Assessing Public Awareness of the Malaria Vaccine in Sub-Saharan Africa. Trop Med Infect Dis. 2022;7(9):1-9. https://doi.org/10.3390/tropicalmed7090215
Liberia. Malaria Indicator Survey Malaria Indicator Survey. 2022.
Ngum NH, Fakeh NB, Lem AE, Mahamat O. Prevalence of Malaria and Associated Clinical Manifestations and Myeloperoxidase Amongst Populations Living in Different Altitudes of Mezam Division, North West Region, Cameroon. Malaria Journal. 2023;22(1):1-14. https://doi.org/10.1186/s12936-022-04438-6
Knudsen JB, Pinder M, Jatta E, Jawara M, Yousuf MA, Søndergaard AT, et al. Measuring Ventilation in Different Typologies of Rural Gambian Houses: A Pilot Experimental Study. Malar J. 2020;19(1):1–11. https://doi.org/10.1186/s12936-020-03327-0
Naswir N, Hamzah E, Syukur M, Saleh M. Survey of Malaria Vectors in the Rainy Season in Inalipue Village, Wajo District, South Sulawesi. J Public Heal Serv. 2024;3(2):113-121. https://doi.org/10.24252/sociality.v3i2.47678
Rubuga FK, Ahmed A, Siddig E, Sera F, Moirano G, Aimable M, et al. Potential Impact of Climatic Factors on Malaria in Rwanda Between 2012 and 2021: A Time-Series Analysis. Malaria Journal. 2024;23(1):1-12. https://doi.org/10.1186/s12936-024-05097-5
McCann RS, Kabaghe AN, Moraga P, Gowelo S, Mburu MM, Tizifa T, et al. The Effect of Community-Driven Larval Source Management and House Improvement on Malaria Transmission When Added to the Standard Malaria Control Strategies in Malawi: A Cluster-Randomized Controlled Trial. Malar J. 2021;20(1):1-16. https://doi.org/10.1186/s12936-021-03769-0
Bertozzi-Villa A, Bever CA, Koenker H, Weiss DJ, Vargas-Ruiz C, Nandi AK, et al. Maps and Metrics of Insecticide-Treated Net Access, Use, and Nets-Per-Capita in Africa from 2000-2020. Nat Commun. 2021;12(1):1–12. https://doi.org/10.1038/s41467-021-23707-7
Solanke BL, Soladoye DA, Birsirka IA, Abdurraheem A, Salau OR. Utilization of Insecticide-Treated Nets and Associated Factors Among Childbearing Women in Northern Nigeria. Malar J. 2023;22(1):1–11. https://doi.org/10.1186/s12936-023-04620-4
Nawa M, Mupeyo-Mudala C, Banda-Tembo S, Adetokunboh O. The Effects of Modern Housing on Malaria Transmission in Different Endemic Zones: A Systematic Review and Meta-Analysis. Malar J. 2024;23(1):1–13. https://doi.org/10.1186/s12936-024-05059-x
Lwenge M, Govule P, Katongole SP, Dako-Gyeke P. Malaria Treatment Health Seeking Behaviors Among International Students at the University of Ghana Legon. PLoS One. 2023;18(10):1–13. https://doi.org/10.1371/journal.pone.0276412
Odufuwa OG, Moore SJ, Mboma ZM, Mwanga R, Matwewe F, Hofer LM, et al. A Household Randomized-Control Trial of Insecticide-Treated Screening for Malaria Control in Unimproved Houses in Tanzania. Malar J . 2025;24(1):1-16. https://doi.org/10.1371/journal.pone.0276412
Kotepui M, Mahittikorn A, Wilairatana P, Masangkay FR, Wangdi K, Kotepui KU. Methemoglobin Levels in Malaria: A Systematic Review and Meta-Analysis of Its Association with Plasmodium Falciparum and Plasmodium Vivax Infections and Disease Severity. Sci Rep. 2024;14(1):1-12. https://doi.org/10.1038/s41598-024-53741-6.
