Factors associated with clinically diagnosed malaria among adolescents attending public health centre IVs in Wakiso District, Uganda

Abstract

Introduction: The burden of clinically diagnosed malaria in sub-Saharan Africa is increasingly shifting towards adolescents. In Uganda, adolescents are gradually facing an increased malaria risk, yet the specific factors influencing malaria in this group within public health facilities are not well understood. This study assessed the factors associated with clinically diagnosed malaria among adolescents attending public Health Centre IVs in Wakiso District, Uganda. Materials and methods. A cross-sectional survey using quantitative and qualitative methods was conducted among 434 adolescents presenting at 6 selected public Health Centre IVs in Wakiso district, between August and September 2024, using a digitized semi-structured questionnaire. Additionally, 13 key informant interviews were conducted with selected health workers. Quantitative data was analyzed using STATA v14.0 with descriptive statistics and Modified Poisson regression to identify factors associated with clinically diagnosed malaria. Qualitative data was analyzed inductively using Atlas. Ti version 7. Results: Up to 29.95% (130/434) of adolescents were clinically diagnosed with malaria. Most respondents 87.56% (380/434) demonstrated good knowledge about malaria. Although 93.78% (407/434) sought care for their recent malaria episode, only 18.43% (75/407) did so on the day symptoms began. While 80.41% (349/434) received antimalarials, only 67.05% (291/434) adhered to the prescribed regimen and 23.96% (104/434) supplemented it with herbal remedies. Lower occurrence of clinically diagnosed malaria was observed among adolescents residing in rural areas (APR = 0.67, 95% CI: 0.49–0.92), those with higher socioeconomic status (APR = 0.65, 95% CI: 0.46–0.91, APR = 0.70, 95% CI: 0.50–0.97), and older adolescents (APR = 0.42, 95% CI: 0.29 0.61). Conversely, distance to health facilities (APR = 4.71, 95% CI: 2.64–8.41), irregular bed net use (APR = 4.19, 95% CI: 2.41–7.31), and receiving information on malaria from multiple sources (APR = 1.62, 95% CI: 1.17–2.25) were associated with higher occurrence of clinically diagnosed malaria. Health workers reported increased adolescent facility attendance during school term transitions, untimely care seeking, and a preference for injectable over oral antimalarials as challenges to effective management of clinically diagnosed malaria among this age group. Conclusion and Recommendations: The proportion of adolescents with clinically diagnosed malaria was 29.95%, associated with factors such as urban residence, lower socioeconomic status, younger age (10-14 years), greater distance to health facilities, male gender, irregular use of bed nets, and paradoxically, higher exposure to malaria information and good prevention practices. Tailored health education focusing on information critical to clinically diagnosed malaria including early symptom recognition, prompt care seeking within 24 hours, and adherence to prescribed treatment is urgently needed to reduce adolescent malaria morbidity.