Determinants of malaria prevalence among children under 5 years of age in 17 sub-Saharan African countries: insights from Malaria Indicator Surveys.

BACKGROUND

Malaria remains a major public health burden among children under five in several Sub-Saharan African (SSA) countries, largely attributable to their underdeveloped immune systems, constrained access to healthcare services, and environmental conditions conducive to transmission.

OBJECTIVE

This study aims to identify the key determinants of malaria infection among children under five by examining both individual-level characteristics and community-level drivers within this vulnerable population.

METHODS

We conducted a secondary analysis of the Malaria Indicator Surveys (2016-2022), including 51,457 children under five from 17 SSA countries. A multilevel mixed-effects logistic regression model was applied, with significance set at p < 0.05. Determinants were reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

RESULTS

The analysis showed that more than one-third of children under five in several sub-Saharan African (SSA) countries were infected with malaria. At the individual level, significant risk factors included age (1-2 years: AOR = 1.46) and low household wealth index (AOR = 1.94). Protective factors were maternal primary education (AOR = 0.84) and the use of insecticide-treated bed nets (AOR = 0.80). At the community level, increased malaria risk was associated with rural residence (AOR = 2.69) and high community illiteracy rates (AOR = 1.76).

CONCLUSIONS

The study findings highlight the sustained health threat that malaria poses to children under 5 years of age in many sub-Saharan African countries. Policymakers should prioritize reducing infections in vulnerable groups, expanding access to insecticide-treated bed nets, and promoting targeted health education to strengthen family and community awareness.