Mahittikorn A, Masangkay FR, Kotepui KU, Milanez GDJ, Kotepui M. The High Risk of Malarial Recurrence in Patients with Plasmodium-Mixed Infection After Treatment with Antimalarial Drugs: A Systematic Review and Meta-Analysis. Parasites and Vectors. 2021;14(1):1-18. https://doi.org/10.1186/s13071-021-04792-5
Mahittikorn A, Ramirez MF, Kotepui KU, De G, Milanez J, Kotepui M. The High Risk of Malarial Recurrence in Patients with Plasmodium-Mixed Infection After Treatment with Antimalarial Drugs: A Systematic Review and Meta-Analysis. Parasites & Vectors. 2021;14(1):1-18. https://doi.org/10.1186/s13071-021-04792-5
Sanclemente-Cardoza V, Payán-Salcedo HA, Estela-Zape JL. Severe Malaria Due to Plasmodium falciparum in an Immunocompetent Young Adult: Rapid Progression to Multiorgan Failure. Life. 2025;15(1201):1-8. https://doi.org/10.3390/life15081201
Mezieobi KC, Alum EU, Ugwu OPC, Uti DE, Alum BN, Egba SI, et al. Economic Burden of Malaria on Developing Countries: A Mini Review. Parasite Epidemiol Control. 2025;30(6):1-14. https://doi.org/10.1016/j.parepi.2025.e00435
Kazanga B, Ba EH, Legendre E, Cissoko M, Fleury L, Bérard L, et al. Impact of Seasonal Malaria Chemoprevention Timing on Clinical Malaria Incidence Dynamics in the Kedougou Region, Senegal. PLOS Glob Public Heal. 2025;5(1):1–15. https://doi.org/10.1371/journal.pgph.0003197
White NJ. Severe Malaria. Malar J. 2022;21(1):1–17. https://doi.org/10.1186/s12936-022-04301-8
Mawili-Mboumba DP, Batchy OFB, M’Bondoukwé NP, Ndong NJM, Moutombi DBC, Agbanrin AA, et al. Hospital Attendance, Malaria Prevalence and Self-Medication with an Antimalarial Drug Before and After the Start of COVID-19 Pandemic in A Sentinel Site for Malaria Surveillance in Gabon. Malar J. 2025;24(1):1-10. https://doi.org/10.1186/s12936-025-05272-2
Zalwango MG, Migisha R, Agaba BB, Bulage L, Kwesiga B, Kadobera D, et al. Self-Medication for Malaria and Associated Factors in Kakumiro District, Uganda, August 2023: Implications for Malaria Management and Mortality Prevention. Malar J . 2025;24(1):1-9. https://doi.org/10.1186/s12936-025-05488-2
Mundagowa PT, Chimberengwa PT. Malaria Outbreak Investigation in a Rural Area South of Zimbabwe: A Case-Control Study. Malar J. 2020;19(1):1–10. https://doi.org/10.1186/s12936-020-03270-0
Xu JW, Deng DW, Wei C, Zhou XW, Li JX. Treatment-seeking Behaviours of Malaria Patients Versus Non-Malaria Febrile Patients Along China-Myanmar Border. Malar J. 2023;22(1):1–13. https://doi.org/10.1186/s12936-023-04747-4
Swastika IK, Hutagaol SDS. Science Midwifery Relationship of Knowledge and Patient Activity with Malaria Incidence. Sci Midwifery. 2023;11(3):2721–9453. www.midwifery.iocspublisher.org
Kua KP, Lee SWH. Randomized Trials of Housing Interventions to Prevent Malaria and Aedes-Transmitted Diseases: A Systematic Review and Meta-Analysis. PLoS One. 2021;16(1):1–23. https://doi.org/10.1371/journal.pone.0244284
Ngum NH, Fakeh NB, Lem AE, Mahamat O. Prevalence of Malaria and Associated Clinical Manifestations and Myeloperoxidase Amongst Populations Living in Different Altitudes of Mezam Division, North West Region, Cameroon. Malar J. 2023;22(1):1-14. https://doi.org/10.1186/s12936-022-04438-6
