Factors Associated with Prevalence of Malaria among Children-under-5-Years Following Mass Net Campaign and Indoor Residual Spraying in Amolatar District, Northern Uganda: Cross-Sectional Study

Abstract Background: Globally, 3.3 billion people are at risks of contracting malaria, and the disease still endemic in 91 countries. Despite the scale up of interventions geared towards controls and eliminations of malaria, the number of malaria cases that progress to severe causing malaria-related deaths remains high. WHO identified mass LLINs distribution and IRS as effective measures for malaria preventions and control. In 2021, malaria caused an estimated 247 million clinical episodes and 619,000 deaths mostly vulnerable children in sub-Saharan Africa. Objective: To determine the prevalence of malaria and associated factors among children under 5 years following mass net (LLINs) campaign and indoor residual spraying in Amolatar district, Northern Uganda. Methods: A community-based, cross-sectional research design used. Quantitative survey for data collection employed. We collected blood sample from children under 5 years to detect the prevalence of malaria using plasmodium falciparum malaria rapid diagnostic test (PF.mRDT). Bivariate analysis and multivariate logistic regression analysis at 95% CI, p-value of 0.05 for significant variables were performed to identify the factors associated with the prevalence of malaria among children under 5 years. Results: Overall, 44.1% (105/238) of children tested positive of malaria. The mean age the caretakers were 24 years, SD 9.4. More than half of caretakers had attained primary level of education 50% (119/238). Children living with married caretakers had 3.2 increased odds of testing positive for malaria (AOR 3.2, 95%CI: 1.395-7.378, P<0.006). Having 2 children in the HH had a significant association of testing positive for malaria (AOR 0.4, 95%CI: 0.219-0.869, P<0.018]). However living in the HH ≥6Km from water body (AOR 0.3, 95%CI: 0.024-3.532, P<0.334) wasn’t significantly associated of testing positive for malaria. Conclusion: Children who lived with the married caretakers, having 2 children in the HH, and not sleeping under the LLINs had significant association of testing positive for malaria. While living in a HH ≥6Km from stagnated water bodies had reduced odds of testing malaria positive. We recommend strengthening awareness campaigns on the importance of consistent use of LLINs while targeting caretakers especially married households (HHs), where LLINs usage is low and community engagement strategies that focus on behavioral change to increase LLINs adherence.