Spatial patterns and determinants of malaria risk among children under five years in Uganda

Abstract

Malaria is one of the risk factor diseases which can result into an epidemiological disaster if not handled holistically and effectively in Uganda. However, little is known about the risk factors for this disease at national level. The specific objectives of this study were to:1) analyze the spatial-temporal patterns of malaria prevalence; 2) examine the spatial factors associated with malaria prevalence and 3) assess the household and individual leveldeterminants of malaria infections among children under five years in Uganda.From the 2018-19 Uganda Malaria Indicator Survey (UMIS), 7304 children under five years were included. Socio-economic characteristics of households and the spatial covariates were extracted. Hotspot and spatial percentages were used to determine malaria prevalence. Descriptive statistics were used to provide the frequencies. Chi-square test was used to analyze the association between the dependent and independent variables. Multivariable logistic regression analysis was used to determine the magnitude of the association using Odds ratio. A 95% confidence interval was use and the significance levels were put, p<0.001, p<0.01, p<0.05. All analyses were performed in STATA version 18 and ArcGIS 10.8.The Eastern and Northern regions of Uganda had very high malaria prevalence percentages compared to Karamoja and southwestern regions from 2000 to 2015. The odds of contracting malaria infections were 360% higher (aOR= 4.6,95% CI =3.1-6.9) in children who had been given malaria medication in past two weeks compared to the counterparts who had not received malaria medication the past two weeks. The odds of contracting malaria were higher in households whose children were aged 25-36 months with 240% (aOR = 3.4, 95% CI: 2.3-5.1) followed by children aged 37-48 months with 220% (aOR= 3.2, 95% CI: 2.2-4.5) and above 49 months with 210% (aOR = 3.1, 95% CI: 2.1–4.5). However, households with educated mothers had lower chances of acquiring malaria infectionsthat is 30% lower (aOR = 0.0, 95% CI: 0.0-0.2) primary, 80% lower (aOR = 0.7, 95% CI: 0.5-0.9) secondary and 100% lower (aOR = 0.0, 95% CI: 0.0-0.2) higher level compared to households with uneducated mothers.There was a spatial and temporal variability of malaria occurrences, with the Eastern and Northwestern regions registering the highest prevalences. The Karamoja and South western regions had the lowest prevalences. The major individual based factors influencing malaria prevalence were; child’s age, child having a bed, malaria medication, lack of maternal formal education, while the household level factors were; household wealth status, household size, household main wall, floor and roof materials, ownership and sleeping under mosquito bed nets. More emphasis should be put on children whose mothers have never attended school and children between the ages of 24 and 59 months when designing malaria control programs in Uganda. The Eastern and northern regions need special consideration due to their higher prevalence of malaria.