Smith JL, Mumbengegwi D, Haindongo E, Cueto C, Roberts KW, Gosling R, et al. Malaria Risk Factors in Northern Namibia: The Importance of Occupation, Age And Mobility in Characterizing High-Risk Populations. PLoS One. 2021;16(6):1–23. https://doi.org/10.1371/journal.pone.0252690
Farias MF, Figueiredo ERL, Silva RNS, Galhardo DR, Silva CL, Moreira EMF, et al. Malaria Mortality in Brazil: Age–Period–Cohort Effects, Sociodemographic Factors, and Sustainable Development Indicators. Trop Med Infect Dis. 2025;10(2):1-17. https://doi.org/10.3390/tropicalmed10020041
Su XZ, Xu F, Stadler R V., Teklemichael AA, Wu J. Malaria: Factors Affecting Disease Severity, Immune Evasion Mechanisms, and Reversal of Immune Inhibition to Enhance Vaccine Efficacy. PLoS Pathog. 2025;21(1):1–20. https://doi.org/10.1371/journal.ppat.1012853
Mouwenda YD, Jochems SP, Van UV, Ongwe MEB, Steenhuijsen PWAA, Stam KA, et al. Immune Responses Associated with Protection Induced by Chemoattenuated PFSPZ Vaccine in Malaria-Naive Europeans. JCI Insight. 2024;9(9):1–13. https://doi.org/10.1172/jci.insight.170210
Weiss DJ, Dzianach PA, Saddler A, Lubinda J, Browne A, McPhail M, et al. Mapping the Global Prevalence, Incidence, and Mortality of Plasmodium Falciparum and Plasmodium Vivax Malaria, 2000–22: A Spatial and Temporal Modelling Study. The Lancet. 2025;405(10483):979–990. https://doi.org/10.1016/S0140-6736(25)00038-8
Abebe W, Ashagre A, Misganaw T, Dejazmach Z, Kumie G, Nigatie M, et al. Prevalence of Antimalaria Drug Resistance-Conferring Mutations Associated with Sulphadoxine-Pyrimethamineine-Resistant Plasmodium Falciparum in East Africa: A Systematic Review and Meta-Analysis. Ann Clin Microbiol Antimicrob. 2025;24(1):1-27. https://doi.org/10.1186/s12941-025-00795-7
Snow RW, Sartorius B, Kyalo D, Maina J, Amratia P, Mundia CW, et al. The Prevalence of Plasmodium Falciparum in Sub-Saharan Africa Since 1900. Nature. 2017;550(7677):515–518. https://doi.org/10.1038/nature24059
Kotepui M, Kotepui KU, Milanez GDJ, Masangkay FR. Prevalence of and Risk Factors for Severe Malaria Caused by Plasmodium and Dengue Virus Co-Infection: A Systematic Review and Meta-Analysis. Infect Dis Poverty. 2020;9(134):1-14. https://doi.org/10.1186/s40249-020-00741-z
Pinder M, Bradley J, Jawara M, Affara M, Conteh L, Correa S, et al. Improved Housing Versus Usual Practice for Additional Protection Against Clinical Malaria in the Gambia (Roopfs): A Household-Randomised Controlled Trial. Lancet Planet Heal. 2021;5(4):220–229. https://doi.org/10.1016/S2542-5196(21)00002-4

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
1. Copyright of all journal manuscripts is held by the Jurnal Kesehatan Lingkungan.2. Formal legal provisions to access digital articles of electronic journal are subject to the provision of the Creative Commons Attribution-ShareAlike license (CC BY-NC-SA), which means that Jurnal Kesehatan Lingkungan is rightful to keep, transfer media/format, manage in the form of databases, maintain, and publish articles.
3. Published manuscripts both printed and electronic are open access for educational, research, and library purposes. Additionally, the editorial board is not responsible for any violations of copyright law.
JKESLING by UNAIR is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.






































