Changes in malaria prevalence among children aged under five in Uganda from 2009 to 2014/15

Abstract

Malaria remains a major public health problem in Uganda. The last two malaria indicator surveys show that malaria prevalence among children aged under-five years has reduced from 42% in 2009 to 19% in 2014/15. However, there is paucity of information explaining this reduction in relation to variations in household socio-demographic, socio-economic, and malaria prevention factors as well as their effects. This study therefore sought to understand how variations in these factors and their effects explain these temporal changes in malaria prevalence. A secondary analysis of the Uganda malaria indicator survey data of 2009 and 2014-15 was conducted. Data on 3,983 children from 4,421 households collected during the 2009 survey and 9,804 children from 5,345 households collected during the 2015-15 survey were analyzed. Multivariate logistic decomposition was used to assess the changes in malaria prevalence between 2009 and 2014-15 attributed to variations in changes (overtime) in household factors and effects of these factors. Logistic regression results indicated that sleeping under a mosquito bed net (p=0.016) and interior Indoor residual wall spraying (p=0.000) explain the observed reduction in malaria prevalence from 2009 to 2014-15. Multivariate decomposition showed that the variations in household factors contributed 2% and effect of these household factors 98% of the observed reduction in malaria prevalence. The analysis also highlighted that malaria prevalence would further reduce by 8.1% if the effect of interior wall spraying in 2009 was as high as one in 2014- 15, and the reduction would be statistically significant (p=0.000). Indoor residual spraying when used consistently overtime, alongside other important interventions such as, information education and communication via media and use of mosquito nets, can significantly reduce malaria prevalence overtime. Government should therefore consider implementing indoor residual spraying alongside other priority malaria control interventions such as mass media campaigns and universal distribution of insecticide treated mosquito nets.